Cornerstone

Understanding Mercy Care Drug Treatment Coverage

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

Alcohol and Drug Treatment Coverage with Mercy Care

When dealing with substance use disorder, having reliable health insurance coverage can make a significant difference in accessing necessary care.

MercyCare recognizes the importance of comprehensive alcohol and drug treatment benefits and is committed to supporting you.

We will help you understand the key aspects of your MercyCare plan, including network coverage, claims approval, plan types, and deductibles.

Our goal is to ensure that you fully comprehend your benefits and can confidently navigate the path to recovery.

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Mercy Care drug treatment coverage

Choosing an in-network treatment center for alcohol or drug rehabilitation can offer significant advantages when MercyCare covers you.¹ Our network includes many trusted providers who have met strict quality standards, ensuring you receive high-quality care. We’ve negotiated competitive rates with these providers, so you’ll typically have lower out-of-pocket costs when you stay within the MercyCare network.

In-network facilities can handle claims directly with MercyCare, simplifying your billing process. However, in-network options may be more limited than out-of-network choices, and you’ll need to verify that the specific services you require are covered under your plan.

While MercyCare encourages using in-network providers, we understand that sometimes an out-of-network facility may best fit your unique needs. One advantage of choosing an out-of-network treatment center is the broader range of options. This can be particularly beneficial if you’re seeking specialized care or have personal preferences regarding location or treatment approach.

However, it’s crucial to remember that out-of-network services often come with higher out-of-pocket costs, as these providers have yet to agree to MercyCare’s negotiated rates. You may be responsible for a more significant portion of the bill and likely need to handle claims submission yourself. Before committing to an out-of-network facility, review your plan details carefully and contact MercyCare for guidance on coverage and potential out-of-pocket expenses.

Information about Mercy Care Plan Types

Mercy Care is a Medicaid-managed care organization providing Arizona residents with healthcare services through the Arizona Health Care Cost Containment System (AHCCCS).² It offers comprehensive medical, behavioral health, and substance use treatment services to eligible individuals and families. As part of AHCCCS, Mercy Care aims to deliver high-quality, coordinated care that promotes health and wellness, particularly for low-income individuals, seniors, and people with disabilities. Members benefit from various services, including preventive care, hospital visits, prescription medications, and specialized addiction treatment programs.

Mercy Care Advantage is a Medicare Advantage Special Needs Plan (SNP) offered through Mercy Care, designed for individuals eligible for both Medicare and Medicaid (AHCCCS) in Arizona.³ This plan provides comprehensive healthcare coverage, combining Medicare and Medicaid benefits into a single, coordinated plan. Members receive various services, including medical, dental, vision, and prescription drug coverage and specialized care for chronic conditions and disabilities. Mercy Care Advantage aims to enhance the quality of care and improve health outcomes for its members by offering personalized, integrated services and support.

Understanding Policy Terminology

A deductible is the amount you pay out of pocket for covered healthcare services before your MercyCare insurance plan starts to pay.

For example, if your plan has a $1,000 deductible, you must pay the first $1,000 of covered services yourself.

Once you’ve met your deductible, MercyCare will begin to cover some of the costs for covered services, including alcohol and drug treatment.

Co-insurance is the percentage of the cost you share with MercyCare for covered services after you’ve met your deductible.

For instance, if your plan has 20% co-insurance and you’ve already met your deductible, you’ll pay 20% of the allowed amount for a covered service, while MercyCare pays the remaining 80%.

Co-insurance helps you understand your share of the costs for substance use disorder treatment services.

The out-of-pocket max is the most you’ll pay for covered services in a given plan year.

This includes your deductible, co-insurance, and copayments.

Once you reach your out-of-pocket max, MercyCare will cover 100% of the allowed amount for covered services for the remainder of the plan year.

This can provide peace of mind, knowing there’s a limit to your financial responsibility for alcohol and drug treatment and other covered healthcare services.

Mercy Care Approval Process for Treatment

When you’re ready to begin alcohol or drug treatment, the first step is to verify your MercyCare insurance coverage. The treatment center you choose will contact MercyCare on your behalf to confirm your benefits and determine what portion of the costs you’ll be responsible for, if any. This verification process helps you understand your financial obligations upfront, allowing you to focus on your recovery without unexpected expenses. MercyCare works closely with your provider to ensure a smooth coverage verification process.

