Rehab Centers That Accept Meritain Health Insurance

Recovering from a substance use disorder (SUD) is often a long and difficult journey, but you don’t have to do it alone. Working with medical professionals at an in-network treatment facility can significantly improve your chances of success and make the process more manageable. If you have a plan managed by Meritain Health Insurance, it may cover therapy, medications and other addiction treatment services.

Meritain Health usually serves as a third-party administrator (TPA) for self-funded employer health plans rather than acting as the insurer that funds the benefits. The employer designs the plan and pays covered claims, while Meritain processes claims, provides member services and connects members with the plan’s selected provider network, often Aetna and CVS Health. Coverage for drug and alcohol rehab, including deductibles, coinsurance, network rules and precertification requirements, depends on the employer’s specific plan. 

Many insurance plans offered through Meritain Health include behavioral health benefits and drug rehab coverage. Some also cover eligible dependents, such as spouses and children, making substance abuse treatment more accessible. However, the exact amount of coverage for each service depends on the type of plan you have.

Meritain Health insurance may cover detox, inpatient rehab and outpatient treatment through Aetna’s extensive network of providers. Each covered service may have a cost-sharing requirement, meaning you pay for some portion of your care.

These are some of the most common out-of-pocket costs for substance use disorder treatment:

• Co-pay: A copay is a fixed amount of money you pay for a service, such as $30 for a therapy session or $150 for an emergency department visit.
• Coinsurance: Some services have coinsurance, which is a fixed percentage of the approved amount. If your coinsurance is 20%, you have to pay 20% of each covered expense (e.g., $200 of a $1,000 bill).
• Deductible: This is the amount you pay out of pocket before your health insurance plan covers anything.

Many plans managed by Meritain Health require preauthorization for inpatient rehab and other services. This means your provider needs to get permission before providing the requested care.

Insurance companies used to be able to deny coverage for addiction-related care or set arbitrary limits on approved services. Two pieces of legislation made substance use treatment more accessible.

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires insurers to provide the same level of benefits for mental health and substance use disorders as they do for physical health conditions. It prevents insurance companies from charging higher co-pays, deductibles or other out-of-pocket costs for mental health or addiction treatment. The MHPAEA also prohibits insurers from limiting the number of covered inpatient or outpatient treatment days for behavioral health.

When the Patient Protection and Affordable Care Act (ACA) passed in 2010, it significantly expanded access to coverage by creating the Health Insurance Marketplace. The ACA also designated substance use disorder treatment as an essential health benefit.

Understand and Verify Your Meritain Drug Rehab Coverage

Because Meritain Health insurance is offered exclusively through employers, coverage details and benefits often depend on the terms of your employer’s specific contract. Some plans may include deductibles, co-pays or coinsurance. 

Confirming your coverage is easy. You can use the search tool on the Meritain Health website, call the customer service number on the back of your insurance card or speak to your employer’s benefits administrator.

When you contact Meritain Health, ask about preauthorization requirements, network restrictions and estimated out-of-pocket costs. Treatment facilities may also assist with verification. You just have to provide your member ID, group number and other details about your insurance plan.

Quality addiction treatment can be expensive for families already dealing with the physical, emotional and financial strain of a substance use disorder. However, plans managed by Meritain Health cover a wide range of treatment options, easing this burden and providing critical access to care.

Your plan may cover these services:

• Detox: Meritain Health covers medically necessary detox, helping members safely withdraw from addictive substances while under medical supervision. However, coverage may depend on facility type, co-pays and deductibles. You must also meet Meritain Health’s medical necessity criteria.
• Inpatient or residential rehabilitation: Inpatient rehab is available with most Meritain Health plans, although prior authorization may be required. This type of treatment involves living full-time in a hospital or rehab facility, so it provides the highest level of structure and support. Inpatient programs typically offer medication management, several types of therapy and other services to help people recover from substance use disorders.
• Outpatient treatment: Meritain Health may cover several levels of outpatient addiction treatment, including intensive outpatient programs (IOP) and partial hospitalization programs (PHP). Participants live at home or in recovery housing, but they receive therapy and other services for several days each week. You usually have to obtain these services from in-network providers.
• Medication-assisted treatment (MAT): MAT combines FDA-approved medications with counseling to manage withdrawal symptoms and reduce relapse risk. Meritain Health usually covers this service, but your plan may require prior authorization for certain drugs or providers.
• Therapy and counseling: Individual and group therapy are essential for long-term recovery and relapse prevention. Meritain Health plans generally cover evidence-based treatments, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT) and motivational interviewing. Some plans allow members to receive these services via telehealth, increasing access for those who lack transportation or can’t get to a treatment center due to illness.
• Family therapy: Some people with substance use disorders lie, withdraw from social activities or engage in risky behavior. This takes a toll on loved ones, making family therapy an important part of recovery. Meritain Health may cover family therapy when it’s provided by a licensed professional at an in-network facility.
• Aftercare and relapse prevention: Recovery is a process that requires ongoing support. Meritain Health often covers ongoing therapy, relapse-prevention programs and other rehab aftercare services. Continuing care can be essential for maintaining long-term sobriety.

