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.
When seeking the right treatment approach or checking whether a program accepts your insurance, you can learn more about rehab options to discover aligned facilities.
By Cary Damerow
Cary holds a BA in Liberal Arts and over 30 years of nursing experience as a Licensed Practical Nurse. During her career she has focused her work on high risk populations including pregnant women, children and adolescents, and those facing healthcare disparity.
Medically Reviewed by Anna Spooner
Anna has 10 years of experience in insurance and has been a content and copywriter since 2011. She strives to make all of her writing approachable and easy to understand while drinking copious amounts of tea. Anna writes about accessing addiction treatment, insurance, and finance.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
I didn't know what to expect when trying this therapy but it has turned out to be helpful to me. I just basically need someone w/some knowledge and experience to listen to my problems and any input or advice or even just listening to me is comforting. No one personal is willing to hear or deal w/me but this therapy will. Thankful for that. BTW my therapist is Stephanie and she is wonderful.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Everyone there is so nice especially Mrs Hodges she is my doctor and I don't know if she works there still but she is one of the nicest people I've ever met and so is everyone else that is there
James Cox (JJ)
1 month ago
We have been coming to this location since our daughter was an infant. Absolutely love Dr Amy Hodges & team. They listen, they care and go above and beyond. Our daughter also feels comfortable.
Nicole Hartness
1 month ago
Highly recommend 1st Choice Healthcare! Knowledgeable, Friendly, and Always Caring! Have Always received wonderful quality care!
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
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 truly cannot say enough good things about this facility. From the moment I arrived, I felt loved, cared for, heard, and supported. The staff, RAs, therapists, and my peers all played such an important role in making my experience what it was, and I will forever be grateful for each and every one of them. I flew from Alabama and there is no other place I would rather go. This is honestly one of the best recovery centers in the country.
Heidi, in particular, had such an impact on me. She quickly became one of my favorite people there, and I genuinely cannot put into words how much I value her. She made me feel seen, cared about, and understood during moments when I really needed it. She was more than someone just doing their job.
The therapists here are truly out of this world. I was thankful to share my time there with Shae. She is a kick ass therapist who helped heal me in so many way. They genuinely care about each individual person there. I always felt listened to and understood, and I never felt like just another patient.
The facility itself is beautiful, peaceful, and feels like a place where you can actually heal. The director is such a warm-hearted soul who genuinely cares about every single individual who walks through those doors. You can feel how much heart and thought she has put into creating such a beautiful place for people to come and heal. Synergy I truly thank you for everything you did for me. I came here at a point when I needed help more than ever, and I’m leaving with a completely different outlook on myself, my life, and my future!
Five stars doesn't feel like enough!
Blayklee Turnipseed
1 week ago
You are treated with respect at Synergy. The highly trained staff, consisting of therapists, instructors, and medical personnel are committed to helping you get to the root of your issues and coming up with solutions. I was not able to find that prior to my stay at Synergy. The facility is beautiful and accommodations warm and comfortable. The experience at Synergy changed my life!
Janice Kohler
1 week ago
I'm so happy to say this place has been a life changer for me ! Just so many good experiences. From the staff when I walked in the door, to all the councilors, all the aids, the professional chiefs. EVERYTHING is top notch. They know what really matters when it comes to mental health and care about each and everyone of us ! Thank you synergy!!
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Emma was an amazing therapist who truly listened to me, supported me, and helped me work through so many things during my journey. I’m so grateful for her patience, understanding, and the encouragement she gave me when I needed it most. Holly was also an exceptional case manager who was always there to help, guide me, and make sure I had the support and resources I needed. I appreciate both of them more than they know, and I’m truly thankful for everything they did to help me grow and continue moving forward in my recovery.
Ashley Outlaw
1 week ago
I just completed my time at Cornerstone Healing Center in Scottsdale, and I’m extremely grateful for the experience. The staff genuinely cares about the people they work with and treated me with respect, compassion, and understanding throughout my stay. The support, structure, and guidance I received helped me make meaningful progress and gave me a much stronger foundation moving forward. I would highly recommend Cornerstone to anyone looking for a supportive and professional environment to begin their recovery journey.
Sincerely
Brian Oliver
Brian Oliver
3 weeks ago
I’m truly grateful for my experience at this treatment center\. The staff were supportive, compassionate, and genuinely invested in my recovery
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
I highly recommend Rosecrance to anyone that's suffering in addiction anyone that wants to quit anyone that's suffering mentally. The staff here are amazing, caring, and supportive.
Nathan Howard
2 weeks ago
This place has always been great to me. All of the staff truly care and will do whatever they can to make your experience the most fulfilling! I am trying to get back into detox and I'm hoping they can help.
Alyssa
3 weeks ago
I thought it was well organized from what I saw at the detox intake. The girl at the desk handled it well when there was a sudden rush of people. And people were treated good.
As far as my daughters treatment don’t know yet still new, hopefully will be very beneficial for her.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
There very polite and helps with the needs and care of patient
Robert Volanos
1 week ago
Joan Butler is a compassionate psychiatrist and she really listens to my concerns. She makes me feel comfortable and safe to talk with her about my struggles etc. I highly recommend her to anyone who might need some extra medicinal support while processing challenging issues via therapy sessions. She puts you at ease and explains options as well as what to expect with taking each med. I feel well-informed and able to make educated choices for myself that I'm most comfortable with.
Melissa Attebury
2 weeks ago
Easy to work with and comfortable with the technology.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
This place saved my life after 13 years of severe addiction! They truly care. I highly recommend. My appointments always run on time and they are always working with me to accommodate my schedule.Everyone I have take care of me there have always showed me respect and never made me feel less than. If you want to get your life back this is where you start!
Bobbie sioux
2 weeks ago
I'm going to brightview for 6 years they saved my life went there straight out of the hospital after having endocarditis and a stroke that's a great place to get clean the people there are so nice it saved my life
Cindy Brock
3 weeks ago
This place helped me get my life together. Just go for an appointment. All you have to do is try and it works
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Arizona Rehab Campus changed my life in ways I never imagined. It gave me a second chance, helped me find my purpose, and showed me the strength I had within me. But one of the greatest rewards of this journey is the text I got from my mom that stated " I'm proud of you". After everything we’ve been through, knowing that she’s finally proud of the man I’m becoming means more to me than words can explain. This journey saved my life, rebuilt my future, and gave my family a reason to believe in me again. Forever grateful ♥️
Eddie Carter
1 week ago
Im so grateful for the ARC they helped me regain my life back. The ARC team has given me the tools to succeed against my addiction.
If you know anyone struggling with addiction the ARC is the best place in Arizona.
Roman Marin
3 weeks ago
I have 8 months of sobriety. Life looks differently when you get yourself on the right track. I am forever grateful to the program and the people who makes this place work. Thank you to staff like Katy Donnie and Vanessa
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Frequently Asked Questions
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.
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.
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.
Calls to numbers on a specific treatment center listing will be routed to that treatment center. Calls to any general helpline could be forwarded to SAMHSA or a verified treatment provider.
If you wish to connect with non-sponsor centers, you can browse top-rated listings, visit our homepage and browse by state, or visit SAMHSA.
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