Does American Behavioral Health cover rehab? Many plans that use American Behavioral Health can help pay for addiction treatment, but what’s covered depends on the type of benefit you have and your specific plan. The Ranch Pennsylvania Outpatient Services accepts many American Behavioral Health plans, and our admissions team can check your benefits before you start outpatient rehab.
What Is American Behavioral Health on Your Insurance Card?
When a behavioral health company’s name appears on your ID card or benefits paperwork, it usually means that company handles the mental health and substance use side of your coverage for your employer or health plan. In some cases, the name refers to an employee assistance program (EAP) instead. Several organizations use similar names, so the most reliable way to know what you have is to check your own card, your plan documents or your employer’s HR team.
This matters because the two types of benefits work very differently when it comes to rehab.
EAP Benefits vs. Behavioral Health Plan Benefits
Employee assistance programs (EAPs)
The U.S. Office of Personnel Management describes an EAP as a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services. EAPs can help with substance use concerns, stress, grief and family problems. They are a good first step for getting assessed and referred, but they generally aren’t designed to pay for a full rehab program.
Managed behavioral health benefits
If American Behavioral Health manages the behavioral health part of your health insurance, that’s the benefit that typically pays for structured treatment like partial hospitalization (PHP) and intensive outpatient programs (IOP). An EAP counselor can often refer you to this benefit when you need more care.
Does American Behavioral Health Cover Rehab Through Your Health Plan?
When your behavioral health benefits run through a health plan, federal rules apply. HealthCare.gov explains that all Marketplace plans cover mental health and substance abuse services as essential health benefits and can’t deny you coverage or charge more because of a pre-existing substance use disorder. For job-based plans that include these benefits, the Department of Labor explains that under federal parity law, financial requirements like copays and deductibles for mental health and substance use care need to be similar to those for medical care.
Plans commonly cover several levels of addiction care, such as:
- Medically supervised detox
- Inpatient or residential treatment
- Partial hospitalization (PHP)
- Intensive outpatient treatment (IOP)
- Outpatient counseling and psychiatric care
Medication can also be part of care for some people. SAMHSA notes that buprenorphine should be prescribed as part of a comprehensive treatment plan that includes counseling. Ask your plan how these medications are covered.
Prior Authorization and Medical Necessity
Higher levels of addiction care often need approval before you start. HealthCare.gov defines preauthorization as a decision by your health insurer or plan that a service is medically necessary, and notes that it isn’t a promise the plan will cover the cost.
To decide what level of care fits, many plans rely on the ASAM Criteria from the American Society of Addiction Medicine. ASAM calls them the most widely used and comprehensive set of standards for placement and transfer of patients with addiction and co-occurring conditions. The criteria use a strength-based assessment across six dimensions of your health and life to match you with the least intensive care that is still safe and effective. Your treatment team usually handles the authorization request for you.
Using American Behavioral Health Benefits at The Ranch Pennsylvania Outpatient Services
Our Lancaster, PA, addiction treatment programs include:
- Partial hospitalization (PHP): full-day programming five days a week at our Outpatient Center. Most clients complete it in about 8 to 12 weeks.
- Intensive outpatient (IOP): three-hour group sessions three days a week while living at home, typically for about 5 to 6 weeks.
PHP clients can stay at our Outpatient Residence, a 16-bed, substance-free home with 24/7 support staff and transportation to programming. We use CBT, DBT, motivational interviewing and family therapy, with psychiatric care and medication-assisted treatment when clinically appropriate. Detox is not done on site, but it can be coordinated with residential care at The Ranch Pennsylvania before you step down to outpatient care.
How to Check Your American Behavioral Health Coverage
- Look at your ID card. Find the behavioral health or mental health/substance use number on the back of your card, which may be different from your medical number.
- Ask whether you have an EAP, a health plan benefit or both. If you have an EAP, ask how many free sessions you get and whether they can refer you to a program.
- Ask about PHP and IOP. Find out your deductible, copays or coinsurance, whether prior authorization is needed and whether the program is in network.
- Let us help. Our admissions team can verify your American Behavioral Health insurance for you.
Our guides to checking your insurance coverage for rehab and insurance coverage for rehab in Pennsylvania walk through the details.
Frequently Asked Questions
Can I use an EAP to pay for rehab?
EAPs usually offer a limited number of free counseling sessions and referrals rather than paying for a full program. Your health plan’s behavioral health benefit is what typically covers PHP or IOP.
Does American Behavioral Health cover outpatient rehab?
Many plans do cover outpatient addiction care, but costs and approval rules vary. Verifying your benefits before you start is the best way to avoid surprises.
What if my claim for addiction treatment is denied?
You can appeal. For job-based plans, the Department of Labor says you have at least 180 days to file an appeal, and many plans also allow an independent external review.
Does American Behavioral Health cover mental health care too?
Many plans cover both. See our guide to American Behavioral Health mental health coverage.
Get Help for Addiction in Lancaster, PA
If you’re still asking “does American Behavioral Health cover rehab” for your situation, we can help you get a clear answer. The Ranch Pennsylvania Outpatient Services serves Lancaster County and central Pennsylvania, including York, Harrisburg, Reading and Lebanon, with PHP and IOP addiction care. Verify your insurance online or contact our admissions team. We’re available 24/7, and calls are free and confidential.
