When considering addiction treatment, one of the most pressing questions is whether insurance will cover the cost. If you are enrolled in an insurance plan with Ambetter, the good news is that Ambetter does cover addiction treatment.
In this article, we’ll break down what Ambetter plans typically cover, how you can check specific plan coverage, and how Sana Lake can help you on your recovery journey.
Does Ambetter Cover Detox for Drugs and Alcohol?
Yes, many Ambetter plans include coverage for medically supervised detox programs. Detox is a critical first step in addiction treatment, helping individuals safely manage withdrawal symptoms.
What’s typically included:
- Medical Monitoring: 24/7 supervision by medical professionals.
- Medication-Assisted Detox: Medications to alleviate withdrawal symptoms if medically necessary.
- Supportive Care: Ensuring safety and comfort during the process.
Detox is essential for individuals withdrawing from substances like alcohol, opioids, or benzodiazepines, where unmanaged withdrawal can be life-threatening. Ambetter does require pre-authorization for inpatient detox.
Does Ambetter Cover Inpatient Rehab?
Yes, Ambetter generally covers inpatient rehab, which involves staying at a treatment facility to receive 24/7 care.
Coverage typically includes:
- Therapy and counseling
- Medication management
- Recreational activities
Inpatient rehab provides a structured environment that allows individuals to focus entirely on their recovery without outside distractions. It’s a highly effective option for individuals with complex cases of addiction or those who have tried outpatient programs without success.
Ambetter does require pre-authorization for inpatient care. Our admissions team at Sana Lake can help you with this process.
Does Ambetter Cover Outpatient Rehab?
Yes, most Ambetter plans cover outpatient rehab. Outpatient rehab allows individuals to live at home while attending structured therapy and counseling sessions. This is a great option for those with work or family commitments.
Ambetter coverage for outpatient rehab usually includes:
- Group therapy and individual counseling.
- Peer support programs.
- Flexible schedules tailored to your needs.
Outpatient programs come in various intensities, from Partial Hospitalization Programs (PHP), to Intensive Outpatient Programs (IOP) that meet several times a week, to General Outpatient Programs (GOP) that require fewer hours per week.
Ambetter plans often cover these options, making it possible for individuals to continue their daily responsibilities while seeking treatment.
Does Ambetter Cover Medication-Assisted Treatment?
MAT combines FDA-approved medications, such as Suboxone, with counseling and behavioral therapies to treat opioid addiction.
Ambetter plans typically cover:
- Initial Evaluations: Coverage for consultations to determine if MAT is appropriate for you.
- Ongoing Prescriptions: Access to medications like Suboxone, Methadone, and Vivitrol to reduce cravings and withdrawal symptoms.
- Therapy Sessions: Counseling services that are essential for long-term recovery.
Important to Know: Ambetter may require pre-authorization or proof of medical necessity for MAT.
FAQs About Ambetter and Addiction Treatment
Does Ambetter cover all rehab centers?
Not all rehab centers are in-network with Ambetter. Choosing an in-network facility like Sana Lake can help minimize out-of-pocket costs.
What if my insurance plan doesn’t cover the full cost of rehab?
It’s important to remember that when a plan “covers” treatment, that doesn’t always mean the cost of treatment is paid in full. There are often co-pays and deductibles you will likely have to pay out of pocket. Most addiction treatment programs offer flexible payment plans to ensure you receive the care you need.
Is Suboxone treatment covered long-term?
Many Ambetter plans to provide ongoing coverage for Suboxone prescriptions as part of a MAT program. Limits may apply, so it’s essential to check your plan’s coverage and talk through it with your treatment provider.
Can I use my Ambetter plan for both detox and outpatient care?
Yes, Ambetter covers multiple levels of care, including detox, inpatient rehab, and outpatient treatment.
How do insurance companies determine medical necessity?
Insurance companies evaluate medical necessity by reviewing your medical history, treatment needs, and established clinical guidelines like ASAM criteria for addiction care. This process may require pre-authorization, which involves submitting documentation to show why the treatment is essential.