Meritain Health is the only TPA to combine plan administration, products and automation solutions with Aetna and CVS Health offerings. Thanks to Aetna’s extensive provider network, members have access to more than 1.6 million healthcare professionals throughout the United States. Due to the number of options available, treatment costs can vary significantly based on location, plan type and network status. 

State-Specific Variations in Meritain Health Coverage

Meritain Health works with employers nationwide, providing coverage in all 50 states. It operates as an independent subsidiary of Aetna, giving members access to exclusive products and services. However, there are some state-specific differences, as some states have stricter behavioral health coverage requirements than others.

The best way to confirm what’s available in your state is to contact member services. A representative can help you find in-network rehabs and understand coverage limitations specific to your location.

Plan Type and Level of Benefits

Meritain Health allows employers to build custom health insurance plans, making it easier to provide employees with targeted, cost-saving benefits. This means there can be significant differences in coverage from one plan to another.

Deductibles, co-pays and other out-of-pocket expenses vary based on the type of plan you have. Verifying your benefits before treatment can help you avoid any unnecessary confusion or stress.

In-Network Vs. Out-Of-Network Considerations

Some addiction treatment providers have agreed to accept discounted reimbursement rates for services covered by Meritain Health. They’re known as in-network providers. Getting care from doctors and rehabs in your network typically helps minimize your out-of-pocket costs.

Out-of-network providers haven’t agreed to accept discounted rates, so your Meritain Health-managed plan may not cover them. If your plan does cover out-of-network care, you may have to pay a higher percentage of the cost. You can verify network status by contacting rehabs directly.

Meritain Health offers partial out-of-network rehab coverage on some plans, but it’s usually more limited and comes with higher out-of-pocket costs. You may even be subject to balance billing, which means you have to pay the difference between the provider’s charge and the amount your plan allows.

Some plans don’t cover nonparticipating providers at all, with limited exceptions. For example, Aetna may approve out-of-network coverage if there aren’t any in-network facilities that can provide the care you need. These exceptions often require additional referrals, preauthorization and/or proof of medical necessity.

Choosing an in-network facility generally ensures you’ll have more coverage. Comparing costs before you begin rehab can help you minimize your out-of-pocket expenses and avoid treatment delays.

Meritain Health insurance is available to individuals whose employers have selected Meritain Health as their third-party administrator for group health benefits. This means that access to Meritain Health insurance is exclusively available through employer-sponsored plans.

When setting up health insurance, your employer may have chosen a health maintenance organization (HMO), preferred provider organization (PPO) or high-deductible plan. The type of plan you have determines how much coverage you have for substance abuse treatment.

Here’s how these plans work:

• HMO plans: HMOs are the most restrictive plans. You need to choose a primary care provider (PCP) and ask for referrals any time you need specialty care, including addiction-related services. HMOs also provide no coverage for out-of-network providers, except in medical emergencies.
• PPO plans: PPOs are the most flexible, as there’s no need to get referrals from your PCP. Many PPO plans also provide at least partial coverage for out-of-network services.
• High-deductible plans: As the name implies, high-deductible health plans (HDHPs) have higher deductibles than other types of health insurance. HDHPs have lower premiums, so employers typically choose them to save money.

Meritain Health makes coverage decisions based on medical necessity and plan rules, not specific substances, so your plan may cover treatment for:

• Alcohol use disorder
• Opioid addiction (heroin, prescription painkillers)
• Stimulant addiction rehab
• Benzodiazepines
• Marijuana addiction
• Prescription drug abuse

Many plans also cover treatment for co-occurring disorders. This is when you have a substance use disorder combined with another mental health condition. Treating both disorders at the same time reduces the risk of relapse, so your Meritain Health-managed plan may cover therapy, medications and other related services.

Many Meritain Health plans use the Aetna network, making it easy to find participating providers with experience helping people recover from addiction. In addition to verifying network status, you should ask each rehab about its accreditations, specialties and levels of care. A little research can help you find a treatment center that meets your unique needs.

Some people can recover while living at home, while others need 24/7 supervision and support. Before committing to a rehab, find out if it offers both inpatient and outpatient care.

Meritain Health members have several options for locating in-network facilities:

• Call the customer service number on the back of your insurance card: A representative can verify your coverage and provide a list of in-network rehab centers in your area.
• Use the provider finder tool on the Meritain Health website: Enter your location and use the filters to narrow your options.
• Call the rehab facility directly: If you have a specific facility in mind, speak with someone in the billing or insurance department to confirm your coverage and out-of-pocket costs.
• Use RehabNet’s helpline or online contact form: Our services are free, confidential and available 24/7.

Substance use disorder affects every aspect of your life, making it easy to feel like you’re fighting alone. The good news is that evidence-based care can help you build healthy habits and learn how to cope with stress without using drugs and alcohol. Seeking help as early as possible reduces the risk of complications and sets you up for a successful recovery.

If you’re ready to look for rehabs that accept Meritain Health insurance, RehabNet has free tools to help you find high-quality addiction treatment programs. Reach out today to explore your options and get started on your recovery journey.