Mercy Care Insurance Coverage for Addiction Treatment
Explore MercyCare’s addiction rehab coverage in Illinois and Wisconsin. Verify your benefits today to get the care you need.
Mercy Care Insurance Coverage for Addiction Treatment
Explore MercyCare’s addiction rehab coverage in Illinois and Wisconsin. Verify your benefits today to get the care you need.
MercyCare was founded in 1994 and offers health plans in Northern Illinois and Southern Wisconsin. The insurance plans use the Mercyhealth hospital system as their network allowing members to access seven hospitals and over 85 specialty facilities.
The company offers individual and family plans on the state Marketplaces as well as employer plans and Medicare supplement plans. They are committed to high quality affordable medical care.
Does MercyCare Cover Addiction Rehab?
Most MercyCare plans will cover addiction rehab, including all plans sold in the state Insurance Marketplaces. In 2010 the Affordable Care Act (ACA) was passed and one component of the law states that mental healthcare and substance use disorder treatment is considered essential medical care. However there are exceptions to the law so it is important to get your full plan details and understand your coverage and requirements.
In most cases a determination of medical necessity is required for insurance to cover the treatment. Your primary care provider can work with you to determine the appropriate level of care needed for your alcohol or substance use disorder.
One way this can be accomplished is by completing the ASAM — the American Society of Addiction Medicine assessment. This tool looks at factors such as your needs along with assets and strengths. It also considers obstacles and liabilities as well as resource structures to help determine the appropriate level of care for you and to create a personalized treatment plan. This treatment plan shows what’s medically necessary in your specific case and can help you look for the right treatment center right away.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionMental Health And Substance AbuseSubstance AbuseMental Health+1
Adult ProgramYoung Adult ProgramLGBTQ ProgramMilitary ProgramProgram For Women
Private InsuranceSelf-Pay Options
I had an amazing opportunity here!! From the food, staff, exercising, massages, pool. I can’t recommend this enough to anyone wanting to start a new life. Thank you everyone for letting me be apart of your journey as well! I appreciate the love and support so much!
Rachel Sheets
4 weeks ago
The most wonderful place you could ever imagine, if I could put 10 stars I …
Truly genuine people that care, and are ALWAYS there for you… upon arriving there, I was told by a beautiful staff member, “I promise you you’re not gonna wanna leave”, completely doubting that statement with full confidence, I was humbled when the day came to leave and she was right…. You never want to leave! So incredibly grateful for this place and everything it has done for me! They are angels 😇 🙏
Val
1 month ago
Synergy House is an amazing treatment center. The staff is very caring and the food and amenities are excellent. This is a great place to get started. A beautiful home atmosphere and acres of ground in the country. The classes were tailored to what I needed in life for successful sobriety.
Overall, for about 6 years, I have been satisfied.
Edwin Schmidt
3 weeks ago
I've been with vale del sol for many years and my doctor Jones is very good she's understanding my needs hears me what I'm going threw I really like vale del sol the only thing is that I don't have a navigator to help me when I need help
Rosemary Manriquez
4 weeks ago
Dr butler is the nicest lady. I enjoy talking with her. The staff is always nice, they call you back unlike some places. All around good experience
The ARC is amazing, the staff is great! Big thank you to the bhts Delilah & Angie you helped me so much! Michael, Asia, Nicole, Jasmine thank you! My therapist Jonathan was great! My first week I was gonna leave everyday but they talked me through my anxiety! I am so grateful I chose this place, the food was great! And a big thank you to Chris! Anyone who is is struggling I highly recommend The Arc! And to Luciana my birthday twin i hope you had a great birthday 🎂
Heather Smith
3 weeks ago
I loved this place! Very good therapy and wonderful staffs. I got my substance abuse certificate here and gained custody of my kids back after I completed this program.
Maine G
1 month ago
This place is wonderful the staff is great and they really care and I feel like after the 30 residential program like my thinking is changed allot they have a wonderful program and if your not serious about recovery they call you on your b.s. I'm not in I.O.P. and it's great classes mon-saturday and the residential and iop are wonderful places to live while recovering and working on you
Great staff, great environment, very well structured.
