Addiction Treatment Covered by EmblemHealth Insurance

EmblemHealth is a healthcare company that provides health insurance plans in New York and surrounding states, including New Jersey.

As one of the country’s largest not-for-profit insurance companies, they serve more than 3 million members in the New York tristate area. The company was created by a merger between Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP).¹

EmblemHealth uses a robust provider network, which includes local addiction treatment facilities like Sunrise House Treatment Center in Lafayette, NJ.

In this article, we’ll go over some of the treatments that EmblemHealth may cover and what to expect when using your health insurance to pay for rehab.

Does EmblemHealth Cover Drug & Alcohol Rehab?

Yes, you can use Emblem GHI coverage for addiction treatment.

Per stipulations in the Affordable Care Act (ACA), most long-term health insurance plans are required to include at least some coverage for addiction and mental health treatment. There are also parity protections that ensure many mental health services are offered at the same level as other medical conditions.²

Emblem drug rehab coverage will vary depending on your specific plan. Employer plans may have different options than individual plans purchased through the Marketplace, which are held to standards under the ACA.

Your Emblem plan may cover treatment at Sunrise House Treatment Center if you live in Connecticut, New Jersey, or New York. EmblemHealth provides behavioral health services, which include addiction treatment, through its partner Beacon Health Options.³

To learn more about GHI Emblem treatment for substance use disorders, fill out . You’ll only need a few pieces of information and will promptly receive an email back with details about your benefits and important next steps.

You don’t have to go through this process alone. Our admissions navigators will help you every step of the way and can answer any questions that arise.

Which EmblemHealth Plans Cover Addiction Treatment?

There are many types of insurance plans, and most are required to offer at least some coverage for addiction treatment. EmblemHealth offers plans in each tier, from Platinum to Bronze. The higher the tier, the more comprehensive the coverage and less you pay for deductibles and copayments. However, you’ll pay more per month for this coverage than lower tiers.⁴

Health plans are designated as either Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), or Exclusive Provider Organizations (EPOs). Each type has different rules on whether you can get coverage for care outside of their network and if you need referrals to see a specialist.⁵

Sunrise House Treatment Center is in-network for EmblemHealth PPO and EPO plans.

EmblemHealth also offers some GHI plans to New York City employees. These plans cover both in-network and out-of-network treatment options, although you’ll pay significantly less for in-network care. You may need preauthorization before getting treatment through the GHI plan.⁶

Using EmblemHealth for Rehab

How do you use your GHI Emblem substance abuse coverage? The best bet is to stay within the provider network. Then, you can present your health insurance card and the provider will bill the insurance company directly.

If your plan provides coverage for out-of-network care, you’ll need to pay upfront and fill out paperwork to get reimbursed. You may not be reimbursed for the full cost of the service. If you have questions or concerns, you can always call the number on the back of the insurance card to check your benefits. You can also call Beacon Health directly for 24/7 assistance.⁷

For immediate help, contact us at . Our admissions navigators can review your insurance coverage, talk you through the admissions process, and guide you along the way as you pursue treatment.

Cost of Addiction Treatment with EmblemHealth Insurance

The cost of addiction treatment will vary depending on your specific health insurance plan. Factors that can affect the final cost include type and duration of treatment, as well as medical history and individual circumstances surrounding the substance use disorder.⁸

For addiction treatment in New Jersey, there may be certain out-of-pocket costs, such as a deductible and copayment or coinsurance. The good news is there are lots of options for Northeast residents to get help paying for rehab.

Most quality treatment centers, like Sunrise House, offer payment plans and other financing.

Why Use GHI Emblem Insurance for Addiction Treatment?

There are several valid reasons to consider using EmblemHealth for addiction treatment. For instance, it may make the cost of treatment substantially more affordable.

Additionally, alcohol and substance abuse are growing and serious issues in the tristate region. About 17.6 million Americans—1 in every 12 adults—suffer from alcohol abuse or dependence, and millions more engage in risky drinking behavior.⁹ In New Jersey, nearly 90% of drug overdose deaths were related to opioids, even though the overall prescription rate for opioid drugs is below the national average.¹⁰

Getting on the road to a better, substance-free life is worth the effort. And we’re here to help. Simply fill out the form below to check your insurance coverage and find out exactly how you can get started today.