AvMed Insurance Coverage for Drug & Alcohol Rehab

Does AvMed Insurance Cover Drug & Alcohol Rehab?

AvMed insurance provides coverage for both substance use disorders and mental health treatment, although the specifics of this coverage can differ significantly based on the individual plan. For example, certain plans may offer extensive support for inpatient rehabilitation services, therapy sessions, and medication management, while others might have limitations on the number of covered outpatient visits or specific types of therapies. It’s essential for policyholders to carefully review their plan documents or consult with a representative to understand the exact benefits, co-pays, and any requirements for pre-authorization for services associated with mental health and substance use treatment.

How To Verify AvMed Health Plan Coverage

There are two ways to verify your coverage for drug or alcohol rehab.

1. Call us today at where an admissions advisor can hear your story, walk you through your options, verify your insurance over the phone, and help you begin treatment as soon as possible.
2. Fill in our confidential online insurance verification form.

Types of Treatment Options AvMed Health Insurance Typically Covers

Most health insurance plans, including AvMed, cover substance use treatment.

However, the types of treatment covered and the level of coverage will depend on your plan. Forms of rehab that may be covered include:

• Detox, where professionals help patients through withdrawal.
• Inpatient/residential, which occurs in settings where you stay overnight for periods of a few days to several months. Inpatient rehab can be hospital-based, or it may take place in residential facilities. Treatment often includes medical care, individual and group therapy, 12-step meetings, drug education, and recreational activities.
• Partial hospitalization programs (PHPs), which may be operated in connection with inpatient hospital rehabilitation programs. For some people, a PHP serves as the initial point of treatment; in other cases, it represents a step-down program for those having already completed an inpatient or residential program. Partial hospitalization programs (PHPs) are usually similar to inpatient programs, offering several hours a day of groups and other forms of therapy. The major difference between PHPs and inpatient treatment is that you return home at night. Some partial programs may meet 4 or 5 days a week, while some meet 7 days per week. American Addiction Centers (AAC) provides room and board for clients in its PHPs.
• Intensive outpatient programs (IOP), which typically meet 2-3 hours per day, 2-4 days per week. Like partial hospitalization, an IOP can be the first form of treatment someone receives, or it can be a step down from either partial hospitalization or an inpatient or residential program. AAC may provide room and board for clients in its IOPs who are not local residents.
• Standard outpatient treatment, which usually consists of one-on-one or group therapy sessions with a counselor, usually held once per week, though you might go more than once per week. Outpatient treatment is usually a follow-up to inpatient treatment, partial hospitalization, or an IOP treatment program.

After reading these descriptions, you may be wondering which type of program is the best fit for you. Some of the factors used to determine the right rehab setting for someone include:²

• Withdrawal-associated risks.
• Length of Stay (ranging from a few days for detox to 30 days for inpatient, and longer)
• General physical health.
• Mental health.
• Readiness to begin the recovery process.
• Potential for relapse.
• Home environment.

Suddenly discontinuing the use of certain substances, notably alcohol or benzodiazepines, can lead to severe withdrawal symptoms, including the risk of seizures. This is particularly true for individuals who have been regularly consuming these substances for an extended period, typically a few months or longer. In such cases, it is crucial to seek medical supervision during the withdrawal process to ensure safety and minimize complications.

Medical detox can take place in specialized inpatient treatment facilities or in standalone detox centers equipped to offer round-the-clock care. These environments provide the necessary monitoring and support to manage withdrawal symptoms effectively.

Once the detox phase is successfully completed, it is highly advisable to move into a structured treatment program. This transition helps individuals address the psychological aspects of addiction and enhances their chances of sustained recovery by providing ongoing counseling, support, and skills development designed to foster long-term sobriety.

Addiction Treatment Covered by AvMed

Many rehab programs treat all types of substance addiction, and AvMed plans typically cover the full range, including addictions to:

• Heroin.
• Alcohol.
• Benzodiazepines, such as Xanax and Klonopin.
• Opioid painkillers, such as oxycodone and hydrocodone.
• Methamphetamine.
• Marijuana.
• Other prescription drugs, such as Adderall or Ambien.
• Cocaine.

What Does AvMed Health Insurance Specifically Pay For?