Sean Barton
2 weeks ago
It's really one of the best places out of my maybe 30 to 25 years that I have had an addiction I love rosecrance and one of their alumni's and I do my best to advocate that treatment real treatment works if applied it's just like the book says those who are constitutionally incapable of following simple directions once understood comprehended and process
Duke Clarence (Sincere at heart)
1 month ago
Very good staff understanding and works with patients well
I can’t say enough great things about this program. If you are someone dealing with addiction or mental health or a combination of both you are going to learn so much from everyone at Cornerstone. I just finished my IOP today and it has literally changed my life! From Judy , my wellness coach , to Niki , the most amazing therapist and person I’ve ever met this program will change your life forever! THANK YOU CORNERSTONE!! 1000 stars ⭐️
Craig Horvath
Vanessa and Craig
3 weeks ago
This was truly the best decision I’ve ever made. The whole group of therapists, wellness coaches really do care about your healing and well-being. I highly recommend Cornerstone if you’re looking to free yourself from any demons or addictions.
Joanne Kousnetz
3 weeks ago
As someone who has had a fair amount of rehabs under my belt. I can honestly say this is by far the best. A very structured program, that institutes all of the fellowships into your daily life. The navigators (bht) went out of there way for me and were an inticle part of my recovery. I'm now over 6 months sober. The longest I've been clean in 29 years.
Thanks cornerstone for giving me a second chance at life.
I’m in Cindy Fishers IOP and it is by far the best IOP that I have been in. It has helped me so much! I find myself using everything I learn in her class. She is a great counselor and a great example!
Jennifer Rabideau
4 months ago
This is great class! I enjoy the conversations we have, and enjoy Laura’s feedback . Also learn something new at every meeting. Rosecrance is a wonderful place for sharing our experiences.🙂
I have been coming here for over 15 years and would tell anyone struggling with opioid addiction that there is a place where you can find help and never have to suffer from debilitating pains in agony because your body is going thru withdraw and you will never have to suffer in silence trying to hide from your addiction that is always going to catch up with you so if your ready to free yourself from burden of having to chase pills and always wandering if you'll have enough to make it thru another day just hoping you can find someone who has some thing to stop those withdraws this is the place for you to find what your looking for. Methadone treatment saved my life and don't listen to what anyone tells you or what you may have heard about methadone treatment just make the call and come talk to one of the counselors to get the facts and then give it a chance because they don't expect anyone to be cured overnight but they can offer the support and start you on medication and give you more the next day and keep sticking to that plan to show up everyday youll keep getting a little bit more everyday by the end of your first week you will start to feel so much better by end of week 2 you'll be able to get a good night's rest 3rd week you won't worry because the withdraws will subside by week 4 you'll still be raising your dose but withdraws will be gone but you may still have cravings or you may not need to raise your dose any higher but whatever the case they will give you everything you need to get you drug free until you have no more cravings and you will soon wander why you waited so long to start treatment. Whatever excuses you have not to start or keep going back they can help with getting rides , filling application for access if you need help paying or can't pay they have lots of programs that might qualify you for help to get started on treatment so give them a call , you won't regret it and privacy for patience is a top priority so if your worried someone might find out like an employer or family member they do not and will not ever acknowledge if someone is or is not a patient so they can protect every person who walks thru their doors from having to worry about the choice to come there and consequences of someone finding out they make every patient sign a non disclosure agreement so if someone you know happens to show up one Day they are banned from exposing any person or patient or even talking about seeing someone while they are there for treatment so it's very discreet and you need to take a chance make the call and get your life back on track because your never to old to learn something new like how to live your life sober and happy so they will give you the tools you will need to succeed and I hope if I can convince just one person to try then these words will have been worth all it took to get them somewhere to let someone find them and if I save just one person that's enough for me and I hope to see you there one day
Forever Lisa99
2 months ago
This place doesn’t make you feel worthless because of the reason you are here. They extend more than just help with drugs. They’re sincere and human and my counselor Marne is amazing and a wonderful woman. She has definitely been in my life and has made such a huge difference in my recovery from prescription pain meds to now Suboxone. This is going to be my sixth year in recovery. Highly recommend this place.
Debbie Leigh
4 months ago
The staff was very helpful and understanding. I recommend this place to anyone struggling w sobriety of opiates.
I have been coming to ITS in mesa for almost 2 years and this place has been so important to my sobriety! Every single staff member there has gone ABOVE and beyond to make sure I get the services that I need. When I was having issues with my insurance and thought I couldn't continue treatment, Kanoi reached out and made sure to figure out a way so that I could stay. Tammy is amazing as well, so helpful, kind and keeps this office running smooth and so much more. Monica is so sweet, and genuinely cares about all of the patients that come here..the doctors are all so great and the peer support/counseling staff is so relatable and easy to talk to (especially Celeste, love her!) Not one person here has ever made me feel bad about being in recovery, so uplifting and encouraging I would 10/10 recommend anybody struggling with addiction go here to start their recovery journey!
