What Do You Need to Know About EmblemHealth Insurance for Rehab?

EmblemHealth is one of the largest nonprofit health insurance providers in the New York tri-state area. Although EmblemHealth mainly focuses on New York, New Jersey, and Connecticut, it offers coverage in other states. For example, EmblemHealth insurance rehab coverage is available at some drug and alcohol addiction treatment clinics in Florida. If you wish to use your EmblemHealth coverage for substance abuse rehab in Florida, there are a few aspects you need to know, including what types of services are covered, how much does addiction rehab cost in Florida, and whether you need pre-authorization before starting rehabilitation services.

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Table of contents

» What Types of Addiction Treatment Services Does EmblemHealth Cover?

» How Do You Check Your Rehab Benefits With EmblemHealth?

» Do You Need Pre-Authorization for Rehab With EmblemHealth?

» What Should You Ask a Rehab Center About EmblemHealth Coverage?

» Key Takeaways on EmblemHealth Insurance Rehab Coverage

» Resources

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What Types of Addiction Treatment Services Does EmblemHealth Cover?

Generally speaking, EmblemHealth provides insurance coverage for the treatment of both alcohol and drug use. However, the type of coverage may depend on your specific insurance plan and the clinic you go to. The Affordable Care Act (ACA), implemented in 2010, also mandates that most health insurance providers cover substance use disorder treatments as part of “essential health benefits.”

EmblemHealth insurance rehab coverage normally includes treatment for:

• Alcohol abuse
• Prescription medications
• Stimulants like cocaine and methamphetamine
• Opioids like heroin
• Psychoactive drugs like marijuana and hallucinogens
• Inhalants like gases, nitrites, and aerosols

How Important Is Substance Abuse Rehab?

Drug and alcohol abuse continues to be a problem in the U.S. According to the National Institute on Alcohol Abuse and Alcoholism, about 2.3 million Americans ages 12 and older who had alcohol use disorder received alcohol rehab treatment in 2023. And the Substance Abuse and Mental Health Services Administration (SAMHSA) reported in its 2023 National Survey that 16.8% of people in the U.S. ages 12 and older had used an illicit drug.

Like chronic illnesses such as heart disease, there is no “cure” for substance abuse addiction. However, effective rehabilitation treatment can help detoxify a person from alcohol or drugs, and can help keep them from relapsing, or going back to addictive behavior.

According to the National Institute on Drug Abuse, between 40% and 60% of people with a substance abuse disorder will relapse if they stop following their treatment plan.

Types of Substance Abuse Treatments

There are several different types of treatments used for substance abuse disorders. Some are inpatient treatments, where you would stay at a treatment facility for a certain period, while others are outpatient treatments where you go to a treatment center at an appointed time and then leave once your session is done.

Some usual treatments used for substance abuse rehab include:

• Cognitive Behavioral Therapy (CBT)
• Medically Assisted Treatment (MAT)
• Dialectical Behavior Therapy (DBT)
• Family therapy
• Group and individual counseling
• Medical detox
• Medication-assisted treatments

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How Do You Check Your Rehab Benefits With EmblemHealth?

Your EmblemHealth insurance rehab coverage will depend on the plan you are currently on and the state where you live. There are a few ways to check your accepted insurance coverage for substance abuse treatment in Florida:

• Call EmblemHealth: Call the phone number listed on your member ID card or 800-447-8255 for general customer service. An EmblemHealth representative can review your plan and inform you about your substance treatment coverage.
• Log in Online: Log in to your myEmblemHealth account to view the details of substance abuse treatment under your current plan.
• Ask Your Provider: Call the drug and alcohol addiction treatment center you are considering going to and ask if they accept EmblemHealth, and if so, what your out-of-pocket costs would be based on your specific plan and the treatment you seek.

When checking your substance abuse rehab benefits with EmblemHealth, you can also find out your deductible, any co-pays or other fees you may have to pay out-of-pocket, and find out the financial differences between using an in-network or out-of-network treatment center.

