EmblemHealth Provider Information
About Emblem Insurance
EmblemHealth has provided health coverage since the 1930s, offering various health plans, like Medicaid and Medicare and private plans, to businesses, families, individuals, retirees, and government workers for addiction treatment and mental health services. EmblemHealth centers on practicing a whole-person method of health care insurance to help members stay healthy for the long term by ensuring mental health services and addiction treatment services are accessible through insurance coverage.
Mental health and substance abuse coverage levels will vary for each member based on their state of residence and insurance plan. However, most EmblemHealth plans cover at least a portion of substance abuse treatment, including partial hospitalization programs, intensive outpatient programs, and inpatient and residential programs for alcohol rehab, addiction rehab, and co-occurring disorder treatment.
In most cases, a treatment program will need to be pre-authorized regardless if it is an inpatient treatment program, an intensive outpatient program, or another type of substance use disorder treatment. Also referred to as prior authorization, the health insurance company will decide if a healthcare service or treatment is medically necessary. Outpatient treatment and emergency visits usually will not require reauthorization, but inpatient rehab programs or a partial hospitalization program may require prior approval to ensure your insurance benefits cover treatment.
EmblemHealth will normally require members to meet deductibles, co-payments, or coinsurance for mental health treatment services and addiction treatment services for co-occurring disorders, substance addictions, or mental health, especially if in a higher intensity treatment setting like the inpatient programs offered at Behavioral Health Centers.
If you or someone you love is looking for a rehab for mental health treatment or substance abuse services that takes EmblemHealth insurance, contact us today at 772-774-3872 to have our team run a confidential, no-cost verification of your benefits, or click here to complete our insurance form so you can get help today.
Explanations of a deductible, co-payment, and coinsurance include:
- A deductible is the responsibility of the member to pay upfront for covered services prior to the health insurer covering costs. For example, members with a $500 deductible plan must pay upfront the first $500 of coverage costs.
- A co-payment is a set fee that members finance for treatment. It is usually required before, but sometimes after a member has paid their deductible.
- Coinsurance is a percentage of the entire cost for a covered treatment a member is liable for after their deductible has already been satisfied. Health plans with more expensive monthly premiums will usually have lower co-payments and coinsurance rates than those with lower monthly premiums.
Suppose you or a loved one is covered under EmblemHealth insurance and requires a medical facility to assist with detox before seeking rehab. In that case, these treatments are normally covered under the plan. EmblemHealth is a non-profit health insurance company that covers more than 3 million residents of Connecticut, New Jersey, New York State, and the tri-state New York City area. EmblemHealth will usually cover substance abuse treatment and mental health disorders, depending on the specific plan. Even if the plan provides coverage, members could still be responsible for deductible costs, copayments, and coinsurance to cover addiction treatment.
How to Cover What EmblemHealth Insurance Won’t
For those with an EmblemHealth plan who don’t have upfront money for addiction treatment that your plan doesn’t cover, you may want to check with providers that can offer payment plans. Overall, patients usually have several different choices to cover substance addiction treatment, which include:
- Borrowing from friends or family
- Payment plans
- Personal loans
Verifying Coverage and Finding the Best Treatment
In regards to verifying coverage plans, EmblemHealth makes the process quite simple. Members can seek treatment at an approved outpatient treatment facility within its network. This means members can show up at any network provider and receive substance addiction treatment that is needed almost immediately. While some members might be skeptical in choosing outpatient treatment, according to statistics on substance addiction rehabs, residential and outpatient treatment centers’ success rates are almost the same.
It would be best to locate the appropriate treatment center and rehab facility to tailor an addiction treatment program to fit your specific addiction treatment needs. For those who need help finding a rehab center, it is advised to call EmblemHealth to learn more about your plan.
The best way to verify your EmblemHealth insurance benefits for drug and alcohol rehab is by reaching out to our admissions specialists to discuss your addiction treatment options. Everything is confidential to speak freely about your mental health or substance abuse disorder, so call us today at 772-774-3872 to learn more about what mental health treatment and substance abuse treatment is covered by EmblemHealth insurance.