New York State Health Insurance Program, commonly abbreviated to NYSHIP, provides healthcare coverage for eligible state employees and their family members across New York [1]. This coverage ensures that all NYSHIP plan holders can access evidence-based addiction treatment throughout New York State and beyond.

NYSHIP rehab coverage meets substantial portions of treatment costs for substance abuse and mental health services, helping members recalibrate their lives without financial strain.

For help verifying NYSHIP coverage for rehab, call Gratitude Lodge today to get started. 

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NYSHIP Rehab Coverage

NYSHIP offers two main health insurance options: Empire Plans and HMOs (health maintenance organizations) approved by the insurer. Both types of coverage provide comprehensive benefits for all addiction treatment that healthcare professionals deem clinically necessary.

All employees of New York State are eligible for coverage under the NYSHIP Empire Plan [2]. Empire Plan coverage includes both inpatient and outpatient programs, depending on the severity of the addiction and personal circumstances. Members benefit from affordable co-insurance and co-payment rates, as well as annual maximums for out-of-pocket costs.

All NYSHIP health plans provide coverage for substance abuse treatment at the same levels as coverage offered for other chronic medical conditions that need professional interventions [3]. 

NYSHIP Drug & Alcohol Rehab Program

An NYSHIP drug and alcohol rehab program typically follows broadly similar lines.

Clinical and psychological evaluations help treatment providers develop customized plans within NYSHIP rehab coverage guidelines. Admissions teams at vetted rehab centers work with NYSHIP to establish the scope of benefits and maximize coverage utilization.

Treatment typically begins with supervised medical detox. Detoxification addresses physical dependence on drugs, alcohol, or prescription medications, and prepares individuals for ongoing treatment. Detox programs provide 24-hour care, emotional and clinical support, and medication management [4].

After about one week of detox, individuals move into an inpatient or outpatient treatment program. Drug and alcohol rehab programs blend medication-assisted treatment with evidence-based talk therapies and counseling to probe the psychological side of addiction and promote whole-body healing. Therapy sessions take place in one-to-one, group, and family settings.

Benefits Of NYSHIP-Covered Treatment

NYSHIP rehab coverage delivers multiple benefits for those engaging in addiction treatment with health insurance. NYSHIP plans cover treatment at all levels on the continuum of care, from detox and outpatient programs to residential rehab [5]. This enables plan members to receive treatment that meets them where they are on their recovery journey.

The primary advantage of NYSHIP rehab coverage is the financial savings it offers. Annual maximums for out-of-pocket expenses cap total healthcare costs in any given year. After reaching this threshold, NYSHIP insurance covers all treatment costs for the remainder of the year.

NYSHIP maintains a vast network of providers, enabling plan members to access addiction treatment facilities throughout the United States, which is beneficial for those who need specialized treatment unavailable locally or individuals who prefer to engage in treatment away from home.

NYSHIP mental health providers cover family interventions to help family members understand the effects of addiction, improve communication skills, and create home environments conducive to sustained recovery.

NYSHIP-Covered Treatment

Treatment covered by NYSHIP health plans encompasses all levels of intensity when determined clinically necessary.

Inpatient rehab is the most intensive form of addiction treatment covered. This is generally indicated for those with severe addictions, co-occurring mental health challenges, or unstable home environments. Programs last 30, 60, or 90 days.

PHPs (partial hospitalization programs) involve 6 or more hours of therapy sessions on all weekdays. PHPs offer similar services to those delivered in residential rehab while allowing participants to return home every night. This level of care may serve as a step-down from inpatient rehab or as a standalone treatment option with NYSHIP rehab coverage.

IOPs (intensive outpatient programs) offer up to 15 hours of therapy sessions on several weekdays. An IOP often works well for those with mild or moderate addictions or for individuals who require a smooth transition from more intensive treatment to independent sober living.

All treatment plans, whether inpatient or outpatient, include aftercare components to encourage ongoing recovery without relapse. NYSHIP rehab coverage extends to any medically necessary ongoing therapy due to the chronic and relapsing nature of all addictions.

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Struggling with addiction? We can help.

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What Type of Addiction Treatment is Covered Under NYSHIP?

NYSHIP rehab coverage typically includes all levels of addiction treatment, including:

• Supervised medical detox.
• Residential rehab.
• Outpatient programs.
• Intensive outpatient and partial hospitalization programs.
• Individual, group, and family therapy sessions.
• Medication-assisted treatment, including FDA-approved medications and monitoring.
• Diagnostic services and lab testing.
• Aftercare services and continuing care.

Call Gratitude Lodge today to verify your insurance coverage for rehab. 

Nyship Rehab Coverage | FAQs

Does the NYSHIP Empire plan cover therapy?

Yes, NYSHIP Empire Plans cover therapy services that include individual, group, and family therapy sessions. NYSHIP mental health coverage plans extend to treatment from psychiatrists, psychologists, and licensed therapists to deliver sessions deemed clinically necessary.

Is NYSHIP the same as the Empire Plan?

New York State Health Insurance Program (NYSHIP) includes both the Empire Plan and HMOs approved by NYSHIP. The Empire Plan provides substance abuse treatment and NYSHIP mental health providers for New York State workers eligible for the program.

How do I know if therapy is covered under my insurance?

Get in touch with NYSHIP or review your summary of benefits to verify the specifics of your therapy coverage. Alternatively, contact your chosen treatment provider for verification of your benefits. 

Does insurance cover all therapy sessions?

Coverage for therapy sessions varies depending on the NYSHIP plan type and determinations of medical necessity. Most health plans from NYSHIP cover as many annual therapy sessions as healthcare providers recommend to promote sustained recovery. Some plans require authorization for prolonged periods of therapy.

Get Effective Addiction Treatment Covered by Insurance at Gratitude Lodge

If you need help unchaining yourself from drug or alcohol addiction, contact Gratitude Lodge today. We work with most major health insurance providers to reduce your out-of-pocket expenses and can help verify your benefits.

Our medical detox services streamline the withdrawal process and prepare you for inpatient treatment at our Long Beach or Newport Beach treatment facilities. Programs are highly structured and provide an environment free of triggers and distractions where you can address the psychological side of substance abuse.

Everyone’s recovery needs are unique, so all Gratitude Lodge treatment plans are customized to reflect this. Therapies might include: 

• Family therapy.
• Group therapy.
• Individual counseling.
• MAT (medication-assisted treatment).
• Talk therapies.
• Motivational therapy.
• Holistic therapy.
• Aftercare planning.

To verify your insurance coverage and begin addiction recovery, call admissions at 844-576-0144. 

Sources

[1] https://www.cs.ny.gov/employee-benefits/group/4/15/1/welcome.cfm

[2] https://www.cs.ny.gov/employee-benefits/sbc/empire/index.cfm

[3] https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder

[4] https://www.ncbi.nlm.nih.gov/books/NBK64119/

[5] https://www.asam.org/asam-criteria/about-the-asam-criteria