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Do You Need Pre-Authorization for Rehab With EmblemHealth?

Pre-authorization—also known as prior authorization—requires that the substance abuse treatment center you select contact EmblemHealth to obtain approval for you to be seen by them before you receive treatment.

Like many health insurance providers, EmblemHealth requires pre-authorization for all types of rehab treatments, including substance abuse.

If your treatment center does not take the proper steps to obtain prior authorization before treating you, your insurance carrier may not cover any of the medical costs. That’s why it’s essential to check if you need pre-authorization and, if so, make sure your doctor gets it.

Here are a few important tips when it comes to getting pre-authorization for your EmblemHealth insurance rehab coverage:

• If you select an in-network treatment center, they can normally start the pre-authorization process immediately.
• If you select an out-of-network treatment facility, you must contact the facility to determine their need to get the ball rolling. For example, they may need you to fill out some forms as part of the process.
• Keep copies of all forms and written communications you give or receive to the treatment center and EmblemHealth in case there are any issues during the process.
• The prior authorization process can take up to two weeks before you hear back from your insurance company, whether it is approved or denied.
• If your pre-authorization request is denied, you can appeal. Sometimes, the insurance carrier just needs additional information or better documentation. The treatment center can help you appeal any denials.

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What Should You Ask a Rehab Center About EmblemHealth Coverage?

If you have EmblemHealth, the first step before making an appointment at a treatment center is to determine whether they accept your health insurance and the cost of deductibles and co-pays for addiction treatment.

Once you know they accept EmblemHealth, make sure to ask your selected treatment facility:

• Are you an in-network or out-of-network provider with EmblemHealth?
• Is pre-authorization required before I can start treatment? If so, what do you need from me to begin the process?
• Does EmblemHealth cover both inpatient and outpatient treatments?
• Are medications for substance abuse treatment covered by EmblemHealth?
• Does EmblemHealth cover medical detox if needed?
• What about therapy and counseling — are those covered through EmblemHealth?
• What is my deductible, or what amount will I need to pay out-of-pocket before my EmblemHealth insurance kicks in?
• What copayments or other out-of-pocket fees should I be aware of?
• How long does EmblemHealth cover substance abuse treatment for?
• Does EmblemHealth offer coverage for any support after my treatment concludes?

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Key Takeaways on EmblemHealth Insurance Rehab Coverage

• EmblemHealth is a large non-profit health insurance provider in the New York tri-state area that also offers coverage for substance abuse rehab in Florida.
• EmblemHealth typically covers treatment for alcohol and drug use; however, how much they cover is dependent upon your insurance plan and the treatment center you go to.
• Always check your EmblemHealth insurance rehab coverage by calling EmblemHealth or logging in online before making an appointment.
• EmblemHealth requires pre-authorization for all types of rehab treatments.
• When you find a treatment facility, ask if they accept EmblemHealth and ask for information on deductibles and copays.

WhiteSands Treatment has provided inpatient, outpatient, and aftercare services for those addicted to drugs or alcohol through our Florida locations. We offer various therapy programs, including family therapy, medical detox, and access to a sober living facility.

As many substance abuse problems are co-occurring with other mental health issues, WhiteSands Treatment also offers dual diagnosis treatment. And we also integrate holistic and alternative treatments such as yoga and art therapy into our programs, as we know they can make a massive difference during treatment for a substance abuse disorder.

If you or a loved one is struggling with substance abuse, WhiteSands Treatment Center can help. Call us today at 877-855-3470 to learn how we can help.

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Resources

• Office of National Drug Control Policy — Substance Abuse and the Affordable Care Act
• National Institute on Alcohol Abuse and Alcoholism — Alcohol Treatment in the United States
• Substance Abuse and Mental Health Services Administration (SAMHSA) — Highlights for the 2023 National Survey on Drug Use and Health
• National Institute on Drug Abuse — Drugs, Brains, and Behavior: The Science of Addiction — Treatment and Recovery

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.