QualCare Insurance Coverage for Drug & Alcohol Rehab
Treatment for mental health problems and substance abuse is at least partially covered for most QualCare insurance members.
Which Addictions Does QualCare Cover?
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?
Substance 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. Substance abuse treatments may include:
- 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.
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 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.
Services that QualCare may cover in a rehab program include:
- Lab work.
- 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, 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.
What Is QualCare Insurance?
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