Cornerstone

Understanding AHCCCS Drug Treatment Coverage in Arizona

Q: How do I verify my coverage for drug treatment?

To verify your coverage: Contact AHCCCS Directly: Call AHCCCS at (602) 417-7200 or 1-800-331-5090 to speak with a representative who can provide detailed information about your benefits. Check with Your Treatment Provider: Many rehab centers offer free insurance benefit checks to help you understand what services your AHCCCS plan covers. Review Your Member Handbook: The AHCCCS member handbook and website provide comprehensive details on covered services and how to access them.

Q: What should I do if my claim is denied?

If your claim is denied: Appeal the Decision: Your treatment center will likely handle the appeal process for you, submitting additional information or clarification needed to support your claim. Work with the Billing Department: Treatment centers are experienced in dealing with insurance claims and will do their best to ensure that any denied service is paid. They can also help you understand why the claim was rejected and what steps to take next. Contact AHCCCS: If needed, contact AHCCCS directly for guidance on the appeals process and to ensure all required documentation is provided.

Learn about using your AHCCCS insurance policy to cover substance abuse treatment

Alcohol and Drug Treatment Coverage with AHCCCS

Navigating the journey to recovery can be challenging, but understanding how AHCCCS (Arizona Health Care Cost Containment System) supports your treatment needs can make a significant difference. AHCCCS provides comprehensive coverage for alcohol and drug treatment, ensuring that eligible individuals receive the necessary care to overcome addiction.

This guide will explore essential topics such as network coverage, claims approval, types of plans, and managing financial hardships. By understanding these elements, you can make informed decisions and maximize the benefits available through AHCCCS, paving the way for a successful recovery journey.¹

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AHCCCS drug treatment coverage

Choosing an in-network treatment center with AHCCCS can significantly reduce your out-of-pocket expenses. In-network providers have pre-negotiated rates with AHCCCS, which means you pay less for the services you receive. Using in-network providers ensures smoother and quicker claims processing, minimizing potential billing issues. The downside is that your options may be limited to the treatment centers and providers within the AHCCCS network.

Cost Savings: In-network providers offer services at reduced rates pre-negotiated with AHCCCS, reducing your financial burden.
Streamlined Claims Processing: Claims are processed more efficiently using in-network providers, which can help avoid delays and complications in receiving treatment.²
Limited Choices: The main limitation is the restricted choice of providers and treatment centers. It is crucial to verify whether your preferred treatment center is within the AHCCCS network to maximize your benefits.

Choosing an out-of-network treatment center under AHCCCS is generally not recommended due to the limited coverage provided. AHCCCS typically only covers out-of-network services in emergency situations or for pre-authorized treatments, which can be challenging to secure. As a result, you may face significant out-of-pocket costs if you opt for out-of-network care. Additionally, navigating the claims process for out-of-network services can be complex and time-consuming, often requiring extensive documentation and follow-up.

Types of AHCCCS Plans

Mercy Care Plan is a not-for-profit health plan serving AHCCCS members (Medicaid acute, DDD and long-term care). They have been serving the community for over 30 years and are dedicated to delivering compassionate, high-quality healthcare services. Mercy care is one of Arizona Medicaid members’ biggest health coverage providers. They offer substance abuse and mental health treatment coverage.

Learn more about Mercy Care drug treatment coverage.

Health Choice Arizona is a managed care organization that provides healthcare services to Arizona residents. They offer a variety of health plans designed to meet the unique needs of each member. Their mission is to improve the health and wellness of their members through compassionate and comprehensive care.

More information on Health Choice AZ drug and alcohol treatment coverage.

UnitedHealthcare Community Plan is part of the UnitedHealthcare family, offering a variety of health insurance plans for individuals and families. It is dedicated to providing access to quality healthcare services and ensuring its members receive the necessary care and treatment for their well-being. This plan covers substance abuse treatment along with mental health treatment.

Molina Healthcare is a managed care organization providing health insurance to individuals through government programs such as Medicaid and Medicare. Molina Healthcare focuses on providing high-quality care to individuals and families who need it the most. Molina provides coverage for substance abuse and mental health treatment.

Banner – University Family Care offers comprehensive healthcare services with a network of providers, specialists, and hospitals. They are committed to providing quality, personalized care, and support to their members, ensuring they receive the best possible care.

Care1st Health Plan is a comprehensive healthcare plan that provides a wide range of healthcare services to its members. They are committed to maintaining excellence in service, providing high-quality care, and improving the health of their members.

AIHP, short for the American Indian Health Program, is a comprehensive healthcare initiative that caters to eligible American Indians residing in Arizona. The program is dedicated to enhancing the health and wellness of the American Indian community.

AHCCCS Approval Process for Treatment

Before beginning treatment, the treatment center will verify your coverage with AHCCCS. They will check what services are covered and inform you of any out-of-pocket costs you may incur. This ensures you understand your financial responsibilities upfront.

Coverage Check: The treatment center confirms what services are covered under your AHCCCS plan.
Financial Clarity: You are informed of potential out-of-pocket costs before starting treatment.
Pre-Approval: Ensures your treatment plan aligns with AHCCCS coverage guidelines.

The treatment center usually submits claims on your behalf. This involves sending the necessary documentation to AHCCCS to request payment for the services provided.

Documentation: Treatment centers handle the paperwork and documentation required for claims.
Claims Process: The claim is submitted to AHCCCS for payment.³
Provider Responsibility: The treatment center manages the submission process, reducing your administrative burden.

The Adjudication process consist of AHCCCS reviewing the claim to ensure it meets the coverage criteria. This process involves verifying the medical necessity of the treatment and ensuring all required information is provided.

