Cornerstone

Understanding AmeriBen Drug Treatment Coverage

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

Alcohol and Drug Treatment Coverage with AmeriBen

At AmeriBen Solutions, we understand that seeking treatment for alcohol and drug addiction is a courageous and crucial step toward a healthier life. We want you to know that you’re not alone in this journey and are here to support you every step of the way.

This guide explores how AmeriBen insurance can help you access the care you need, including in-network and out-of-network coverage options, the claims approval process, types of plans available, deductibles, and assistance for financial hardships. We aim to empower you with the knowledge and resources to make informed decisions about your treatment and recovery.¹

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AmeriBen drug treatment coverage

When it comes to seeking drug treatment using your AmeriBen insurance, choosing an in-network treatment center can offer several advantages. In-network providers have established contracts with AmeriBen, which often means lower out-of-pocket costs for you. These treatment centers are also more likely to be familiar with AmeriBen’s coverage policies and claims processes, making the administrative side of your treatment more seamless.

In-network options may be more limited than out-of-network facilities, and you may need to travel further to find an in-network center that meets your needs. Choosing between in-network and out-of-network care should be based on your circumstances and priorities.²

While AmeriBen insurance primarily focuses on in-network providers, there may be situations where you prefer or require treatment at an out-of-network facility. The main advantage of choosing an out-of-network treatment center is the increased flexibility and options available. You may have access to a wider range of specialized programs or facilities that cater to your specific needs.

Out-of-network care typically comes with higher out-of-pocket expenses, such as higher deductibles, copayments, or coinsurance. You may also need to pay for the services upfront and then seek reimbursement from AmeriBen. Reviewing your policy documents or contacting AmeriBen directly to understand the specific coverage details and requirements for out-of-network treatment is essential.

Information about AmeriBen Plan Types

If you’re considering an AmeriBen Health Maintenance Organization (HMO) plan for your drug treatment, it’s important to understand how this type of plan works. With an HMO, you’ll typically need to select a primary care physician (PCP) to coordinate your care and provide referrals to specialists when necessary.

One of the main benefits of an HMO is that they often have lower out-of-pocket costs compared to other plan types. It’s important to note that HMO plans generally only cover in-network services, so you’ll want to ensure that your preferred treatment providers are within the AmeriBen network before enrolling.

An AmeriBen Preferred Provider Organization (PPO) plan might be a good fit for those seeking more flexibility in their drug treatment options. PPO plans allow you to visit both in-network and out-of-network providers, although you’ll typically pay less when you stay within the network. This can be especially beneficial if you have a specific treatment center or specialist in mind that may need to be in-network.

Remember that PPO plans often come with higher out-of-pocket costs than HMOs, such as higher deductibles and copayments. However, the added flexibility can be valuable for prioritizing healthcare decisions.

An AmeriBen Exclusive Provider Organization (EPO) plan is a managed care plan that balances cost and flexibility. Like HMOs, EPO plans typically only cover in-network services, which helps lower costs. However, unlike HMOs, you generally don’t need to select a primary care physician or obtain referrals to see specialists within the network.

This can be a good option if you value an HMO’s lower costs but want more freedom in accessing care. Just remember that if you choose to go out-of-network for your drug treatment, you’ll likely be responsible for the full cost of care.

If you’re looking for a plan that combines features of both HMOs and PPOs, an AmeriBen Point of Service (POS) plan might be worth considering. With a POS plan, you can choose between in-network and out-of-network providers, but you’ll typically pay less when you stay in-network. Like an HMO, you may need to select a primary care physician and obtain referrals for specialist care.

POS plans offer the flexibility to go out-of-network, albeit at a higher cost. This can be a good choice if you want the cost savings of an HMO with the added safety net of out-of-network coverage.

An AmeriBen High Deductible Health Plan (HDHP) might be a fitting choice for those looking to balance lower monthly premiums with higher out-of-pocket costs. HDHPs typically have lower monthly premiums but higher deductibles than other plan types. This means you’ll pay more upfront for your drug treatment services before your insurance coverage kicks in.

HDHPs are often paired with Health Savings Accounts (HSAs), which allow you to set aside pre-tax dollars to cover qualified medical expenses, including drug treatment. If you’re generally healthy and want to save on monthly premiums while still having coverage for unexpected treatment needs, an HDHP could be a viable option.

For those who qualify, AmeriBen also offers Medicaid and Medicare plans to help cover the cost of drug treatment. Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. If you meet your state’s Medicaid eligibility requirements, you may be able to access drug treatment services at a lower cost. On the other hand, Medicare is a federal health insurance program primarily for people 65 or older and some younger individuals with disabilities.

Medicare Part A and Part B, or Original Medicare, can help cover certain aspects of drug treatment, such as inpatient rehabilitation and outpatient therapy. However, coverage details can vary depending on your specific Medicaid or Medicare plan, so be sure to review your benefits carefully.

