By We Level Up | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: March 13, 2023

Emblem insurance may help pay for medical care, mental health care, and substance use treatment. Benefits may include medication-assisted treatment, intervention services, family programs, and outpatient therapy. Your benefits can vary by plan, which may also affect the providers you can use and how much you may pay.

EmblemHealth offers different health plans and provider networks. Some plans may have in-network and out-of-network benefits. Others may have stricter network rules. Your member ID card and plan documents can show which network applies to you.

You can check your benefits online or call the member services number on your EmblemHealth ID card. Ask about the care you need, your network, costs, and any approval rules. We Level Up can also review the insurance details you provide and discuss treatment options. Call (844) 597-1011 to speak with our team about your plan and possible care options. An insurance check does not promise payment or coverage.

Emblem Health Drug Rehab & Emblem Health Mental Health Coverage Free Quick Check

Emblem Health Insurance Plans

Emblem health insurance plans can have different rules for care, providers, referrals, and costs. EmblemHealth offers several types of plans, including HMO, PPO, EPO, POS, Essential Plan, and Medicare plans.

EmblemHealth HMO Plans

An HMO plan often uses a set group of doctors, hospitals, and other providers. Some EmblemHealth HMO plans do not include out-of-network benefits. Some may also have referral rules.

EmblemHealth PPO Plans

A PPO plan can give you more provider choices. Some EmblemHealth PPO plans include out-of-network coverage. Out-of-network care may still cost more than in-network care.

EmblemHealth EPO Plans

An EPO plan may use a set network of providers. Current EmblemHealth plan information shows some EPO plans include out-of-network coverage, but the rules can vary by plan.

Your plan documents show the rules that apply to you. Check your plan before choosing a treatment provider.

What Does Emblem Health Insurance Cover?

Emblem health insurance coverage can include medical, mental health, and substance use services. The services available to you depend on your plan and benefits. EmblemHealth lists mental health and substance use care among its behavioral health services. Covered care can include different types of mental health and substance use support.

Your plan may also have rules for network providers, referrals, precertification, treatment limits, and your share of the cost. Review your benefits to learn what applies to you.

Emblem Insurance Coverage for Addiction Treatment

Emblem plans may help pay for drug and alcohol treatment. The type of care you need can depend on your health, safety, substance use, and need for support.

• Medical Detox: We provide medical support for people who need help while stopping drugs or alcohol.
• Inpatient Treatment: Our inpatient program gives you a safe place to stay while receiving care day and night.
• Residential Treatment: We offer a structured setting where you can live on-site while working on recovery.
• Partial Hospitalization Program (PHP): Our PHP provides several hours of care during the day without an overnight stay.
• Intensive Outpatient Program (IOP): This program gives you regular treatment while you live at home or in another safe setting.
• Mental Health Treatment: We provide support for mental health needs that may occur with or without substance use.

EmblemHealth plans may cover some of these services. Your plan decides which services are covered and what costs may apply.

Emblem Insurance and Behavioral Health Care

EmblemHealth offers behavioral health support for people who need mental health or substance use care. Its current provider information says applicable members can access behavioral health services through Carelon Behavioral Health’s contracted providers.

Care may include mental health treatment, substance use care, therapy, and other behavioral health services. The care available to you depends on your plan and benefits. Some EmblemHealth plans may also include care for people with both mental health and substance use needs. This is often called co-occurring or dual diagnosis care.

Emblem Health Network Providers

Emblem Health network providers are doctors, hospitals, treatment centers, and other health providers that work with a specific EmblemHealth network. Your network can affect where you receive care and how much you pay.

EmblemHealth has several networks for different plans. Its current plan information shows networks such as Prime, Select Care, CBP, National, Tristate, and Bridge. The network linked to your plan can depend on your coverage.

Does EmblemHealth Require Precertification?

Some EmblemHealth plans may require precertification before certain services begin. Precertification means the plan reviews the requested care before it starts. EmblemHealth’s current provider information shows that some procedures and services may need preauthorization. The exact rules depend on the plan and service.

Call the member services number on your EmblemHealth ID card to ask if your planned treatment needs approval. You can also ask about network rules and other steps you may need to follow. Precertification does not guarantee payment. Your plan benefits, limits, exclusions, and cost rules still apply.

What Can Affect Emblem Health Insurance Cost?

Your Emblem health insurance cost can depend on your plan and the care you receive. Different services may have different costs.

• Deductible: The amount you may pay before your plan starts to pay for covered care.
• Copay: A set amount you may pay for a covered service.
• Coinsurance: The part of a covered cost you pay after your deductible.
• Out-of-pocket maximum: The most you pay for covered care during your plan year, based on your plan rules.
• Network status: In-network care may cost less than out-of-network care.
• Type of care: Different types of treatment may have different costs.
• Length of care: More days of care may lead to higher costs.
• Plan rules: Your plan may have limits or approval rules for certain services.

For example, a member with an EmblemHealth PPO may pay a different amount for medical detox than for outpatient therapy. The cost may also change when the provider is outside the plan’s network.

Emblem Insurance Coverage at We Level Up

We Level Up Treatment Centers offers addiction and mental health care at locations in several states. Services can vary by location and may include detox, inpatient care, residential treatment, PHP, IOP, and mental health care.