Review Process: AHCCCS examines the claim to confirm it meets the criteria for coverage.
Medical Necessity: Verifies that the treatment is medically necessary and justified.
Complete Information: Ensures all necessary documentation is included for a smooth approval process.

Once the claim is approved, AHCCCS processes the payment, covering the agreed-upon portion of the treatment costs. You will receive a statement detailing the payment and any remaining balance you are responsible for.

Payment Processing: AHCCCS pays the treatment center for the covered services.
Patient Statement: You receive a detailed statement showing the payment made and any balance owed.
Coverage Portion: The amount covered by AHCCCS is deducted from your total bill.

What will substance abuse conditions will AHCCCS cover?

Addiction Treatment Coverage by AHCCCS

AHCCCS will provide coverage for all substance addictions.

Alcoholism: Arizona AHCCCS covers treatment related to alcohol misuse and problematic consumption.
Cocaine: Arizona Medicaid covers treatment for conditions related to cocaine use.
Fentanyl: Fentanyl use is covered under Arizona medicaid plans.
Prescription Drugs: Coverage includes treatment for addiction to medications such as painkillers (opioids), sedatives, and stimulants.
Methamphetamine: : Treatment for methamphetamine use is covered and may include residential and outpatient treatment programs.

Tips for Accessing Care with AHCCCS Insurance

Expand Your Search

Look beyond your immediate area for treatment facilities. Some centers further away may have shorter waitlists or more capacity. Also, consider different types of programs, such as outpatient or partial hospitalization, which might have more availability and can start providing support sooner.⁵

Utilize Community & Online Resources

While waiting for a spot in a treatment program, engage with community resources like local support groups (e.g., Alcoholics Anonymous or Narcotics Anonymous). Online forums and virtual meetings can also provide support and keep you connected with recovery communities.

Stay in Contact With Providers

Maintain regular contact with your healthcare provider who can offer interim support such as medication management or referral to other services like counseling or local health clinics that can provide temporary assistance until a treatment spot opens.

FAQs About Using AHCCCS Benefits to Pay for Alcohol and Drug Treatment

What types of drug treatment does AHCCCS cover?

AHCCCS covers a range of drug treatment options, including:

Medical Detox: Managed withdrawal from drugs or alcohol with medical supervision and medications to ease symptoms.
Residential Rehab: Live-in programs provide intensive therapy and support in a structured environment, typically lasting 30 to 120 days.
Inpatient Rehab: 24-hour medical care for individuals with severe addiction and co-occurring health conditions, focusing on stabilization and safety.
Outpatient Rehab: This includes Partial Hospitalization Programs (PHPs), Intensive Outpatient Programs (IOPs), and standard outpatient rehab, which offer the flexibility for patients to live at home while receiving treatment.
Medication-Assisted Treatment (MAT): Combines medications like methadone or buprenorphine with counseling and behavioral therapies to treat opioid and alcohol use disorders.
Sober Living Homes: Structured living environments supporting ongoing recovery for individuals transitioning from rehab to everyday life.

How do I verify my coverage for drug treatment?

To verify your coverage:

Contact AHCCCS Directly: Call AHCCCS at (602) 417-7200 or 1-800-331-5090 to speak with a representative who can provide detailed information about your benefits.
Check with Your Treatment Provider: Many rehab centers offer free insurance benefit checks to help you understand what services your AHCCCS plan covers.
Review Your Member Handbook: The AHCCCS member handbook and website provide comprehensive details on covered services and how to access them.

What should I do if my claim is denied?

If your claim is denied:

Appeal the Decision: Your treatment center will likely handle the appeal process for you, submitting additional information or clarification needed to support your claim.
Work with the Billing Department: Treatment centers are experienced in dealing with insurance claims and will do their best to ensure that any denied service is paid. They can also help you understand why the claim was rejected and what steps to take next.
Contact AHCCCS: If needed, contact AHCCCS directly for guidance on the appeals process and to ensure all required documentation is provided.

What types of grants are available for substance abuse treatment in Arizona?

Substance Use Prevention, Treatment, and Recovery Block Grant (SUBG)

- Description: Provides funding for primary prevention services and treatment services for individuals without health insurance or other resources who seek specialty treatment and prevention services for substance use disorders.
- Eligibility: Priority is given to pregnant women, teenagers who use drugs, individuals who inject drugs, and substance using women with dependent children.
- More Info: SUBG Grant | SAMHSA

State Opioid Response (SOR)

- Description: Increases access to opioid use disorder treatment, recovery support services, and prevention activities.
- Eligibility: Individuals seeking treatment for opioid use disorders.
- More Info: State Opioid Response Grant | NASADAD

Partnerships for Success

- Description: Provides trauma informed and culturally sensitive drug abuse prevention services aimed at reducing marijuana and underage drinking among foster youth aged 920.
- Eligibility: Foster youth and at risk populations.
- More Info: PFS Grant | AZ.Gov

Sources

[1] Coverage Overview | AHCCCS

[2] Claims | AHCCCS

[3] Copayments|AHCCCS

[4] Denial Guide | AHCCCS

[5] List of Grants | AHCCCS

[6] SUBG Grant | SAMHSA

[7] State Opioid Response Grant | NASADAD

[8] PFS Grant | AZ.Gov

CLINICALLY REVIEWED

Lionel Estrada, LISAC

CLINICAL DIRECTOR

Lionel, our Clinical Director is a Licensed Independent Substance Abuse Counselor (LISAC) with over 4 years at Cornerstone, specializes in addiction and mental health. Trained in EMDR therapy, he employs a trauma-informed, empathetic approach to address the underlying causes of these issues.

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