In Network with AAC

How to Pay for Drug Rehab With QualCare Insurance

Last Updated: October 25, 2019

If you’re considering drug treatment, it is important to understand your health insurance benefits and know which treatment options are covered.

Treatment for mental health problems and substance abuse is at least partially covered for most QualCare members. If you are interested in receiving treatment through American Addiction Centers, confirm your benefits today.

What Is QualCare?

QualCare is one of the biggest managed care organizations in New Jersey, with its headquarters located in Piscataway. QualCare offers a number of different healthcare insurance plans and serves more than 900,000 people. It offers services in New Jersey, New York, and Pennsylvania.1

QualCare’s services extend beyond traditional insurance plans. The company focuses on improving quality of life and wellness. Plan types and services include:1,2

  • Open access.
  • Health maintenance organization (HMO).
  • Point of service (POS).
  • Preferred provider organization (PPO).
  • Third party administration (TPA).
  • Provider network access.
  • Wellness programs.
  • Care management services.
  • Worker’s compensation.
  • Consultative services.
  • Small group health plans.
  • Insurance management services.

QualCare services a broad range of industries and employers including school boards, governments, health systems, unions, and other commercial employers.1

In-network QualCare providers and services include more than 40,000 doctors and other healthcare providers as well as over 100 rehabilitation, acute, and specialty hospitals.1

Verify Your Insurance Coverage

american addiction centers photo
Your information is safe & secure
Get a response instantly - for free.
What you need to get started:
Health Insurance Card
Let’s verify your coverage for treatment at an American Addiction Centers location. We promise to keep your information confidential.
All Fields Required
First Name
John
Last Name
Smith
Phone Number
555-555-5555
Email
jsmith@mail.com
Date of Birth
Insurance Carrier
1
Aetna
american addiction centers photo
Membership ID
WXY1030Z01
This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
By submitting this form you agree to the terms of use and privacy policy of the website.
We respect your privacy. We request this information to provide you with detailed coverage of benefits. By sharing your phone number, you agree to receive texts from us – including details about your benefits. Message and data rates may apply. Sharing this information is not a condition of treatment.
1Insurance 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.

Which Addictions Does QualCare Cover?

QualCare will normally cover most addictions.

QualCare will normally cover most addictions, such as heroin, alcohol, cocaine, methamphetamine, marijuana, inhalants, hallucinogens, and prescription drugs. Prescription drugs can include stimulants, benzodiazepines, and opioids.

QualCare will typically cover co-occurring disorders as well. These are instances in which a person struggles with an addiction and a mental health disorder at the same time. If you suffer from anxiety and alcohol addiction, for example, you would be considered to have a co-occurring disorder. Treatment would need to be modified to target both the mental health and substance abuse components of your disorder.

Most rehabilitation programs treat the addictions listed above. It is important to identify in-network providers so your services are covered under QualCare.

Which Types of Treatment Are Covered?

Close-up of therapist's hands explaining a problem to his patientsSubstance abuse treatment and rehabilitation involves many different types of services, which can range from very intensive to nominally intensive with a relatively low time commitment. Service necessity is based on the severity of your addiction. Factors to consider include the type of substance or substances you are addicted to, your physical health, the length of your addiction, and the amount of substance(s) you use.

Detoxification is the initial step in substance abuse treatment. It involves the use of medical care and medications to assist people in withdrawing from drugs and/or alcohol. Certain substances, such as benzodiazepines, opioids, and alcohol, may require medically supervised detoxification while other substances may not. Following detoxification, many people continue their recovery in a formal treatment program.

Inpatient or residential treatment can last for days, weeks, and in some instances months. These programs provide 24/7 support and in many cases offer medical care. Some may include detox. Programs often consist of group and individual therapy, 12-step meetings, recreational activities, and alternative therapies such as art therapy, yoga, and meditation.

Treatment in a partial hospitalization program (PHP) may take place after residential treatment or serve as an initial point of treatment. A PHP is relatively less intensive than residential treatment but provides many of the same types of treatment. You can expect to spend 4 to 5 days a week and 4 to 8 hours per day at a PHP. The difference between PHP and residential is that in a PHP, you go home each day.

Intensive outpatient programs (IOPs) can last for weeks or months and consist of group therapy, though some may include individual therapy as well. You can expect to spend roughly 9 hours a week in an IOP. IOPs can serve as continued treatment after completion of a residential treatment program or be used as an initial intervention depending on the severity of your substance use disorder.

Standard outpatient treatment is the least intensive form of treatment and generally requires 1 to 3 hours of group or individual therapy per week.

Services Covered

Services that QualCare may cover in a rehab program include:

  • Assessments.
  • Lab work.
  • Exams.
  • Therapy.
  • Residential treatment expenses (including room and board).

Our admissions navigators can help you identify which form of treatment is best for you or your loved one based on your specific characteristics. It is important to be as honest as possible with our admissions navigators as they are trained to help identify appropriate rehabilitation and services for you based on your needs.

How Much Will I Pay Out of Pocket?

Out-of-pocket costs are determined by a number of factors including the type of insurance plan you have.

Out-of-pocket costs are determined by a number of factors including the type of insurance plan you have, the state you live in, the length of services, and the kinds of services you receive.

Many plans require a preauthorization for services. A pre-authorization is a confirmation from your insurance provider that the services you are seeking are medically necessary. Pre-authorizations are generally required for secondary or specialty medical services.

It’s important to remember that a pre-authorization is not a guarantee of coverage. If you are unsure about your plan and whether you require a pre-authorization, contact QualCare to confirm.

Even with a pre-authorization, you may still be responsible for out-of-pocket costs including coinsurance, deductibles, and co-pays. Coinsurance represents a fixed percentage that you are responsible for paying for covered services after your deductible has been met. The percentage amount can vary depending on your plan.

A deductible is the amount that you must pay before your insurance provider will begin to pay for services. For example, if your deductible is $500, you must meet that $500 obligation before your insurance provider will assume payment. Like coinsurance, deductibles can vary based on your insurance plan.

A co-pay is a fixed amount you pay at the time you receive services. Co-pays can vary based on not only your insurance plan but also the services rendered. For example, your co-pay at your doctor’s office may be different than your co-pay at an urgent care clinic.

What if My Provider Is Out of Network?

Your healthcare plan will most likely recommend that you obtain treatment with an in-network provider. In-network providers are contracted with the insurance company to provide services at a negotiated rate. Because out-of-network providers do not have this arrangement, out-of-pocket costs are higher if you receive services through them.

If you choose to receive substance abuse services from an out-of-network provider, you may have to pay for all or most of the cost of the services you receive. You can talk to the provider to see if they have payment plans available or offer financial assistance such as grants, scholarships, or discounts.

How Do I Get Started?

If you are thinking about getting treatment, the first step in the process is to verify your insurance benefits with American Addiction Centers. After that, we can help you choose the most appropriate facility based on your treatment needs, insurance coverage, and specific circumstances.

You can verify coverage in several ways. You can contact one of our admissions navigators by phone at 888-966-8152 or use our convenient chat feature. You can also use our benefits verification form online.

No matter how you verify your coverage, you can be rest assured that your information will be kept completely confidential.

Sources

  1. QualCare. (n.d.). About.
  2. QualCare. (n.d.). Health plans.
Last Updated on October 25, 2019
Share
About the author
Jacquelyn Buffo
american addiction centers photo
Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C., is a licensed professional counselor with experience and expertise in substance abuse and mental health issues.

Start your recovery today.

American Addiction Centers can help you get the care you deserve.