Locations With Detox

Medical detox is available at:

• California
• Washington
• New Jersey
• Lake Worth, Florida
• Texas

Locations With Inpatient Care

Inpatient care is available at:

• California
• New Jersey
• Lake Worth, Florida
• Texas
• Washington

Locations With Residential Care

Residential care is available at:

• California
• New Jersey
• Lake Worth, Florida
• Texas
• Washington, for residential mental health care
• Palm Beach, Florida, for mental health residential care
• Tamarac, Florida, for mental health residential care

Location With PHP

Mental health PHP is available at:

• Lawrenceville, New Jersey

Locations With IOP

IOP is available at:

• Lake Worth, Florida, for substance use
• Pompano Beach, Florida, for substance use
• Texas, for substance use and mental health

EmblemHealth coverage and network status can vary by plan and facility. Contact We Level Up to review the insurance information you provide and discuss available care.

How to Check Your EmblemHealth Benefits

Checking your benefits can help you understand your treatment choices and possible costs.

1. Find Your EmblemHealth ID Card

Your EmblemHealth ID card has important member details. It can also show the plan or network linked to your coverage.

2. Ask About Your Coverage

Ask if your plan covers the care you need. You can also ask about your deductible, copay, coinsurance, network, and approval rules.

3. Check Your Member Account

Your online member account may help you review your plan details and find providers. EmblemHealth also has tools that can help confirm network information.

4. Verify Your Insurance With We Level Up

You can verify your insurance with We Level Up. Our team can review the insurance information you provide and discuss treatment options that may fit your needs.

Insurance verification does not guarantee payment or coverage. Your EmblemHealth plan decides which benefits apply to your care.

Emblem Insurance and Co-Occurring Care

Some people have both a mental health concern and a substance use problem. These are called co-occurring disorders. Care can address both needs as part of one treatment plan.

EmblemHealth provides behavioral health services for mental health and substance use needs. Applicable members may access these services through Carelon Behavioral Health and its provider network.

We Level Up provides dual diagnosis treatment at select locations. Care may include therapy, mental health support, substance use care, recovery skills, and other services based on each person’s needs.

Is Emblem Health a Good Insurance?

This can depend on what you need from your health plan. A plan may be a good fit when its network, benefits, and costs meet your needs.

EmblemHealth offers several types of plans and networks. Some plans include out-of-network benefits, while others have tighter network rules. Your plan can also affect referrals, provider choices, and costs.

If you need mental health or substance use care, check your plan’s behavioral health benefits and provider network. This can help you see if the plan works for the care you need.

Why Check Your Emblem Insurance Benefits?

Checking your benefits can help you understand your treatment choices before care begins. It can also help you learn about possible costs and network rules. You can ask if your care is covered, whether the provider is in-network, and if approval is needed. You can also ask about deductibles, copays, coinsurance, and out-of-network benefits.

Because EmblemHealth plans can have different rules, use the benefits for your specific plan when making treatment choices.

Frequently Asked Questions

Explore Your EmblemHealth Insurance Coverage 

Emblem insurance may help pay for drug, alcohol, and mental health care. Your plan may include benefits for medical detox, inpatient care, residential treatment, PHP, IOP, therapy, and other services.

Your benefits and costs can vary based on your plan, provider, network, and type of care. Your plan may also have rules for deductibles, copays, coinsurance, referrals, and approval.

If you have EmblemHealth insurance, call We Level Up at (844) 597-1011. Our team can review the insurance details you provide and discuss available care options. Insurance checks do not promise payment or coverage. Your EmblemHealth plan makes the final decision on your benefits.

Emblem Health Mental Health Video

To help you take the initial step toward recovery, our team of admissions coordinators is here to help. They are also accessible to address any queries or worries you may have. We are aware that starting something new can be challenging, especially when struggling with addiction. Our team is familiar with your situation firsthand. We want you to know that you are not alone on this path and that we are here to help.

Sources

Florida Department of Health. Public health information and resources. https://www.floridahealth.gov

National Institute of Mental Health. Mental health information and conditions. https://www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration. Mental health and substance use resources. https://www.samhsa.gov

The Joint Commission. Behavioral health care accreditation. https://www.jointcommission.org

Centers for Disease Control and Prevention. Mental health resources. https://www.cdc.gov

HealthFinder.gov. Mental health and wellness information. https://health.gov/myhealthfinder

EmblemHealth. Mental health and behavioral health member resources. https://www.emblemhealth.com

National Institutes of Health. Mental health information and research. https://www.nih.gov

MedlinePlus. Mental health information and resources. https://medlineplus.gov/mentalhealth.html

National Alliance on Mental Illness. Mental health information and support resources. https://www.nami.org

National Library of Medicine. Mental health and medical information. https://www.nlm.nih.gov

U.S. Department of Health & Human Services. Mental health resources. https://www.hhs.gov

SAMHSA National Helpline. Mental health and substance use treatment resources. https://www.samhsa.gov/find-help/national-helpline

Commission on Accreditation of Rehabilitation Facilities (CARF). Behavioral health accreditation and quality standards. https://www.carf.org