Understanding Policy Terminology

A deductible is the amount you’ll need to pay out-of-pocket for covered services before your insurance starts to pay its portion. For example, if your plan has a $1,000 deductible and your drug treatment costs $5,000, you’ll be responsible for paying the first $1,000, and then your insurance will begin to cover its share of the remaining costs. Deductibles can vary widely depending on your specific plan, so it’s crucial to review your policy documents or contact AmeriBen directly to understand your deductible amount and how it applies to your drug treatment coverage.

Co-insurance refers to the percentage of covered healthcare costs you’ll pay after you’ve met your deductible. For instance, if your plan has a 20% co-insurance and your deductible has been met, you’ll pay 20% of the remaining covered costs, while AmeriBen will pay the other 80%.

It’s essential to factor in your co-insurance when estimating your out-of-pocket expenses for drug treatment, as these costs can add up quickly. Remember that co-insurance percentages can vary based on your specific plan and whether you use in-network or out-of-network providers.

When considering your AmeriBen insurance coverage for drug treatment, it’s also important to understand the concept of an out-of-pocket maximum or out-of-pocket max. This term refers to the maximum amount you’ll have to pay for covered services in a given plan year, including your deductibles, copayments, and co-insurance. Once you’ve reached your out-of-pocket max, AmeriBen will typically cover 100% of the remaining covered costs for the rest of the plan year.

This can provide a sense of financial protection and peace of mind, knowing there’s a limit to how much you’ll have to pay out-of-pocket for your drug treatment. Review your specific policy to understand your out-of-pocket max and any other important details related to your coverage.

AmeriBen Approval Process for Treatment

The first step in using your AmeriBen insurance for drug treatment is verification. This process involves the treatment center contacting AmeriBen to confirm your active coverage and determine your plan’s specifics. During verification, the treatment center will learn important details such as deductible, co-insurance, and out-of-pocket maximum. They will also find out if there are any specific requirements or limitations related to drug treatment coverage. Once verification is complete, the treatment center will clearly explain your financial responsibility, if any, for your treatment. To make this process easier, we offer a convenient insurance verification tool on our website, which you can use to check your coverage quickly.

After you’ve begun treatment, claim submission is the next step. In most cases, the treatment center you choose will handle this step on your behalf. They will gather all the necessary information about your treatment, including dates of service, types of services provided, and associated costs. The treatment center will then submit these claims directly to AmeriBen for processing. This streamlines the process for you and ensures that your claims are submitted accurately and promptly. Choosing a treatment center experienced in working with AmeriBen is important, and the claims submission process ensures a smooth experience.

After submitting your claim, AmeriBen will review it during the adjudication process to determine if the provided services are covered under your plan and meet the necessary medical criteria. This involves verifying patient eligibility, treatment appropriateness, and claim accuracy. If everything is in order, the claim will be approved, and payment will be issued to the treatment center. However, if there are issues or discrepancies, AmeriBen may request additional information or deny the claim, which could lead to an appeal process. The adjudication process ensures proper coverage and efficient claim handling, and your treatment center’s billing department will work to meet AmeriBen’s specific requirements and guidelines.

Once your claim has been submitted and processed by AmeriBen, the next step is payment. If your claim is approved, AmeriBen will pay the covered portion of your treatment costs directly to the center. Depending on your specific plan and coverage details, you may be responsible for paying some of the costs, such as your deductible or co-insurance. The treatment center will typically bill you for any remaining balance after receiving payment from AmeriBen. It’s important to communicate with AmeriBen and your treatment center throughout this process to ensure you understand your financial responsibilities and address any questions or concerns.

In some cases, a claim for drug treatment may be denied by AmeriBen. This can happen for various reasons, such as a lack of medical necessity or a service not covered under your specific plan. If your claim is denied, don’t lose hope – your treatment center will likely file an appeal on your behalf. Treatment centers have experienced billing departments that are well-versed in handling denials and appeals. They will work diligently to gather additional information, provide supporting documentation, and make a strong case for why the denied service should be covered. It’s important to remember that treatment centers aim to provide only services that are likely to be approved. Still, in the event of a denial, they will be your advocate and work hard to get the decision overturned.

Get Help Paying Your Deductible

File a Hardship With AmeriBen

If you’re struggling to pay your deductible for drug treatment, one option to consider is filing a hardship with AmeriBen. A hardship is when you cannot pay your deductible due to financial difficulties. If you demonstrate that paying your deductible would cause significant financial strain, AmeriBen may be willing to work with you to find a solution. This could involve setting up a payment plan, reducing your deductible, or finding alternative coverage options. To file a hardship, you’ll typically need to provide documentation of your financial situation and explain why paying your deductible would be a significant burden. Contact AmeriBen directly to learn more about the hardship filing process and what options may be available to you.

Assistance Programs & Payment Plans

If you’re having trouble affording your deductible for drug treatment, there are assistance programs and payment plans that can help. Many treatment centers offer financial assistance programs for patients who qualify based on income and other factors. These programs help cover a portion of your deductible or other out-of-pocket costs. Additionally, treatment centers often offer payment plans that allow you to spread the cost of your deductible over time, making it more manageable. Some plans may even offer low or no interest rates. Be sure to ask your treatment center about any available assistance programs or payment plans that could help make your treatment more affordable.

