AmWINS Insurance Coverage for Addiction Treatment

Amwins was founded in 2000 and is a specialty insurance distributor that helps employers provide insurance to their employees. They can help small and large employers as well as those who self fund their insurance coverage.

They often work with brokers who help employers design their insurance plans. However they can also work with employers directly. They focus on their product expertise and broad geographical coverage to help employers create an ideal insurance solution.

Amwins partners with more than 150 carriers in nine states and can help employers offer dental and vision coverage as well as life insurance. The states Amwins operates in are Arizona and California and Florida and Connecticut as well as Maryland and New Hampshire and New York. They also serve Rhode Island and Virginia.

Does Amwins Cover Drug and Alcohol Rehab?

Amwins helps employers connect with health care plans but they don’t determine what’s covered or at what level. Most plans will cover addiction treatment at some level but the details vary. You will need to talk to your employer to determine what benefits your insurance plan has and whether you need a referral or preauthorization for addiction treatment.

Insurance plans focus on covering medically necessary care so it’s important work closely with your doctor to create a treatment plan. That will allow you to focus on finding specific types of treatment and will help prove to the insurance company that care is necessary.

What Insurance Products Does Amwins Provide?

Amwins offers a variety of services and insurance solutions. In health insurance they offer group benefit services. This includes services for self funded employers and employers looking for an all-in-one solution.

For self funded employers Amwins has cost containment solutions and stop loss plans. They also have alternative risk solutions for employers who want to set up a captive insurer to cover employees. Finally, self funded employers can take advantage of Amwins’s pharmacy benefit management to offer employees prescription drug coverage.

For employers looking for fully insured solutions Amwins offers small to mid market insurance benefits. They work to be an extension of the employer’s team and can connect employers to more than 150 carriers in nine states. They also offer additional plans such as dental coverage and vision along with disability coverage and life insurance.

Employers can also get help with retiree medical insurance. Services offered by Amwins include fully insured and self funded plans and help with enrollment and billing. Amwin also has claims adjudication and retiree advocacy and meetings. They can connect companies to both medical and pharmacy plans and allow employers to offer retiree assistance programs as well.

What Inpatient Addiction Treatment Does Amwins Cover?

Health insurance generally covers medically necessary care and all employer plans have specific criteria and limits. Not all employer plans cover addiction treatment so check your specific plan coverage before you seek care.

The ASAM Criteria Level of Care Assessment helps determine what kind of substance use treatment you need from inpatient to general outpatient care. Residential treatment requires you to meet a few criteria since it’s for more severe addiction cases. Those criteria might include a diagnosis of substance use disorder over a certain period and personal support factors.

Your insurance may use Amwins to cover medical detox to help manage withdrawal symptoms as well as inpatient care afterward. These kinds of treatments provide more support than typical outpatient programs — they offer residential facilities and intensive therapy along with round the clock professional support.

What Outpatient Rehab Does Amwins Cover?

Your insurance plan may partner with Amwins to cover a variety of outpatient addiction treatments, including partial hospitalization programs (PHP) and intensive outpatient programs (IOP) as well as general outpatient care.

A PHP doesn’t require you to stay overnight at a facility but you still receive at least 25 hours of treatment per week. An IOP typically gives a minimum of 9 hours of treatment per week but may give you up to 15 hours. IOP treatment generally happens in three hour blocks so you can fit it around work or school obligations.

With general outpatient treatment you only have treatment for one or two hours per week. You may also have aftercare covered by your plan including therapy and 12 step programs along with sober living and more.

Before you choose a facility or commit to a certain level of care verify your insurance coverage to make sure it includes your chosen treatment. Employer plans vary in coverage and limits as well as other requirements.

Does Amwins Cover Methadone & Suboxone (MAT)?

If medication assisted treatment (MAT) is covered by your insurance plan it can be used for medical detox and ongoing opioid and alcohol use treatment. With the proper medical supervision MAT reduces withdrawal symptoms and supports you toward long term recovery.

The type of MAT you receive depends on individual factors such as the nature of your substance use. Most of the time you will receive either methadone or suboxone (which is a combination of buprenorphine and naloxone.) Both are long release opioids that cancel out the euphoria of illicit opioids and are considered safe ways to help treat addiction.

Does Amwins Cover Other Mental Healthcare?

While many employer plans cover mental healthcare not all of them do. Check your insurance coverage before you start mental health treatment to be sure your care is included in your policy.

You may have several options for mental healthcare with your plan including various types of therapy as well as inpatient and outpatient options and crisis support. Addiction often comes with co occurring mental health disorders. Mental health disorders can influence—and be influenced by—substance use and treating both at the same time offers the necessary support for long term recovery.

Does Addiction Treatment Need to Be In-Network?

Coverage with employer plans varies even more widely than a typical insurance plan. Some plans will cover out of network care and others will not. If yours does you’ll have a higher deductible and copay than you would with an in network provider. If possible choose an in network provider to get the most out of your insurance coverage.

If you have to use an out of network provider make sure to review your plan so that you can prepare for the potential costs.

What to Do if Amwins Won't Cover the Cost of Rehab

Self funded employer plans may have more limited addiction treatment coverage than traditional health insurance plans — or no treatment coverage at all. Fortunately there are other ways to get the care you need.

Some treatment centers have a sliding scale fee option based on your income. Others offer scholarships and payment plans to make care more accessible. You may also be able to borrow money or use your savings to cover treatment costs. Some free and low cost rehab centers like the Salvation Army let you work to cover treatment costs rather than pay money. State and county run rehabs are often very affordable as well.

How to Verify Coverage With Amwins

Because employer insurance plans are unique to each employer you should verify your coverage with your employer’s benefits manager or the appropriate contact person within the organization.

Some employers give you a customer service number for coverage verification so you can also call that to ask about your plan. These are the best ways to get accurate information about your coverage and ensure that the person you speak to understands your plan accurately.