AHCCCS Substance Abuse Treatment

AHCCCS, as an important provider of Medicaid services in Arizona, typically covers various types of addiction treatment under its health plans.³

However, the coverage can vary based on the specific plan, location, and other factors.

Generally, AHCCCS plans may include coverage for the following types of addiction treatment:

• Detoxification: Medically supervised detox is often the first step in treating substance use disorders. It helps manage withdrawal symptoms safely and effectively.
• Inpatient Rehabilitation: Residential programs offer specialized care and support 24/7 at a live-in treatment facility, including medical and psychological treatment.
• Outpatient Rehabilitation: Outpatient treatment enables individuals to receive services while living at home. Services can involve counseling, therapy, and medical care.
• Partial Hospitalization Programs (PHP): PHP offers a middle ground between inpatient and outpatient care. During the day, patients receive intensive treatment, while at night, they can stay at home.
• Intensive Outpatient Programs (IOP): IOP provides comprehensive outpatient services by offering a wider range of therapy and related activities.
• Medication-Assisted Treatment (MAT): MAT pairs medications like Methadone and Buprenorphine with counseling to treat addiction.
• Therapy and Counseling: Psychological aspects are addressed through a range of therapeutic techniques, including Cognitive Behavioral Therapy (CBT) and family therapy.
• Aftercare Support: Ongoing support after formal treatment, such as 12-step programs, sober living homes, and relapse prevention planning, might also be covered.

Those insured must consult their specific AHCCCS plans regarding coverage details, costs, in-network stipulations, pre-authorizations, and treatment limitations.

Connecting with an AHCCCS representative or medical provider can also offer guidance tailored to unique needs.

You can also reach out to us to learn about our programs, and if you provide us with your insurance details through our insurance verification form, we can quickly determine what your AHCCCS policy covers and help you access the treatment you need and deserve.

The duration of rehab coverage provided by AHCCCS depends on the details of your plan.

Factors such as the type of rehab required, the reason for treatment, and pre-authorization regulations are all important.

AHCCCS may cover a significant portion of expenses for drug and alcohol rehab treatments.

However, it’s worth noting that the exact coverage percentage entirely depends on your policy’s specifics.

If you’ve already reached your deductible and maximum out-of-pocket expenses for the year, AHCCCS may cover the entire cost of your rehab treatment.

Please request an insurance verification to learn about your coverage details, including what’s covered and what’s not.

Follow these simple steps to find out what your AHCCCS policy covers, including addiction treatment and other medical services:

1. Review Your Member Handbook: Start by reviewing the AHCCCS member handbook you received when you enrolled. This document often contains detailed information about covered services.⁴
2. Log In to Your Online Account: Access your account on the AHCCCS online portal. This can provide specific details about your coverage, claims, and any plan documents.
3. Contact AHCCCS Directly: Call the customer service number listed on your AHCCCS insurance card. Customer service can provide specific information about what your plan covers and any restrictions or preauthorization requirements.
4. Request an Insurance Verification from Your Provider: If you are considering specific treatments or services, like drug rehab, ask your healthcare provider to verify insurance. This process involves the provider contacting AHCCCS to determine exactly what your plan covers regarding the treatment.
5. Consult with Healthcare Providers: Talk directly to healthcare providers or treatment centers. They often have experience working with AHCCCS and can offer insights into what is typically covered and the necessary steps to receive approval for treatment.
6. Check for Updates on the AHCCCS Website: Periodically check the AHCCCS website for any updates or changes to coverage policies that might affect your plan.
7. Understand the Appeals Process: If your claim is denied, familiarize yourself with the appeals process outlined by AHCCCS so you know how to contest a decision if necessary.

AHCCCS provides coverage for a broad spectrum of addiction treatments.

The extent of coverage can vary greatly depending on factors such as the type of plan, individual policy, and other variables.

Some treatments and services may have limitations or exclusions, and it’s important to review your plan to understand what is covered and what is not.

• Experimental or Investigational Treatments: Treatments considered experimental, unproven, or not widely accepted in the medical community might not be covered.
• Certain Medications: Some prescription drugs may not be covered, especially if they are considered “off-label” for treating addiction. Additionally, newer and more expensive medications might be excluded if less costly yet effective alternatives are available.
• Luxury or Executive Rehab Centers: High-end treatment facilities that offer luxury amenities often come with higher costs that may not be fully covered by insurance.
• Holistic or Alternative Therapies: Treatments like acupuncture, massage therapy, or herbal supplements might not be covered, often considered alternative or complementary therapies.
• Long-Term Residential Treatment: While inpatient treatment is often covered, AHCCCS might limit the length of stay that it will cover in a residential treatment facility.
• Out-of-Network Providers: If you choose to receive medical treatment from a healthcare provider or facility outside AHCCCS’s network, you may have to bear higher costs, or your plan may not cover the service. However, this solely depends on the type of AHCCCS plan you have. Some AHCCCS plans have provisions for covering out-of-network providers without any issues.
• Private Detox Facilities: Some private detox programs, especially those offering more comfortable or luxurious settings, may not be fully covered.
• Non-essential Amenities: Insurance may not cover services deemed non-essential to recovery, such as private rooms, special food, or recreational activities.
• Over-the-Counter Substances: Even if recommended for treatment (like specific vitamins or supplements), over-the-counter products may not be covered.

It’s best to consult AHCCCS or a healthcare provider for specific coverage and limitations.

If you have AHCCCS insurance coverage, we can usually admit you to our rehab program within a few days.

Please contact us today to get a clearer understanding of the steps you need to take to get admitted.

We are here to help you every step of the way!