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GHI Insurance Coverage for Drug and Alcohol Rehab

  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Modified:
  • Reading Time: 9 minutes
  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Last Update:
  • Reading Time: 9 minutes

Learn more about GHI drug & alcohol rehab coverage.

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GHI Insurance

Emblem Health insurance covers many addiction treatment services.

Rolling Hills Recovery Center accepts a variety of Emblem Health insurance coverage.

Paying for Treatment

Drug Rehab That Accepts GHI Insurance

One in twelve American adults (or 17.6 million people) suffers from alcohol addiction or dependence, and millions more engage in risky drinking habits. The Tri-State Area (consisting of the three states of New York, New Jersey, and Connecticut) is among the most hit regions by the nationwide drug and alcohol abuse epidemic. In New Jersey, nearly 90% of drug overdose deaths directly result from opioid abuse. 

Starting down the road to a healthier, drug-free life is well worth the effort. In the United States, drug treatment centers are doing all they can to help combat the drug epidemic. Most individuals, however, don’t go to treatment for financial reasons. One good news is that insurance companies may assist with rehabilitation costs.

If you have GHI insurance, your policy will likely pay for some or all your time in a drug rehabilitation program. More than three million people in the Tri-State area and beyond are covered by medical insurance plans issued by Group Health Incorporated (GHI), currently known as Emblem Health.

Table of Contents

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Levels of Care
Popular Topics
Families & Addiction

Understanding Insurance

What is GHI Insurance?

Group Health Incorporated (GHI) is one of the largest and most well-known companies in health insurance in the United States, even though it is not wholly a for-profit organization.

The company was founded in the 1930s to give health insurance to people who could otherwise go bankrupt owing to the excessive expenses of an unforeseen illness or accident.

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How Does Insurance Work

The GHI Tier System

To make it simpler to compare various plans, the Affordable Care Act (ACA) mandates that all health insurance policies (except catastrophic insurance policies) be placed into one of four tiers, sometimes referred to as “metal levels.”

  • Bronze

  • Silver

  • Gold

  • Platinum

The primary distinguishing feature between these coverage tiers is the fraction of your healthcare expenses that will be paid by the plan. The out-of-pocket costs and the premiums would differ based on the tier of coverage selected.

Bronze plans are the least expensive and are typically suggested for those who do not regularly need to visit a doctor due to their cheap monthly premiums and large deductibles. The costliest plans are the platinum ones.

Most areas of the country have access to Gold, Silver, and Bronze plans, while those with access to Platinum plans are limited.

In brief, the following describes the various insurance coverage levels:

Bronze

The average percentage of medical costs covered by a bronze plan is about 60%. The monthly costs for this type of coverage are modest, and the deductible is rather high.

Silver

Around 70% of medical costs are covered by this plan. The monthly premium for these plans is somehow high, but the deductibles are lower.

Gold

Members of the Gold Plan pay a greater monthly premium than those of the Bronze and Silver Plans, but their maximum out-of-pocket expenses are lower. Your medical costs will be covered to a degree of around 80%.

Platinum

As far as the alternatives go, this one is the priciest. The best aspect, however, is that it doesn’t break the bank while paying for practically all of your medical care. It offers the highest premiums per month, but the lowest deductible of any plan.

Did You Know Rolling Hills Recovery Center Accepts GHI Insurance?

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Understanding Your Financial Contributions

GHI Insurance Deductibles, Co-Payments, And Out of Pocket Expenses

In the case of paying for medical services using insurance, you may be required to pay a percentage of your expenses in advance. Therefore, you are responsible for a portion of the costs associated with receiving services that are covered by a plan. This is what is referred to as “out-of-pocket payments.”

Deductibles

Your health insurance won’t start paying medical bills until you’ve met your deductible. For instance, after you’ve satisfied your GHI plan’s annual deductible of $1,000, the plan may cover half the cost of psychotherapy. For this example, if you decide to undergo treatment for therapy sessions at $200 each, you will need to set aside $1,000.  Keep in mind that deductibles are often adjusted.

Copayments

A “copay” is an out-of-pocket expense that may be demanded of you when your claim is submitted. Payment is based on a predetermined proportion of the total price of the treatment or service.

Gold

Members of the Gold Plan pay a greater monthly premium than those of the Bronze and Silver Plans, but their maximum out-of-pocket expenses are lower. Your medical costs will be covered to a degree of around 80%.

Platinum

As far as the alternatives go, this one is the priciest. The best aspect, however, is that it doesn’t break the bank while paying for practically all of your medical care. It offers the highest premiums per month, but the lowest deductible of any plan.

How Much Is The Typical GHI Deductible?

