Fidelis Care Coverage for Substance Abuse & Rehab

Fidelis Care is a subsidiary of Centene Corporation and they offer a wide range of health insurance plans in New York. They have individual and family plans in partnership with Ambetter through the state’s Insurance Marketplace and offer Medicaid options. They also have Medicare Advantage plans in partnership with Wellcare.

There are 20 community offices throughout the state so that members who have questions can come in and get in person help. There are also regional offices in Buffalo, Albany, Syracuse, New York City, and Rochester.

The company also has a mascot, Fidelisaurus, which they use to promote child and family healthcare. It’s used to make healthcare and health coverage less intimidating to children and their families and to connect health to having fun and being active.

Does Fidelis Care Cover Addiction Treatment?

Fidelis Care plans include all the essential benefits required by the Affordable Care Act. This means that Fidelis Care plans cover addiction and mental health treatment at some level.

However, every plan has different limits and requirements for coverage. It’s essential to check the specifics of your plan before deciding on a treatment center. You may need a referral and/or preauthorization for certain types of treatment.

All insurance plans focus on medically necessary care so it’s important to work with your doctor to get a treatment plan. The treatment plan will help direct you in what type of care to look for and will show what’s medically necessary in your case.

What Insurance Plans Does Fidelis Care Offer?

Fidelis offers a wide range of plans that span across individual and family plans as well as Medicare and Medicaid.

Individual and family plans are offered in partnership with Ambetter and can be purchased on the Insurance Marketplace in New York. These plans will be separated by “medal level”, designated as Bronze, Silver, and Gold. Bronze plans cost less per month but only cover an average of 60% of the cost of care. Gold plans have more expensive premiums but cover 80% of the cost of care. Silver plans are in the middle, balancing the premium and out of pocket costs.

Fidelis Care also has multiple Medicaid plan options. Those who qualify can get regular Medicaid coverage but also have access to Fidelis’s HealthierLife Plan. HealthierLife is a Medicaid plan that supports those with specific behavioral health needs such as addiction or mental health diagnoses.

The company also offers Child Health Plus for children of families that earn too much to qualify for Medicaid. If you qualify for both Medicaid and Medicare you can also look at the Dual Advantage plan from Fidelis Care. Finally, those who need long term care to live independently at home can get Fidelis Care at Home as Managed Long Term Care coverage.

For those who qualify for Medicare Fidelis Care offers a Medicare Advantageplan. An Advantage plan replaces Orginal Medicare and often gives you additional benefits that Original Medicare doesn’t such as vision and dental care. However you also need to use the provider network of the Advantage plan rather than using any Medicare provider in the country.

What Inpatient Addiction Treatment Does Fidelis Care Cover?

Fidelis Care insurance focuses on medically necessary care so the first step in treatment is to get a treatment plan from your doctor. You can then confirm your insurance coverage and your specific plan details.

Inpatient addiction treatment is typically recommended if you have a more severe case of addiction. Sometimes residential treatment is also recommended if you do not have a stable living environment. Your doctor will do an assessment to decide if this type of care is appropriate for your needs. You may also preauthorization from your insurance plan before you begin.

During inpatient or residential treatment you stay at the treatment center to complete the treatment plan. Depending on what substances you use you may need medical detox before the main treatment phase.

Treatment involves group and individual therapy as well as holistic treatment and recreation. The average length of stay is usually around 30 days but can be as long as 90 days or more.

What Outpatient Rehab Does Fidelis Care Cover?

Outpatient care is less intensive than residential treatment but you’ll still want to check with your insurance company to confirm coverage and get preauthorization if needed.

There are multiple types of outpatient care including partial hospitalization programs (PHPs) and intensive outpatient (IOPs) as well as general outpatient care. A PHP is a full day program in many cases and delivers similar services as inpatient or residential rehab except you are home at night. An IOP is more flexible and generally has three hour sessions a few days per week. You can often choose to have morning or evening sessions to make it easier to manage work and school schedules.

Finally general outpatient care only meets one or two hours a week. Sometimes a period of aftercare is recommended following the completion of a rehab period. Aftercare helps support your new habits and can also connect you to social services that you need to stay stable.

Does Fidelis Care Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) often includes the use of drugs like methadone and suboxone which are FDA approved to treat opioid use disorders. There are also medications that can help with alcohol use.

These medications can be used during the initial detox period that may precede a residential stay for addiction treatment. They can also be used as a long term treatment to help patients stay stable and avoid relapse.

Methadone and suboxone are long acting opioid agonists which means they influence the same receptors as opioids but they don’t deliver a high. Naltrexone and Vivitrol can help control alcohol use disorder during treatment.

Does Fidelis Care Cover Other Mental Healthcare?

As mentioned earlier Fidelis Care plans provide at least some treatment for mental health conditions but it’s important to check your plan details to find out any limits or requirements.

Some treatment possibilities for mental health conditions include crisis support and behavioral therapy. These can help you if you struggle with depression or anxiety. Personality disorders and PTSD and other mental health diagnoses can also be treated.

Co occurring mental health disorders are common with addiction and it’s important to treat both the mental health condition and addiction at the same time to facilitate a long term recovery.

If you have a co occurring disorder — which is also known as a dual diagnosis — your treatment plan will take that into account and you will need to look for integrated mental health and addiction treatment. Fortunately many treatment centers specialize in this kind of care.

How Long Will Fidelis Care Cover Rehab?

Your Fidelis Care insurance plan may have limitations or requirements that affect the length of rehab. In most cases though your length of rehab is based on your medical needs.

Your doctor and the treatment center determine how long you need to be in a rehab program. A PHP or residential treatment can last between 30 and 90 days. Intensive outpatient programs (IOP) typically last between six weeks and three months. General outpatient programs are longer because they help you maintain your new habits and provide ongoing support.

Can I Travel Out of State For Treatment With Fidelis Care?

Whether you can travel out of state depends on your exact insurance plan with Fidelis Care.

If you have Medicaid you’ll be limited to the state you live in. Most other insurance plans require you to stay within a specific provider network unless you need emergency care.

Some Fidelis Care plans do include coverage for treatment outside the network but you’ll end up paying a lot more in deductible and copayment costs. Generally staying in your designated medical network ensures the most coverage and the lowest costs and your network will focus on your local area.

How to Verify Coverage With Fidelis Care

If you need to verify your coverage with Fidelis Care the best way to do so is to contact customer service by phone or by logging into your member account online.

Sometimes, you may have the opportunity to ask your treatment center if they accept your insurance plan. You can verify your coverage this way if you use the exact plan name under Fidelis Care. Not all plans offer the same coverage so even if your treatment center accepts Fidelis Care your plan may not have the coverage you need.