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.
My time at Cornerstone has been an experience which I can only describe as life changing. With the help of amazing therapists, navigators and friends in recovery I was able to begin my journey of self-love and service. I am beyond grateful.
Irving Mange
1 month ago
Cornerstone has changed my life forever. Before coming to them, I did not know where my life was going, and I was not in constant contact with God. They took great care of n me, challenged me, cared, and worked with my. The therapists are excellent and pushed me beyond what I realized I could accomplish. I thank them for the life that I have with God and my family.
Nicole
1 month ago
I recovered here. I love the program. Highly recommend others to seek help here.
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
This place changed my life and reawakened the light in me. great people. great food. great classes.
Kathryn Kach
2 months ago
Synergy has completely changed my life! I just finished 30 days at this gorgeous oasis and I am so grateful and blessed I had this opportunity. The staff, therapists and instructors are top-tier and they really care about each and every woman in the house. I learned so much about myself, the root causes of my addiction and how to live and work for a sober life!! Go to synergy!!!!
Margaret Mulligan
2 months ago
I stayed at Synergy for a little over a month in the early spring. I would absolutely recommend them to anyone struggling with recovery. The staff is warm and supportive, they really make an experience that is often very difficult much easier. The property is gorgeous and spending time outside was very helpful for the recovery process. I couldn’t have found a better or safer environment to begin this journey. Thank you synergy!
Everyone here is professional and helpful! My daughter comes here for the services she needs and when we walk in everyone is so welcoming. Dr Cali answers any questions you may have and is so kind and down to Earth. Both Ricktisha and Elisha have helped us out so much so far! They are both kind, funny, and down to Earth. Thank you everyone for always answering the phone and if I left a voicemail always getting back to me. I highly recommend this location because the services you get here are outstanding! I drive an hour drive to get here but it is well worth it thank you everyone☺️
Kim Compton
1 year ago
John (the Asian dude) is an Amazing tech
Jamil on th other hand told me mentally ill people have demons and need exorcism.
Mckenzie T
1 year ago
Well so much to say, i achieved a lot of good in my life, Janine has been a tremendous help in my life when I was in need of help I thank the whole staff & alot of thanks to Janine she is great 👍
Much appreciated
Jaime Rivas
This place is amazing it truly saved my life and the staff make you feel like family they go above and beyond and the place is full of so much love strength hope and support shout out to Luis Oscar Joe Nikole and the housing staff for helping me become the best version of myself. I did detox, residential, and 3 months of outpatient while living there and now I’m back home but I still go to classes there every week. I finally have a real shot at life and I couldn’t have done it without this place. I’ve made so many friends along the way too
Rachel Velasco
2 months ago
The staff at this place is so loving and awesome and caring that it’s just amazing if you need to go in go into this place because they are incredible. They’ll treat you like a human being and get you back on your feet. I have nothing but a massive amount of love for all of the people that work for this company.
Russell Workman
2 months ago
First and foremost the Arc saved my life. I went into inpatient broken and defeated. I didn’t know what to expect since this was my first treatment center. The BHT,s were kind and caring, they made me feel comfortable and safe. The classes where amazing, the rss,s are very knowledgeable on addiction and metal health and they teach the courses with compassion. I learned about my triggers and trauma, they taught me that recovery is very possible. After 30 days I went over to the IOP program, the housing was amazing, well kept clean, the courses were very educational the instructors where amazing! Thank you Neil, Nikole, Suzanne, Randy, Alexa, Joe and Celina they made me feel comfortable and I felt like a part of the group! A special shout out to Kate and David. They will go above and beyond to make you feel appreciated and comfortable. Anything needed they took care off. They were always there to help and make my stay as comfortable as possible. I thought I was beyond help, then after 75 days there I now have purpose and direction, a foundation with structure and a positive outlook on life today thanks to this place. So I would definitely recommend this place . I am now in the process of goin to school for my RSS certification so I can give back what was so freely given to me.
I was a patient 19 mouths ago August 18 2023 and I am still sober. Rosecrans gave me a new life. The staff is amazing and to be honest I didn not want to live.
If you have any concerns about your mental health, this is the place to go. They re very understanding and keep you updated with new medication s and so forth to help you good luck. Thank you, Joanne Butler
Gayle Burke
3 months ago
I really enjoy places
augustina valdez (Morenita)
3 months ago
My daughter is very comfortable with her doctor and can discuss anything with ease. We are very fortunate to have Valle del Sol and Dr. Butler.
I came here from another clinic and let me tell you I don t trust anyone and this clinic and Celeste have made me feel so welcomed and wanted in my recovery and Celeste is the most amazing counselor I ve ever asked for it s hard for me to open up to anyone and she s gained that trust this clinic is amazing would recommend to everyone Tammy is amazing nurse I think she needs more credit then deserved
Shelly Miller
3 months ago
I just spoke with Monica and you can tell that this place genuinely cares about their patience, Just the conversation I had with Monica has put me at ease to come in.M, KWill be implementing 25% on Canada 25% of Mexico 10% on China tomorrow for the reasons that I have repeatedly laid out in this briefing
M DOC
3 months ago
From what my cousin has shared about his experience at Intensive Treatment Systems, Nikki is an absolutely amazing counselor and Behavioral Health Technician. She made a huge impact on his recovery journey with her kindness, patience, and genuine care. He always spoke about how she took the time to truly listen, offering support without judgment and guiding him through some of his toughest moments.Nikki s dedication to her work is evident in the way she encourages and uplifts those she helps. My cousin felt like he had someone in his corner who really believed in him, which made all the difference. If you re looking for a counselor who is compassionate, understanding, and committed to helping people change their lives, Nikki is one of the best.Thank you, Nikki, for everything you do!
Marne has been a Godsend and I honestly don't know where I would be without her and the team. I have been going through a lot I've been in pain management, I've been to rehab, I've been to prison. I know that not everyone is built the same or seen the same things or experienced the same experiences. But, the people who can just keep an open mind and not judge someone for the first thing they see or the way that someone has lived before all of this. I know I'm no better or different then anyone. I just need help and am so thankful for you guys. And we have good and bad days like everyone else. I hope for the best for any and all of these workers here. The Dr. Is cool too just explain the total truth and they will understand the situation. I know the truth isn't always easy but they will understand. Just try to remember your in a safe environment and they are there to help.
Big Psych CB2480
1 year ago
Doing my clinical hours at New Hope was a great experience. The staff truly cares for the patients and excel in what they do help the patients!
Cherub staff are the best🩷 shoutout to the kitchen staff too they chill
Shelby Chapman
1 month ago
As a visitor, the ambience is inviting and the staff is very receptive and warm. I can see that Rosecrance has influenced my daughter in a positive way and sincerely offer hope for her clean recovery.
Susana Sanchez
1 month ago
Great place to get better, beautiful place to be, some staff care very much!!
Rosecrans has gave me the knowledge to actually be able to understand and comprehend myself when it comes to my health my substance abuse and my mental health all in one place which is great it should be more places like this around the state or even just in the city alone because other places do not teach you this it's like they're just getting government money to be able to bring in hold them for a while let them go back out to do the same thing over there's no real teaching understanding or making sure one comprehends the addiction process and metaphor I love Rosecrans thank you much Clarence Duke
Duke Clarence (Sincere at heart)
4 months ago
The staff are awesome. They are well groomed, to your needs. Jessica is amazing Rosecrans saved my life. I love you guys.
Marshall Smith
5 months ago
I am still so thankful for the experiences that I had there. I am still going strong not drinking. I honestly think I could not of done it without the program. Thank you thank you. If you need help call Rosecrance.
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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.
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