Kaci Moran
4 months ago
I have been to one other clinic but by far ITS is so much better. Kanoe the peer support is so extremely helpful, she is so friendly and always reaching out to see if there is anything I need. My daughter is with me each time and I was always nervous she would be exposed to things if I brought her with to the clinic but she LOVES tagging along. Everyone works so hard to make sure you're feeling supported. I found sobriety again because of ITS. Thank you to all of the staff, especially Kanoe, Celeste and Monica for making this experience so positive.
Gabriella Urrea
5 months ago
Celeste and Nikki were amazing very empathetic and understanding loved them both 🫶🏼
TLC Treatment Center in Mesa helped me get my life back on track. I came in feeling lost and honestly didn’t expect much, but the structure, support, and community completely changed that.
The staff doesn’t sugarcoat things they’re honest, and they push you to do the work, but they also care. You’re not just another number here. They helped me with job search, recovery goals, and even housing support while I was in outpatient treatment.
It’s not about luxury, it’s about real recovery. If you’re looking for a treatment program in Mesa that actually works and holds people accountable, I’d recommend TLC 100%.
Cooper Jones
2 months ago
I’ve seen a lot of treatment centers come and go, but TLC in Mesa really stands out. The program is structured and holds you accountable, but there’s also genuine care behind the rules. The staff meets you where you’re at, and it’s clear they want to see people succeed.
They helped me not just with recovery, but with job readiness and life skills too. Housing was included while I was in outpatient, and that stability made a huge difference. If you’re serious about turning things around, this place can give you a real shot.
It’s not fancy or flashy, but it works and that’s what matters. I’d recommend TLC to anyone in Mesa or nearby who’s looking for solid support and real results in their recovery journey.
Qi Qian
2 months ago
I learned a lot going to TLC. I have heard many stories about others and how they don’t work but this one works! The staff are absolutely amazing and help anyone and everyone in anyway possible. It’s a 4 month treatment center but in that 4 months they teach you so much and they help you get back on your feet. You go out and look for jobs so that when your time is done there you should have a job and some money saved up and not just thrown back out in the streets! This place was a god send!
The combination of filters you have selected has no results. Please refine your selections and try again.
Frequently Asked Questions
What Are MercyCare Plans?
MercyCare offers multiple plans. You can get individual and family plans on the Illinois or Wisconsin insurance Marketplace. These plans are generally health maintenance organizations (HMOs) which require you to have a primary care provider (PCP) to coordinate your care. Your PCP will give you referrals to specialists such as addiction treatment or mental health professionals. They can also help you get preauthorization when needed.
MercyCare also helps employers offer health insurance to their employees. They have options for large and small employers. Many of these plans will have coverage for addiction treatment but you’ll want to make sure you check the details of your plan.
Finally for those who have Original Medicare and want help with their out of pocket expenses MercyCare offers Medicare Supplement plans. These plans are also known as Medigap.
What Inpatient Addiction Treatment Does MercyCare Cover?
Determination of medical necessity is often a requirement for any addiction treatment and especially for inpatient rehab. Inpatient or residential care is the most intensive and expensive type of rehab but it can allow you to lay a solid foundation for recovery if it’s part of your treatment plan.
Medical detox is one type of inpatient treatment that may be a covered service. For individuals who need close medical supervision and medical stabilization this is often the first step in recovery. This is especially true in individuals who have severe addictions to substances that can have dangerous withdrawal symptoms. Medical detox provides 24/7 medical supervision and may treat withdrawal symptoms with medication assisted treatment (MAT).
Inpatient or residential care occurs in hospital settings or addiction treatment facilities. For some this is a continuation of inpatient medical detox and for others this is the first step toward recovery. During inpatient treatment individuals have 24/7 care by medical professionals and addiction specialists. Individual and group therapy is a major focus during inpatient or residential care and uses a range of approaches including cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). Some centers also use motivational interviewing and eye movement desensitization reprocessing (EMDR) along with holistic treatments such as yoga and meditation. Residential treatment also includes exercise and recreational therapy as well as nutritional counseling.
Inpatient or residential programs typically range from 30 to 90 days with research finding the most success with the 90 day programs. It is always important to remember that each individual is on a unique recovery journey and your primary care providers and addictions team will work with you to determine the best program for your needs.
What Outpatient Rehab Does MercyCare Cover?