Important Insurance Terminology to Know
Copay: A fixed amount you pay for a covered health care service.
In-network: Providers or facilities that have an agreement with your insurance plan.
Claims: Requests for payment that you or your health care provider submit to your health insurer.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.
How to Read Your Insurance Card
Your insurance card contains essential information such as your policy number, group number, and contact information for customer service. Understanding this information can help you navigate your coverage and benefits more effectively.
The name of the insured individual.
A unique identifier for your insurance policy. This number is used by health care providers to verify your coverage and file claims.
Identifies the group plan you are enrolled in, often used if you have insurance through an employer.
Indicates the type of health plan you have, such as HMO, PPO, or EPO. This can affect your network of providers and your costs.
Specifies the copay amounts for various services like doctor visits, specialist visits, and emergency room visits.
A phone number to call for questions about your coverage, claims, and benefits.
A number used by health care providers to submit electronic claims to your insurance company.
How to Verify Your Ambetter Coverage
Navigating insurance benefits can feel overwhelming, but understanding your coverage is an essential step in starting treatment. Here’s how to verify your Ambetter benefits:
- Contact Ambetter: Call the customer service number on your insurance card or log into the member portal.
- Ask Key Questions:
- Does my plan cover detox, inpatient, or outpatient rehab?
- Is Medication-Assisted Treatment included?
- What are my co-pays, deductibles, and out-of-pocket maximums?
- Reach Out to Sana Lake Recovery: Our admissions team can handle the verification process for you and walk you through your options, or you can verify your insurance here on the Sana Lake website.
How Ambetter Coverage Works at Sana Lake Recovery
Sana Lake Recovery is In-Network with Ambetter
Sana Lake Recovery is proud to be an in-network provider with several Ambetter-affiliated networks, including:
- PREMIER
- SOLUTIONS
- TXSMP
- Cascade Complete Care (Cascade Select/Public Option)
- CCCWA Exchange (Ambetter)
These networks represent some plans allowing patients to access treatment at Sana Lake with insurance benefits. However, Ambetter operates through various state marketplaces, and network availability may differ by location.
If you’re unsure whether your plan includes our facility, our admissions team is here to help verify your coverage.
Why Choose Sana Lake?
Sana Lake is in-network with many Ambetter plans, which helps reduce costs for treatment. We work with you to create a personalized treatment plan tailored to your specific needs.
Our team also assists with verifying benefits, handling pre-authorization, and explaining coverage details to ensure you understand your options before starting treatment.
Here is what we offer:
- Medically Monitored Detox: Ensuring a safe and comfortable withdrawal.
- Inpatient Residential Rehab: A serene and supportive environment for healing.
- Outpatient Programs: Flexible options for therapy and counseling.
- Medication-assisted treatment: Including Suboxone for opioid addiction.
- Family Programming: Helping loved ones learn how to support your recovery.
- Members for Life Program: Continued support for lifelong recovery.
Take the First Step Toward Recovery
Understanding your insurance coverage is the first step in getting the help you need. At Sana Lake Recovery, we’re here to guide you every step of the way. Our compassionate team works with Ambetter to make addiction treatment accessible and affordable.
If you’re ready to begin your journey toward lifelong recovery, contact us today. We’ll verify your insurance, answer your questions, and help you start your personalized treatment plan.
Ambetter Health. (n.d.). Health plans in Missouri. Retrieved January 30, 2025, from https://www.ambetterhealth.com/en/mo/health-plans
Glossary of insurance terms. Glossary of Insurance Terms. (n.d.). https://content.naic.org/glossary-insurance-terms
Ambetter Health. (n.d.). Sana Lake Recovery Center, LLC: Provider details. Retrieved January 30, 2025, from https://guide.ambetterhealth.com/providers/1417577107-sana-lake-recovery-center-llc/prov-6132240-1624/9266524-sana-lake-recovery-center-llc
Ambetter from Home State Health. (2025). 2025 formulary: Effective January 1, 2025. Retrieved from https://Ambetter.HomeStateHealth.com
