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.
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A Forever Blessing. If you or someone you love is struggling with addiction or mental health and is ready to step into something new, I beg you look no further than Synergy.I m writing this at the very end of my treatment stay, and I truly don t have the words to express how grateful I am. My time here feels like an eternal blessing something that will keep unfolding and supporting me for the rest of my life.I came from out of town, unsure of what to expect. Honestly, I wasn t even fully ready to leave my addiction behind. But from the moment I walked in, something shifted. I arrived lost and powerless, and I m leaving feeling confident, clear, and like I ve reconnected with the version of myself I thought was gone.I found *me* again and that s all thanks to the incredible staff, the other women in the program, and the intentional structure that Synergy offers. The staff here are truly one of a kind. They care deeply and show up for you every single day. I ll be keeping up with some of them for years to come.The community here is so inspiring. I watched woman after woman leave glowing excited, prepared, and ready to take on life again. We now have the tools.Also a big shoutout to chefs Matt and Ian. Not only are they incredible chefs, but their presence brought comfort to each day. The rooms are super nice and cozy. The whole environment is peaceful, clean, and made for healing.Synergy is a gift. If you re ready to change your life, it starts here.
Morgan Tomcho
2 months ago
This has truly been one of the greatest experience of my life. I have struggled with severe depression most of my life. Even though I have had substance abuse in the past, it was not my main focus. My mental heath was my main concern. I have been to mental hospitals in the past but they only treat with medication. I was looking for something where I could get stable on the right medication and learn how to live life again. Synergy offered me exactly what I needed. They completely understood the mental state that I was in. They evaluated my moods and medication until they found what really worked for me. They encouraged me to be present in my own life. At a mental hospital, they will allow you to lay in bed and hide away. At synergy, they offer classes that help you rediscover your true self. They provide activities and help you learn how to reconnect with others. The food that they provide is amazing and very nutritional. The staff in incredibly helpful and they truly care about each individual that walks through the door. Once you are here, you belong. I am so glad that I made the choice to come to Synergy. This has truly been a pivot point in my life.
Amanda Darnell
2 months ago
I am so glad that I came to Synergy. It has been an absolute life changer. The staff is phenomenal, very kind and understanding. The property is amazing and beautiful. Even the food is healthy and delicious. I would recommend Synergy to anyone that is needing help and is willing to follow the program. It really works and like I said, a life changer!!
If you want sobriety, this is the place. I came addicted to meth for 40 years and a drunk for 20 years. I'm not finished yet with my 30 days, however, I can tell you that detox is tolerable, and the food is resort grade, so delicious and made with love. I made some friends that will last a lifetime.They picked me up 30 minutes after I called for help, saved my life.Thank you to everyone at the ARC.
Dee Foley
2 months ago
I just wanna say the ARC saved my life . The staff, in residential and IOP were amazing , kind , and TRULY CARE! staff members like KATY WHO WORKS AT IOP, DOM THE DIRECTOR, LUIS THE DIRECTOR, DOM RSS, ASHLEY RSS, JOSEPH RSS, NICOLE RSS, and honestly I can sit here and go on on on but ALL THE STAFF DESERVE A 5 STAR RATING. I LOVE YOU ALL . THEY REALLY WANT TO HELP THOSE WHO STRUGGLE WITH ADDICTION AND I JUST WANT TO THANK EVERY PERSON WHO I MET AND HAD GROUP WITH. WITHOUT THE HELP OF THSES KIND LOVING , HARD WORKING PEOPLE I WOULDN'T BE HERE! THEY SHOWED ME RECOVERY IS POSSIBLE AND TAUGHT ME THE SKILLS TO USE IN EVERYDAY LIFE WHEN THOSE URGES AND THOUGHTS ARISE. I LOVE THE ARC AND THANK U. I HIGHLY RECOMMEND THIS PLACE TO ANYONE SEEKING A LIFE OF SOBRIETY. I WAS DEALING WITH MY SONS DEATH WHILE IN THE PROCESS OF FIGHTING ADDICTION AND THEY WERE JUST THERE AND HAD MY BACK 1000 PERCENT. LOVE U ALL. GOD BLESS.JOJO
Joe Mendoza
4 months ago
I am so grateful for this place! My best friend was suicidal and had given up on life before entering this facility. Now whenever I talk to him on the phone, he tells me how amazing the counselors , the staff and the program has been. For the first time in years I have hope that he is finally going to be ok! You all literally saved his life! . I only wish that there could be more places like this one!
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
2 weeks 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
2 weeks ago
I recovered here. I love the program. Highly recommend others to seek help here.
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
2 months ago
I really enjoy places
augustina valdez (Morenita)
2 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
2 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
2 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!
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)
3 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
4 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.
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
11 months 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 appreciatedJaime Rivas
I been here a few years and hands down the best counselor I had and have is jaymilyn at it's West lead. She so sweet,caring,and goes above and beyond her job. I always look forward to talking with her she defenitly makes the place better .#savinglives
Candice Palmer
6 months ago
This place works if you put in the time and effort. The people are very nice and friendly. The girls that work in the front are great, especially Dee and Michelle. Derrick does a great job also.
Cole Merryman
7 months ago
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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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