What is Emblem Health Insurance?
EmblemHealth is a health insurance provider in the United States. As one of the nation’s largest not-for-profit health insurers, Emblem Health serves more than 3 million people in the New York tri-state area.1 With a wide variety of insurance plans to choose from, Emblem offers health insurance coverage for individuals, families, and employers as well as Medicare and Medicaid plans.2 EmblemHealth does provide some coverage for substance use disorder treatment for their members.
If you’re seeking drug and alcohol addiction treatment and EmblemHealth is your health insurance provider, you may have some questions about what is covered by your insurance policy, and what out-of-pocket expenses you can expect. Rehab centers can check your coverage levels for you, or you can call the number on the back of your insurance card for more information about your specific plan.
What Types of Substance Addictions EmblemHealth Typically Covers?
EmblemHealth provides insurance coverage for the treatment of drug and alcohol addiction. Addiction to many substances may be covered by your plan, including:
- Prescription medications.
EmblemHealth will work with the treatment center you choose to provide coverage for the services you receive. A variety of levels of care may be covered by your policy plan.
What Different Types of Addiction Treatment Does Emblem Health Cover?
If EmblemHealth is your insurance provider, your policy may cover the following for drug and alcohol addiction treatment:
- Detox services: Medical detox helps you withdraw safely from drugs and alcohol for the first 3-5 days of your time in treatment. Medical supervision is provided around the clock by understanding medical professionals. You may be prescribed medications to manage your symptoms and ensure you withdraw safely.
- Inpatient or residential care: Inpatient/residential live-in treatment facilities provide drug and alcohol rehab while you live at the treatment center. Most inpatient rehab centers last anywhere from 15 days to several months, depending on the program you’re in and your specific needs.
- Partial hospitalization (PHP): Partial hospitalization programs allow you to live at home while you get treatment, and your days are spent at the treatment facility. This is sometimes referred to as “day treatment” and is optimal for people who know they can stay sober at home during the evenings/nights and can commit to attending treatment during the day.
- Intensive outpatient program (IOP): Intensive outpatient programs generally involve attending treatment programs 3-5 evenings a week. You’re able to live at home and go to work during the day and attend treatment sessions in the evenings.
- Outpatient treatment: Outpatient programs are ideal for people who have completed inpatient treatment and would like ongoing support and care in their sobriety. You can live at home but generally must attend treatment 10-12 hours a week to complete the program.
EmblemHealth usually covers these services as part of your addiction treatment:
- Physical and mental health assessments
- Medications (including medical detox)
- Lab work
- Therapy: both individual and group therapies
- Costs for inpatient and residential programs, including room and board and meals
The EmblemHealth health plan you have and the details of your plan—including monthly premiums, copays, deductibles, and potential out-of-network costs—affect your out-of-pocket total cost of drug and alcohol treatment. Some parts of treatment may or may not be covered, depending on your plan, but treatment should be at least partially covered under EmblemHealth regardless of the plan you have.
Does Emblem Health Insurance Cover Mental Health Care?
Many people who have substance use disorder also have mental health conditions, such as anxiety, depression, PTSD, and mood disorders. These are known as co-occurring disorders or dual diagnoses. According to the 2016 National Survey on Drug Use and Health, more than 8 million adults aged 18 or older with substance use disorder also had a co-occurring disorder.3
To ensure optimal treatment outcomes, it is important to treat both co-occurring disorders and to treat them at the same time. These conditions often influence each other. If you look for an addiction treatment facility that also offers mental health counseling and treatments for mental health conditions you will be able to access care for both at the same time.
Under the Affordable Care Act (ACA), substance use disorder is listed as one of the 10 elements of essential health benefits that insurers must provide. As a result, all US insurance providers are required to provide coverage for mental health care and treatment.4 Both co-occurring disorder treatment and stand-alone rehab for drug and alcohol addiction fall under this mandate. EmblemHealth plans cover mental health treatment while in rehab, but the amount covered varies depending on your policy.
How Long Does Emblem Health Insurance Cover Inpatient Rehab Programs?
EmblemHealth offers many different types of policies and plans. Each policy’s coverage varies. Therefore, the length of time for treatment coverage depends on your specific plan.
Longer treatment times are generally considered most effective when it comes to treatment outcomes. Statistically speaking, a longer stay in rehab leads to fewer instances of relapse and better rates for long-term sobriety. According to a recent study, a longer duration of treatment (3-6 months) and structured continuing care—such as outpatient treatment and counseling—are associated with better treatment outcomes for individuals with substance use disorder.5
You can look up your EmblemHealth plan information online to learn how many days of treatment your plan covers per calendar year or call the number on the back of your insurance card to learn more about your specific plan coverage for drug and alcohol rehab.
