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How to Pay for Drug Rehab With AvMed Insurance

Last Updated: September 12, 2019

From its beginning in 1969 as a company focused on providing physicals for airline pilots, AvMed has grown to serve more than 290,000 Floridians. The company offers Medicare Advantage plans, individual and family plans, and plans for employers.1

AvMed insurance covers substance abuse and mental health treatment, though the amount and type of coverage will vary from one plan to another. If you have AvMed health insurance and you need drug rehab, confirm your benefits and learn more about payment options with American Addiction Centers.

Types of Treatment Options AvMed Health Insurance Typically Covers

 Inpatient/residential occurs in settings where you stay overnight for periods of a few days to several months.

Most health insurance plans, including AvMed, cover substance abuse 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:

  • 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, 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.
  • General physical health.
  • Mental health.
  • Readiness to begin the recovery process.
  • Potential for relapse.
  • Home environment.

Abruptly quitting some substances, such as alcohol or benzodiazepines, can trigger seizures during withdrawal.3 Often, if you have been using these substances for a few months or more, you will need medical management of your withdrawal before you begin treatment. A medical detox can be conducted in an inpatient program or a freestanding detox center. After detox, it is recommended that you transition into a formal treatment program.

Types of Addictions Covered

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

What Does AvMed Health Insurance Specifically Pay For?

AvMed coverage varies from one plan to another; however, AvMed plans with rehab coverage often cover the standard services of treatment, 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 allowed to inform someone outside the facility that you are a patient.

Your treatment center is not allowed to inform someone 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 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. There are a few other circumstances that compel your treatment provider to reveal your PHI, which they can explain to you in depth, but those circumstances are rare and would not involve your employer.

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

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*Insurance Disclaimer: American Addiction Centers will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” American Addiction Centers will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

What if My Provider Is Out of Network?

Many insurance policies encourage you to see in-network providers. In-network providers typically have negotiated prices for services and benefits for plan members. Your out-of-pocket costs may be higher if you see an out-of-network provider than if you see an in-network provider.4

How Much Will I Pay Out of Pocket?

Woman handing over credit cardWhether you go to an in-network or out-of-network provider, you will usually have to pay a deductible, co-pay, and/or coinsurance. Your AvMed policy may have a set deductible, which is the amount that you must pay out of pocket for covered services before your insurance coverage begins to take effect. In addition, you may have a co-pay, which is a flat amount you pay each time you receive a service. Coinsurance is a percentage of the cost of a covered service that you pay.5,6,7

For many drug rehab programs, you will also have to get preauthorization from AvMed, where they will make a determination about whether your care is medically necessary.8  Preauthorization may or may not be required for outpatient services. In some cases, you will need to get preauthorization within 48 hours of admission, but in other cases, it may be required before you are admitted.

This process may sound difficult and confusing, but one of our admissions navigators can help you understand your specific benefits and what to expect in terms of your out-of-pocket costs and the steps necessary to begin treatment.

How Do I Get Started?

American Addiction Centers can verify your AvMed insurance benefits and let you know what may be covered. After determining your benefits, we can then help you find the right treatment provider for your specific needs. Rest assured that your call is confidential and there will be no pressure put on you. You can call us today at 888-825-1364 to speak to an admissions navigator, use the chat feature on our site, or check your benefits using the form on this page.

Sources

  1. AvMed. (2019). About Us.
  2. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., and Saitz, R. (2019). The ASAM Principles of Addiction Medicine (Sixth ed.). Philadelphia: Wolters Kluwer.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  4. Centers for Medicare & Medicaid Services. (2017). What You Should Know About Provider Networks.
  5. Healthcare.gov. (n.a.). Deductible.
  6. Healthcare.gov. (n.a.). Copayment.
  7. Healthcare.gov. (n.a.). Coinsurance.
  8. Healthcare.gov. (n.a.). Preauthorization.
Last Updated on September 12, 2019
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About the author
Leah K. Walker
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Leah K. Walker is a licensed marriage and family therapist with a Ph.D. in family relations.