The United States has made great progress in treating those who struggle with mental health and addiction issues. But it wasn’t always this way.
Roughly 40 years ago, people who drank excessively or used illegal drugs were considered to be the lowest members of society. They were treated accordingly.
After research was finally conducted on the way addiction affects a person’s mental and physical health, results brought awareness to the specialized health needs of addicted individuals.
Now, health insurance companies across the country are willing to cover the cost of the treatment centers that are crucial to the recovery process. This includes those insurance companies that work solely with low-income and disabled individuals, such as Amerigroup.
Does Amerigroup Insurance Cover Addiction Treatment?
Amerigroup covers addiction treatment as part of the many essential health benefits that are included in their comprehensive care plans. The insurance plans that they offer are based on a person’s age, income, and whether they are disabled. The first plan is called Medicaid.
Medicaid through Amerigroup provides coverage for both children and adults who live in a low-income family. The second plan is a Medicare advantage plan, which covers only senior citizens who are disabled.
The next plan is a combination of Medicaid and Medicare, so a person has to be over 21 years old to qualify for it. Lastly, there is a Medicare supplement insurance plan that helps to cover any extra costs that the other Medicare plans don’t cover.
Each of the Amerigroup health insurance plans has its own set of rules regarding what kind of coverage they offer to policyholders who need to enter a rehab program.
For the most part, the main concern of this insurance carrier is to ensure that those who need specialized treatment services receive them in an economical manner and efficient manner.
Does Amerigroup Cover The Cost Of Inpatient Drug And Alcohol Treatment?
Inpatient rehab programs are some of the most effective addiction treatment programs available. Also called residential treatment, these rehab programs require the patient to stay at the rehab center for the length of the program. Lengths of programs vary but can range from two weeks to 28 days (short-term treatment) up to six months, one year, or more.
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Amerigroup insurance coverage for inpatient drug rehab may depend on your individual plan and the state you live in. For example, some plans cover residential treatment for addiction while others may only cover outpatient rehab programs.
Further, Amerigroup health insurance may only be accepted at certain treatment facilities, such as state-funded rehab centers.
If you or a loved one are considering addiction treatment and you have Amerigroup insurance, it’s best to explore what’s covered by your insurance plan before heading to rehab. This helps you avoid enrolling in a program that doesn’t accept your insurance coverage and high out-of-pocket treatment costs.
Does Amerigroup Cover The Cost Of Outpatient Addiction Treatment?
Outpatient treatment for substance abuse is considered an essential health benefit and is covered by Medicaid and Medicare plans, including Amerigroup. However, outpatient rehab programs often have to meet certain requirements in order to be covered by Amerigroup insurance.
These requirements could include:
- finding outpatient programs that meet for at least three hours, three times per week
- enrolling in rehab centers that treat no more than a certain number of patients at a time
- finding outpatient therapy groups that have a low clinician-to-patient ratio
Because plans vary, it’s a good idea to understand what’s required by your specific plan prior to enrolling in outpatient treatment programs to ensure your care will be covered.
There are many forms of outpatient treatment for substance abuse, but some of the most common and effective are partial hospitalization programs, intensive outpatient programs, and medication-assisted treatment.
Does Amerigroup Cover The Cost Of Partial Hospitalization Programs?
Amerigroup insurance plans can cover partial hospitalization programs (PHP) if these programs meet the Medicaid program’s requirements.
Health insurance coverage requirements for PHPs will vary by state, but could include whether the program is state-funded, how many hours and days per week the program meets, and how many patients are treated at a time.
Partial hospitalization is often a good choice for those who are ready for less intensive forms of addiction treatment or who cannot enter residential rehab. An insurance carrier customer support specialist could help you determine if PHP is covered through your Amerigroup policy.
Does Amerigroup Cover The Cost Of Intensive Outpatient Programs?
Intensive outpatient programs (IOP) are similar to partial hospitalization treatment and may also be covered under your Amerigroup Medicaid or Medicare health plan.
IOPs offer the next level of care following partial hospitalization for recovering individuals. Those who have completed inpatient treatment and/or a PHP may participate in intensive outpatient treatment to stay goal-focused in the early days of recovery.
Offering similar forms of treatment to inpatient treatment and partial hospitalization programs, intensive outpatient programs occur on a less frequent basis and can be scheduled around a person’s work or school commitments.