What Should I Do if Emblem Health Insurance Won’t Cover the Total Cost of Rehab?
As an EmblemHealth member, at least some of your treatment should be covered by your insurance plan. If your specific insurance policy does not cover all of your rehab expenses, don’t let that keep you from getting into treatment so you can get on the path to recovery. Getting treatment now is more important than waiting until you have insurance coverage or have the money to pay for it. There’s no doubt about it—getting and completing treatment saves lives.
Many drug and alcohol treatment centers work with EmblemHealth to provide coverage for drug and alcohol addiction. Don’t give up on your desire to get sober due to lack of coverage. There are many options to help you pay for treatment, including:
- Payment plans offered by the rehab center so you can pay the costs over time
- Scholarships and grants
- Crowdfunding (asking family and friends for support)
Talk with an admissions navigator at the rehab center(s) you are considering to discuss your payment options. They can help verify your insurance, determine what is covered by your plan, and help you formulate a plan to cover any out-of-pocket expenses.
Emblem Health In-Network vs. Out of Network Drug Rehab Centers
In-network drug and alcohol rehab centers have an agreement with EmblemHealth to offer treatment for individuals at a lower rate than other providers. Out-of-network facilities do not have an agreement with EmblemHealth. If you choose an out-of-network facility, this generally means higher out-of-pocket costs for you.
The difference in cost in selecting in-network vs out-of-network can be significant, as some insurance companies may not provide any coverage for facilities that are not in-network, and you may be expected to cover all costs at the drug and alcohol rehab center.
Whenever possible, work with a rehab center that is in-network with your insurance provider. Selecting a treatment facility that is in-network with EmblemHealth can decrease your out-of-pocket costs and provide much-needed peace of mind so you can focus on what truly matters—your recovery.
In some cases, EmblemHealth may cover out-of-network treatment facilities, though it generally requires a lot of work on your part to get some coverage for an out-of-network provider. Sometimes, EmblemHealth may provide coverage for some individuals who are in an out-of-network facility. For example, if you live in an area where you cannot access treatment at an in-network facility, or you belong to a certain population (e.g., veteran) and need treatment at a veteran-specific facility.
How to Verify Emblem Health Insurance Coverage for Addiction Treatment?
Before you select a rehab facility to attend, check your EmblemHealth policy benefits to determine which costs will be covered by your provider, and which will be out-of-pocket for you. Knowing ahead of time what to expect financially can help provide much-needed peace of mind while in treatment. Call the number on the back of your insurance card to speak with an EmblemHealth customer service agent. Or, login to your account on EmblemHealth’s website to learn the details of your policy, including copays, and/or if a deductible must be reached before coverage kicks in.
Dual Diagnosis Treatment Centers in Florida
American Addiction Centers can verify your insurance coverage for you. Complete the form below to enter your information and see immediately if the center you are considering is in-network with Amerigroup. Alternatively, you can call our helpline at to speak to an admissions specialist who can check your benefits while you’re on the phone.
American Addiction Centers has 2 drug and alcohol addiction treatment centers in Florida:
River Oaks: a premier rehabilitation center in Tampa, Florida that offers addiction treatment combined with a number of amenities so you are comfortable and cared for while in treatment. River Oaks’ specialized treatment for addiction and co-occurring mental health addictions is second to none. This world-class facility is staffed with medical staff who employ cutting-edge treatments for addiction to provide the highest standard of care.
Recovery First: one of Florida state’s leading drug and alcohol rehab facilities. Located in Hollywood, Florida (close to Miami), both inpatient and outpatient programs are offered at this facility. At Recovery First, groups are kept small and intimate to provide you with personalized service and treatment. The people you go through treatment with at Recovery First will become like family, supporting one another in their journey to sobriety and recovery.
No matter which rehab facility you choose, it’s important to learn the details of your EmblemHealth insurance plan to understand what parts of drug and alcohol addiction treatment are covered by your plan, and what you will be responsible for paying out-of-pocket.
There are a number of ways to verify your insurance benefits. Call us at —anytime day or night—to speak with one of our admissions navigators. They can help you discuss your options, verify your insurance, and answer any questions you have about addiction treatment. Everything is confidential, so you can speak candidly about your substance use disorder and mental health conditions you are struggling with, and provide you with the support and information you need to guide you into your recovery.