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

What types of alcohol and drug treatment does Mercy Care cover?

Mercy Care health insurance offers a range of care levels tailored to our member’s specific needs, ensuring they receive the most appropriate treatment.

The levels of care provided may vary by plan, but typically include:

Outpatient Treatment: Weekly therapy sessions and support services allow patients to live at home while receiving care.
Intensive Outpatient Treatment: More rigorous than standard outpatient care, involving multiple weekly therapy sessions.
Partial Hospitalization Program (PHP): Day treatment providing intensive care during the day, with patients returning home in the evenings.
Inpatient Treatment: Full-time care in a hospital or residential setting, offering round-the-clock supervision and support.
Detoxification Services: Medical supervision to safely manage withdrawal symptoms from substances.
Medication-Assisted Treatment (MAT): Use of medications in combination with counseling and behavioral therapies to treat substance use disorders.
Counseling and Therapy: Includes individual, group, and family therapy to address the psychological aspects of addiction.
Holistic Therapies: Incorporates yoga, meditation, and art therapy to support overall well-being and recovery.

These treatment options are designed to address various stages and severities of addiction, providing a comprehensive approach to recovery.

For detailed information about what your plan covers, don’t hesitate to contact us to verify your insurance and receive a free breakdown of your benefits!

How can I apply for Mercy Care (AHCCCS)?

To secure coverage through Mercy Care for drug and alcohol rehab or substance abuse treatment, you’ll need to apply for AHCCCS (Arizona Health Care Cost Containment System).

Here’s how you can apply:

Online Application: Visit the Health-e-Arizona Plus website at https://www.healthearizonaplus.gov and follow the instructions to apply online.

Phone Application: Call the AHCCCS Customer Service Center at 1-855-432-7587. A representative will help you through the application process and answer any questions.

In-Person Application: Apply in person at your local Department of Economic Security (DES) office. You can find your nearest office on the DES website at https://des.az.gov/ by clicking the “Find an Office” button.

Documents Required for AHCCCS Application: You must provide basic personal and household information such as name, address, date of birth, and income. You must also be prepared to submit additional documents verifying eligibility, such as proof of income or residency.

After submitting your application, you will be reviewed and notified of your eligibility status.

If eligible, you can choose from a list of managed care plans, including Mercy Care.

Once you’ve chosen Mercy Care, contact us to begin the admissions process for Mercy Care substance abuse treatment.

Does Mercy Care cover co-occurring or dual diagnosis treatment?

Mercy Care health insurance provides coverage for dual diagnosis treatment, addressing both substance abuse and mental health disorders.⁶

This dual diagnosis treatment is essential in substance abuse treatment as it targets not only the addiction but also any underlying mental health conditions contributing to substance use.

At Cornerstone, we offer specialized co-occurring treatment programs, taking a holistic approach that may include therapy, medication management, and other interventions to address substance abuse and mental health disorders simultaneously.

What is the Substance Abuse Block Grant (SABG) and how does it help with addiction treatment through Mercy Care?

The Substance Abuse Block Grant (SABG) provides federal funding to states, including Arizona, to support the prevention and treatment of substance abuse.⁴

Mercy Care uses SABG funds to improve access to addiction treatment services for uninsured or underinsured individuals.

These funds cover a variety of services, including detoxification, residential treatment, outpatient therapy, and recovery support services.

Mercy Care ensures these services are tailored to meet individual needs, enhancing recovery outcomes and supporting long-term sobriety.

Additional Details:

Eligibility: SABG funds are typically used for those who lack insurance or have insufficient coverage for addiction treatment.
Services Covered: SABG funds can be used for a wide range of services, including:
- Detoxification: Safe management of withdrawal symptoms under medical supervision.
- Residential Treatment: Intensive, 24-hour care in a live-in facility.
- Outpatient Therapy: Regular, scheduled therapy sessions that do not require an overnight stay.
- Recovery Support: Services that support long-term recovery, including counseling, peer support, and relapse prevention programs.
- Goals: The main goal of utilizing SABG funds is to enhance the quality, availability, and effectiveness of substance abuse treatment services, ensuring comprehensive care for those in need.

Sources

[1]Mercy Care ACC – RBHA

[2] Mercy Care (AHCCCS)

[3] Mercy Care Advantage

[4] Substance Abuse Block Grant (SABG) | Mercy Care

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.

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