Amerigroup Medicare or Medicaid plans may cover the full cost of intensive outpatient programs, though certain criteria may need to be met before an individual qualifies for coverage. These criteria could include having a drug or alcohol evaluation or other proof of medical necessity.
Does Amerigroup Cover The Cost Of Suboxone?
Medication-assisted treatment with Suboxone may be covered by Amerigroup Medicaid as part of an outpatient rehab program that combines medication, counseling, and therapy to treat opioid addiction.
Suboxone is typically part of a long-term treatment plan. Understanding how long your plan will cover Suboxone treatment for you is a good idea before deciding on this treatment course. With some Amerigroup plans, pharmacy benefits may not cover the entire cost of Suboxone and individuals may have to cover a small co-pay amount.
Does Amerigroup Cover The Cost Of Methadone?
Methadone is another medication-assisted treatment option for opioid use disorders. An opioid antagonist, methadone is often covered by insurance companies and can be covered through your Amerigroup health insurance.
Many who choose methadone maintenance therapy as part of their opioid addiction treatment plan will take the medication long-term, either in daily pill form or through a monthly methadone injection.
However, Amerigroup insurance coverage for methadone may expire after a certain length of time. An important factor to ask your insurance carrier is how long coverage will last for medication-assisted therapy using methadone.
Does Amerigroup Cover The Cost Of Sober Living?
Sober living facilities in some states are considered a form of continuing care (aftercare) for addiction treatment. This means certain Amerigroup Medicare or Medicaid health plans may cover the cost of sober living.
In these transitional living homes, recovering individuals who no longer need 24-hour medical supervision can begin a new, sober lifestyle.
Sober living houses differ, but many require residents to be enrolled in some form of outpatient treatment, may include weekly check-ins with a rehab program associate, and may ask that residents be enrolled in school or working.
If you or a family member are in need of drug or alcohol treatment, consider contacting your Amerigroup insurance representative to get a better understanding of what’s covered under your plan.
As an alternative, one of our treatment representatives could verify your insurance for you and outline the services covered under your insurance policy.
How To Use Your Amerigroup Medicaid Plan For Addiction Treatment
Figuring out how to use your Amerigroup health plan for drug rehab usually requires a visit to the doctor first. The doctor has to be one of Amerigroup’s approved physicians.
During the appointment, the doctor will discuss the mental and physical health issues that a person may be having because of their addiction. They may also do drug or alcohol testing to determine whether a person currently has drugs in their system.
After this, using Amerigroup to pay for addiction treatment requires that the doctor submit a request to the insurance company to see if they will approve the person being sent to the rehab center.
Usually, doctors have to search for a rehab facility that will accept the insurance, which isn’t always easy. If a person is approved, most of Amerigroup’s plans will cover inpatient rehab and outpatient care, detoxification programs, counseling, and medication.
But the decision to allow someone to be in a residential rehab program is usually based on what substance they are addicted to and whether it would be safe for them to detox without medical supervision.
List Of Amerigroup Plans By State
Rehab centers that accept Amerigroup health insurance are limited because of the special plans that the company offers to low-income individuals and the disabled.
Some of the states that Amerigroup covers only offer certain plans. It is important to contact the insurance company for more specific information about an individual’s particular plan and its exact coverage.
The following is a list of the states that offer Amerigroup insurance plans:
- District of Columbia
- New Jersey
- New Mexico
Finding A Rehab Center That Accepts Amerigroup
Using Amerigroup to pay for addiction treatment requires a lengthy approval process mainly because of the time that it takes health providers to search for a rehab center that will accept the insurance plan.
In order to shorten this time frame, it helps to talk to one of our qualified representatives to get a list of rehab centers to give to the doctor. We can also go over the details of the drug rehabilitation services that your specific plan covers.
This is crucial for those seeking addiction treatment since millions of Americans don’t get drug and alcohol addiction treatment because they don’t realize their insurance plan will help cover the cost of it.
Amerigroup is a health insurance company that focuses on providing services for low-income individuals who are elderly or disabled. With high numbers of those seeking treatment and restrictions on plans by state, the approval process for getting treatment may take longer than with other health plans.
Because of this, we recommend that those with Amerigroup insurance call us for a list of alcohol and drug treatment facilities in their area that they can give to their doctor. To learn more, contact us today.
Updated on July 27, 2020
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