AvMed offers a variety of insurance plans, each with different levels of coverage. When it comes to rehab services, many AvMed plans include comprehensive benefits that typically encompass a range of standard treatment options. This may include physical therapy, occupational therapy, and speech therapy, allowing members access to essential services designed to support their recovery and enhance their quality of life. The specifics of coverage can vary significantly, so it’s important for members to review their individual plan details to fully understand the scope of the rehabilitation services available to them, which include:

• Intake assessments.
• Psychosocial assessments.
• Medical and psychiatric exams.
• Detox treatment.
• Medications.
• Therapy, both group and individual.
• Cost for inpatient or residential rooms and meals.

Will My Employer Find Out?

Your treatment center is not permitted to disclose to anyone outside the facility that you are a patient. The confidentiality of your health information is protected by law. As a result, providers go to great lengths to guard what is known as your PHI, or protected health information. Your PHI includes information such as physical or mental health conditions you may have, healthcare services provided to you, and payment for healthcare services.

There are only a few exceptions when a provider can reveal your information, such as providing information to another healthcare provider if you need emergency treatment or if the information is ordered by a court.

Consequently, you can seek drug rehab without being concerned that your employer will discover that you are receiving substance use treatment.

What if My Provider Is Out of Network?

A significant number of insurance policies incentivize members to utilize in-network healthcare providers. These in-network providers have established agreements with insurance companies that set predetermined prices for various medical services, which often translates to reduced costs for individuals covered by the plan. As a result, when you choose to visit an in-network provider, your out-of-pocket expenses, such as copayments, deductibles, and coinsurance, are typically lower than those incurred when opting for an out-of-network provider. Conversely, if you decide to seek treatment from an out-of-network provider, you may face substantially higher costs, as these providers do not have the same pricing arrangements with your insurance company. This discrepancy can lead to significantly increased bills, making it important to consider your provider’s network status when planning your healthcare visits.⁴

How Much Will I Pay Out of Pocket?

When seeking treatment, whether from an in-network provider or an out-of-network specialist, it’s important to understand the financial responsibilities that may come with your AvMed health insurance policy. Typically, you will encounter several cost components including a deductible, co-pay, and coinsurance, each serving a distinct purpose in the coverage process.

The deductible is a predetermined amount that you are required to pay out of pocket for covered services before your insurance kicks in. For instance, if your deductible is set at $1,000, you will need to bear that expense yourself on eligible services before AvMed starts to contribute to your treatment costs.^5,6,7

In addition to the deductible, you may also face a co-pay, a fixed amount, such as $30 or $50, that you pay for a specific service each time you visit a provider. This co-pay is due at the time of your appointment and varies depending on the type of service rendered.

Coinsurance is yet another aspect to consider; it refers to the percentage of the total cost of a covered service that you are responsible for after meeting your deductible. For example, if your coinsurance is 20%, and your treatment cost is $1,000, once your deductible is met, you would pay $200 while your insurance would cover the remaining $800.

For those seeking drug rehabilitation services, it’s crucial to note that obtaining preauthorization from AvMed is often a necessary step. This preauthorization process involves the insurance company evaluating whether the proposed treatment aligns with medical necessity criteria. Depending on the specific circumstances, you may be required to secure this preauthorization prior to your admission to a facility. In some instances, you may only have 48 hours after admission to obtain this approval.

While navigating these requirements can initially seem overwhelming and complex, rest assured that we have admissions navigators available to guide you through the intricacies of your specific benefits. They can clarify what costs you might incur and outline the essential steps to facilitate a smooth start to your treatment journey.

How Do I Get Started?

American Addiction Centers offers a comprehensive service to help you explore your AvMed insurance benefits. By contacting us, you can receive a thorough verification of what your policy covers, ensuring you have a clear understanding of your financial responsibilities regarding treatment. Once we assess your benefits, our knowledgeable team will work closely with you to identify the ideal treatment provider tailored to your unique needs and circumstances. We prioritize your confidentiality throughout this process, creating a safe space where you can ask questions and express concerns without any pressure. Your well-being is our top priority, and we are here to support you every step of the way.

You can call us today at You can speak to an admissions navigator, use the chat feature on our site, or check your benefits using the form below.