Cornerstone

Understanding AmeriBen Drug Treatment Coverage

Q: Does Cornerstone Healing Center accept AmeriBen insurance?

YES - we do! At Cornerstone, we proudly accept AmeriBen, ensuring you receive the best care with minimal out-of-pocket expenses. To start your recovery journey today, verify your AmeriBen insurance with us.

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

Alcohol and Drug Treatment Coverage with AmeriBen

When struggling with alcohol or drug addiction, the last thing you should worry about is whether your insurance will cover the treatment you need.

AmeriBen Insurance offers comprehensive coverage for substance abuse treatment to help you get back on track.

This guide will explore how AmeriBen can help you access the necessary care, including in-network and out-of-network coverage options, the claims approval process, available plan types, deductibles, and financial hardship assistance.

We aim to empower you with the knowledge and resources to make informed decisions about your treatment and recovery.

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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.¹

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 broader 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 essential to understand its workings. With an HMO, you’ll typically need a primary care physician (PCP) to coordinate your care and provide referrals to specialists. One of the main benefits is that HMOs often have lower out-of-pocket costs compared to other plan types. However, HMO plans generally only cover in-network services, so ensure 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, though you’ll pay less within the network. This is beneficial if you have a specific treatment center or specialist in mind. Remember, 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 balances cost and flexibility. Like HMOs, EPO plans typically cover only in-network services, which helps lower costs. However, unlike HMOs, you don’t need to select a primary care physician or get referrals to see specialists within the network. This can be a good option if you value lower costs but want more freedom in accessing care. Just remember, if you go out-of-network for your drug treatment, you’ll likely be responsible for the total cost.

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 premiums but higher deductibles, meaning you’ll pay more upfront for drug treatment services before coverage. These plans are often paired with Health Savings Accounts (HSAs), allowing you to set aside pre-tax dollars for qualified medical expenses. If you’re generally healthy and want to save on monthly premiums while having coverage for unexpected treatment needs, an HDHP could be a viable option.

AmeriBen offers Medicaid and Medicare plans to help cover the cost of drug treatment for those who qualify. Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. It offers lower-cost drug treatment services to those who meet eligibility requirements. Meanwhile, Medicare is a federal health insurance program for people aged 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.

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 reviewing your policy documents or contacting AmeriBen directly to understand your deductible amount and how it applies to your drug treatment coverage is crucial.

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.

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 essential 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.

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 adjudication 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 expenses, such as your deductible or co-insurance. The treatment center will typically bill you for any remaining balance after receiving payment from AmeriBen. Throughout this process, communicating with AmeriBen and your treatment center is essential to ensure you understand your financial responsibilities and address any questions or concerns.

If AmeriBen denies your claim for drug treatment, it could be for reasons like lack of medical necessity or the service not being covered under your specific plan. If your claim is denied, your treatment center will likely file an appeal on your behalf. Treatment centers have experienced billing departments that can handle denials and appeals well. They will work hard to gather additional information, provide supporting documentation, and make a strong case for why the denied service should be covered. Treatment centers aim to provide only services that are likely to be approved, but in the event of a denial, they will work as your advocate 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 is to file a hardship with AmeriBen. A hardship is a situation that prevents you from affording your medical expenses, such as a job loss, family crisis, or unexpected financial burden. To file a hardship, contact AmeriBen directly and provide documentation of your financial situation. AmeriBen may waive or reduce your deductible if approved, making the necessary treatment more accessible. Remember that the success of your hardship application depends on your specific circumstances and AmeriBen’s assessment.

Assistance Programs & Payment Plans

Many drug treatment centers offer assistance programs and payment plans to help make treatment more accessible and affordable. These programs can help you manage out-of-pocket expenses, such as deductibles and co-insurance. Some centers offer sliding-scale fees based on your income, while others may provide scholarships or grants to eligible individuals. Treatment centers may allow you to spread your payments over time through a payment plan, making it more manageable to cover your share of the costs. When selecting our treatment center, inquire about available assistance programs and payment plans.

Community Resources & Charitable Organizations

In some cases, community resources and charitable organizations may be able to help you cover your drug treatment deductible. These organizations recognize the importance of accessible and affordable addiction treatment and may provide financial assistance to those in need. Some examples include faith-based organizations, local non-profits focused on addiction recovery, and national charities dedicated to helping individuals overcome substance abuse. Research the organizations in your area and contact them to learn more about their assistance programs.

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

What is AmeriBen?

AmeriBen is a Third-Party Administrator (TPA) specializing in providing health benefits and administrative services.²

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.

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.³

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 daily. PHPs involve multiple therapy sessions, medical monitoring, and structured support activities.-
Intensive Outpatient Programs (IOPs): IOPs offer a flexible treatment option with several hours of weekly therapy and support services. They allow 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.

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.

Does Cornerstone Healing Center accept AmeriBen insurance?

YES – we do!

At Cornerstone, we proudly accept AmeriBen, ensuring you receive the best care with minimal out-of-pocket expenses.

To start your recovery journey today, verify your AmeriBen insurance with us.

Sources

[1] Benefits | AmeriBen

[2] About | Ameriben

[3] Health & Wellness Resources | AmeriBen

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.

Still have questions about treatment?

Our admissions specialists are here to explain the process, answer any questions you may have, and ensure you’re getting the help you need to live a healthy life free from addiction.