After meeting a deductible of either $200 for a single person or $500 for families, GHI reimburses $65 for each therapy session. Therefore, if your addiction therapist’s reduced cost is $100 per visit, you would be liable to pay $35 per therapy session after meeting your deductible threshold.

Individual health insurance plans cost $200 per year, with GHI picking up the tab after the first year. The total of all family members’ payments toward the family’s GHI plan must be at least $500. So, whether one person in the family or many people in the same family pay for services totaling $500, GHI will begin reimbursing them at a rate of $65 per medical visit.

What To Know About Your GHI Insurance

Our Admissions Experts Will Help You Navigate This Difficult Information.
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Co-Insurance

Typically, co-insurance percentage range from 20% to 40%, and the insurance company clears the rest.

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Deductibles

The amount you pay out-of-pocket for treatment before the health plan starts helping with payments.

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Copayment

Co-pay is a fixed amount you must clear (usually when you receive treatment) for covered treatment services.

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Most Major Insurance Will Help Cover the Cost of Treatment
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Choosing To Use A Network Vs. Going Off-Network

Staying in-network has its drawbacks since it restricts your choice of medical professionals, and some of them may not accept GHI. However, if you are lucky enough to get a facility affiliated with GHI, you will get the service at a subsidized rate. However, you can choose to get treatment at an out-of-network facility. While utilizing out-of-network plans will likely result in a higher cost, it will also give you more freedom to choose a therapist with whom you choose.

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Understanding My Options

Coverage Under the GHI Insurance Program

If you have GHI insurance, you may be eligible for various addiction treatment options, but this may vary according to your specific situation and the severity of your addiction. To qualify for coverage, your dependence must be evaluated by a medical professional. Depending on your GHI coverage, you may be able to get the following types of addiction treatment:

Detoxification

During detoxification, the body adapts to functioning normally again after being deprived of an addictive drug or alcohol. Withdrawal symptoms will begin to set in during detox. 

The severity and duration of withdrawal symptoms depend on several variables, including:

  • Substance abused.

  • The length of time it was used.

  • Existence of other physical conditions.

  • The regularity of the dosage.

  • Existence of other opportunistic mental disorders like depression and anxiety.

The severity, distress, and even lethality of specific withdrawal symptoms are well-documented, making professional medical care an absolute necessity.

Inpatient Treatment

With GHI coverage, you may get intensive care for up to a year at an inpatient or residential facility if needed. To put it another way, for resident patients, their GHI insurance will cover their medical bills no matter how long it takes them to get well and return to work (within a year). This is a terrific perk since it facilitates participation in long-term treatment programs, which have been linked to improved chances of sustained abstinence and recovery.​

Outpatient

Outpatient care is a kind of treatment in which patients get therapy during the day but are free to return home in the evenings. After completing a residential recovery program, you can continue your rehabilitation at a sober living facility or home ( if you have a supportive family). Your GHI plan can pay for any treatment and counseling you get as a part of an outpatient program.

Medication-Assisted Therapy

FDA-approved alcohol and drug addiction treatment medications, behavioral therapies, and group and individual counseling are a few components of the MAT treatment approach. The meds help by lowering substance tolerance, easing withdrawal, and suppressing cravings. Three medicines are prescribed more often than others: naltrexone, methadone, and buprenorphine.

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Maximize the Benefits of Your GHI Policy

There is no need to worry about paying for your drug or alcohol rehab out of pocket if you have GHI insurance coverage. Your GHI insurance plan will cover at least some of the costs associated with your drug or alcohol treatment. Check with the support staff at your rehabilitation facility or GHI to verify whether the service you are looking for is among those that are covered.

Contact the well-respected Rolling Hills Recovery Center as soon as possible to learn about your options for becoming sober. We have relationships with most of the most renowned insurance companies in the United States. When you work with us, you can be confident that we will direct your attention to the one thing that truly matters: achieving a recovery that is not just long-term but also all-encompassing.

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Written By:

Geoffrey Andaria

Geoffrey Andaria mental health writer at rolling hills recovery center
Rolling Hills Recovery Center

Mental Health Writer

About Author:

Geoffrey Andaria is an experienced mental health content writer and editor. With a B.A. in English and Journalism, Geoffrey is highly educated in freelance articles and research. Having taken courses on social work, Geoffrey is adamant about providing valuable and educational information to individuals affected by mental health and the disease of addiction.

Medically Reviewed By:

Dr. Carl Williams Ph.D., LCADC

Carl Williams, medical content reviewer at rolling hills recovery center
Rolling Hills Recovery Center

Expert Contributor

About Reviewer:

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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