Depending on medical necessity and your plan details your MercyCare plan may cover outpatient rehab. Because plans differ greatly it is important to check with your insurance provider before starting any treatment programs to determine coverage and if there is a need for prior authorizations or referrals. You’ll also want to find out what providers are in the network.
There are various levels of outpatient rehab. The most intense outpatient treatment are partial hospitalization programs (PHPs). These programs allow individuals to return home each night but still require a full day commitment in most cases. Most of these programs require at least 20 hours of treatment per week. During treatment you get individual and group therapy which may include a wide range of approaches. These programs normally last for 90 days but that may differ from person to person.
Intensive Outpatient Programs (IOP) are more flexible because you’re only attending treatment for three to four hours each time. This allows you to work around family and work or school commitments. Relapse prevention and building healthy coping skills are the main objectives in this type of programming. Through individual and group therapy utilizing evidence based practices such as CBT and alternative therapies such as art and music therapy you’ll learn new habits and practice new mindsets to help you achieve and maintain recovery.
MAT is also an option for many individuals in these types of programs. Medication assisted treatment uses FDA approved medications to ease withdrawal symptoms and normalize brain chemistry while also decreasing cravings. When used over a longer timeframe MAT allows you to stay stable in treatment and avoid relapse until you can establish long term sobriety.
Does MercyCare Cover Methadone & Suboxone (MAT)?
Many MercyCare plans will cover MAT if it’s appropriate for your needs. Each insurance plan is different so it is important to verify what your coverage looks like and if you need a referral or preauthorization before you begin.
The use of FDA approved medication like Methadone and Suboxone has been shown to decrease the incidence of relapse and decrease the risk of overdose death. MAT can be used during medical detox or for longer term treatment for opioid or alcohol misuse. When used longer term it is generally paired with evidence based treatment to help you reach long term recovery.
Does MercyCare Cover Other Mental Healthcare?
Under the ACA mental healthcare is considered an essential health benefit and many MercyCare plans will offer coverage for it. However there are exceptions to the law and each plan will have different coverage limits and requirements so be sure to get full details before you start treatment.
For many with addiction there is a co occurring mental health condition such as depression or anxiety or PTSD or other disorders. Comprehensive treatment recognizes that successful recovery not only means sobriety but that underlying conditions are also addressed. For individuals with co occurring conditions integrated care is essential to address mental health and addiction at the same time.
Mental health care can include both inpatient and outpatient care that may include therapy and medication management along with other evidence based practices.
Does Addiction Treatment Need to Be In Network?
This depends on the type of plan you are enrolled in. It is important to understand your benefits in order to make sure you meet the requirements for coverage before starting a program.
Many plans will not cover out of network care. In cases where it is covered, there is likely to be higher out of pocket expenses such as higher deductibles and copayments. It is always best to try to remain in network to get the most out of your benefits coverage.
How Long Will MercyCare Cover Rehab?
The length of time MercyCare will cover rehab depends on a number of factors. This is where having determination of medical necessity and a treatment plan is crucial. Each benefit plan has different requirements and provides different levels of coverage. Working with your primary care provider and addictions team will help you to get the most out of your particular benefits plan.
Time in treatment varies from person to person. For inpatient and IOP, research has shown that 90 day programs are the most effective in preventing relapse and supporting long term sobriety. Individual therapy and aftercare programs can last for months or years, it is always important to remember that each recovery journey is unique and that there is no set time that is right for everyone.
How to Verify Coverage With MercyCare
There are a number of ways to verify coverage with MercyCare. The first is to contact the company directly. Often the member service phone number is on the back of your member ID card. Calling and speaking with a representative is a good way to help you understand what your benefits are and can help you find providers or facilities that will take your type of insurance.
Another way is to utilize MercyCare’s online member services page. Here you can find a wide variety of information including coverage information and in network providers along with details on requirements for coverage.
In some instances a treatment center can help to verify coverage. They will need the exact plan name and your ID and group number because each individual plan has different covered benefits and requirements.
Calls to any general helpline will be answered or returned by a paid advertiser.
By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
Sponsored Helpline
800-784-1361
Alcoholism
Drug Addiction
Dual Diagnosis
Mental Health and Substance Abuse
Opioid Addiction
Substance Abuse
Adult Program
Young Adult Program
LGBTQ Program
Military Program
Program For Women
Private Insurance
Self-Pay Options
Financial Aid
Medicare
Medicaid
Military Insurance
Sliding Scale Payment Assistance