Community Resources & Charitable Organizations

Another avenue to explore when seeking help with your deductible for drug treatment is community resources and charitable organizations. Many organizations at the local, state, and national levels provide financial assistance to individuals seeking addiction treatment. These organizations can help cover a portion or all of your deductible, depending on your specific situation and their available funds. Some examples include the Salvation Army, United Way, and the Substance Abuse and Mental Health Services Administration (SAMHSA) grants.

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

What is AmeriBen?

AmeriBen is a Third-Party Administrator (TPA) that specializes in providing administrative services for health benefits. As a TPA, AmeriBen works with employers, insurance companies, and healthcare providers to manage various aspects of health plan administration. This includes processing claims, managing benefits, handling customer service, and ensuring compliance with regulatory requirements. AmeriBen aims to deliver efficient and effective health plan management, helping employers offer comprehensive healthcare benefits to their employees while maintaining cost-effectiveness and high service standards. ³

Does AmeriBen cover both inpatient and outpatient drug treatment?

AmeriBen insurance plans typically cover a comprehensive range of drug treatment options designed to support individuals in their recovery journey.

These options include:

Inpatient Programs: These are intensive residential treatment programs where individuals stay at a facility for a specified period. Inpatient programs offer a structured environment with 24-hour care, medical supervision, therapy sessions, and support groups. This type of program is particularly beneficial for individuals with severe addiction issues or co-occurring mental health disorders, providing an immersive approach to recovery.
Outpatient Programs: AmeriBen covers various outpatient treatment options that allow individuals to live at home while receiving treatment.

Outpatient services include:

- Partial Hospitalization Programs (PHP): These programs provide intensive treatment similar to inpatient care but allow patients to return home each day. PHPs involve multiple therapy sessions, medical monitoring, and structured support activities.
- Intensive Outpatient Programs (IOP): IOPs offer a flexible treatment option with several hours of therapy and support services per week, allowing individuals to continue working or attending school while participating in treatment.
- Standard Outpatient Programs: These programs involve regular, scheduled therapy sessions and support groups that patients attend while maintaining their daily responsibilities. They are suitable for individuals with milder addiction issues or those transitioning from more intensive treatment.

Detoxification Services: AmeriBen typically covers medical detox programs to help manage withdrawal symptoms as individuals cease substance use. These programs provide medical supervision to ensure the patient’s safety and comfort during the detox process, which is often the first step in addiction treatment.
Medication-Assisted Treatment (MAT): AmeriBen includes coverage for MAT, which combines behavioral therapy with medications to treat substance use disorders. Medications such as methadone, buprenorphine, and naltrexone help reduce cravings and withdrawal symptoms, making it easier for individuals to maintain sobriety. MAT is commonly used for opioid and alcohol addiction.
Counseling and Therapy: Coverage typically includes individual and group therapy sessions, which are crucial components of addiction treatment. These sessions provide psychological support, help individuals develop coping strategies, and address underlying issues contributing to substance use.
Aftercare and Relapse Prevention: AmeriBen supports ongoing recovery through aftercare services, which may include follow-up therapy sessions, support groups, and other resources to help prevent relapse and maintain long-term sobriety.

However, the specific coverage details, including the extent of coverage and any out-of-pocket costs, may vary depending on your particular AmeriBen plan. It is essential to verify your benefits by reviewing your plan documents and consulting with an AmeriBen representative before starting treatment. This ensures that you have a clear understanding of what services are covered and any potential financial responsibilities.

How do I know if a specific treatment center is in-network with AmeriBen?

To determine if a treatment center is in-network with AmeriBen, you can start by asking the center directly. They should be able to tell you if they are an in-network provider. You can also contact AmeriBen’s customer service department or use their online provider directory to search for in-network facilities in your area.

What happens if I need to go to an out-of-network treatment center?

If you go to an out-of-network treatment center, you may face higher out-of-pocket costs than staying in-network. However, depending on your plan, you may still have some coverage for out-of-network services. Review your plan details and talk to AmeriBen about your options before deciding.

Will AmeriBen cover medications used in drug treatment, such as methadone or buprenorphine?

In many cases, AmeriBen insurance plans will cover medications used as part of a comprehensive drug treatment program. This may include medications like methadone, buprenorphine, or naltrexone. However, coverage for specific medications can vary depending on your plan, so verifying your benefits and discussing your options with your treatment provider is important.

How can I make sure I'm getting the most out of my AmeriBen coverage for drug treatment?

To maximize your AmeriBen coverage for drug treatment, start by carefully reviewing your plan documents and understanding your benefits. Choose an in-network treatment center whenever possible to minimize your out-of-pocket costs. Stay in communication with AmeriBen and your treatment provider throughout the process, and don’t hesitate to ask questions or seek clarification when needed. Finally, take advantage of any available resources, such as hardship programs or community organizations, that can help make treatment more affordable.

Sources

[1] About | Ameriben

[2] Benefits | AmeriBen

[3] What is TPA Coverage?

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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