PA Health and Wellness Rehab Coverage for Drug & Alcohol Treatment
As a member of PA Health & Wellness you may be eligible for coverage for drug rehabilitation, alcohol rehabilitation, treatment for mental health, and recovery services.
Coverage is not guaranteed, but reviewing your benefits prior to starting a program will help you fully understand your options.
PA Health & Wellness is a managed care organization in the state of Pennsylvania with Medicaid (Community HealthChoices), Marketplace (Ambetter), and Medicare Advantage (Allwell) programs available.
Several of these programs offer benefits for behavioral health and substance use disorders, although coverage is dependent on your particular plan and medical necessity.
What PA Health & Wellness members should know
- Verify Coverage Quickly
- No Obligation
- Confidential
Does PA Health & Wellness Pay for Drug and Alcohol Rehab Treatment?
PA Health & Wellness provides medical benefits, including addiction treatment and mental health coverage, but it is dependent on the type of health plan you are enrolled in.
Federal laws, such as the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) ensure that if a health insurance plan includes behavioral health benefits, it must provide comparable coverage for medical/surgical services.
Coverage may vary based on your plan, medical necessity, prior authorization, and treatment modality.
PA Health & Wellness Plan Types
Treatment is covered differently based on your plan:
Medicaid (Community HealthChoices)
Pennsylvania Medicaid plans are required to cover substance use disorder treatment and mental health services including long-term services and supports.
Marketplace (Ambetter)
Ambetter is a plan from the ACA Marketplace and its plans include mental health and substance use disorder treatment as essential health benefits.
Medicare Advantage (Allwell)
Allwell is a Medicare Advantage plan and includes all mental health and substance use disorder benefits covered by Original Medicare, in addition to Medicare Advantage benefits.
Each plan has unique benefits so your coverage is the best information to have.
What Addiction Treatment Services May Be Covered?
Your PA Health & Wellness plan may cover the following services (based on medical necessity):
Medical Detox
Medically supervised withdrawal management when needed.
Inpatient/Residential Rehab
A 24-hour, structured treatment program designed to address substance use disorders and co-occurring mental health conditions.
Partial Hospitalization Programs (PHP)
Daytime treatment where patients return home in the evening.
Intensive Outpatient Programs (IOP)
Programs that provide structured treatment several days per week to support recovery and build coping skills.
Telehealth Intensive Outpatient Programs (IOP)
Telehealth-based behavioral healthcare for substance use and mental health conditions.
Outpatient Treatment
Outpatient care to provide individual, group and family counseling, support services and other treatment and recovery resources.
Dual Diagnosis Treatment
Treatment for co-occurring mental health and substance use disorders.
Note: Length of stay and level of care are typically determined by medical necessity and clinical evaluation.
Does PA Health & Wellness Cover Mental Health Treatment?
Yes, the majority of PA Health & Wellness plans provide coverage for mental health treatment. This can include but is not limited to:
- Individual therapy/counseling
- Group therapy
- Family therapy
- Psychiatric assessments
- Medication management
- Co-occurring condition treatment
- Inpatient mental health treatment
It is important to remember that treatment coverage is generally determined by medical necessity and policy-specific terms and conditions.
What Will Rehab Cost With PA Health & Wellness?
The price of rehab depends on your plan and treatment intensity.
Here are several factors that will likely influence how much you’ll have to pay out-of-pocket:
- The type of plan you have (Medicaid, Ambetter, Allwell)
- Whether you are using in-network providers
- Your deductibles, copays, and coinsurance
- Pre-authorization requirements
- Length and intensity of treatment
Banyan Treatment Centers will work with you to check your benefits and provide an estimate of your costs.
What You Can Do Right Now
Banyan Treatment Centers can verify your PA Health & Wellness benefits and help you understand your coverage.
If You Call Your Insurance Provider Directly, Ask:
- Is medical detox covered?
- Are inpatient or residential programs covered under my plan?
- Are PHP or intensive outpatient programs covered?
- Do I need prior authorization?
- Is this facility in-network?
- What are my deductibles, copays, and coinsurance?
- Are there limits on the number of treatment days or sessions?
Or, We Can Verify for You (Recommended)
- We contact your insurance provider directly
- We review coverage details and medical necessity requirements
- We explain the benefits clearly and confidentially
What Banyan Locations Take PA Health & Wellness?
PA Health & Wellness plans are accepted at some Banyan facilities in Pennsylvania. Your specific insurance and participation will depend on your individual plan, so insurance verification is needed.
Some of the Banyan locations that may take PA Health & Wellness are:
* Clearbrook Pennsylvania - Laurel Run, PA
* Banyan Philadelphia - Langhorne, PA
The types of services covered by your specific plan may include inpatient care, outpatient services, mental health support and telehealth treatment depending on your coverage.
Trying to find a treatment center near you? View all of the Banyan facilities and explore programs tailored to you:
Clearbrook Pennsylvania focuses on inpatient and outpatient care for mental health and substance use disorders, while Banyan Philadelphia provides outpatient and telehealth services to Eastern and Northeastern Pennsylvania.
Using Your PA Health & Wellness Benefits at Banyan
Getting started is easy. Just:
- Call Banyan admissions or fill out an online form
- Give us your PA Health & Wellness plan information (Medicaid, Ambetter or Allwell)
- Our team will verify your benefits
- We'll review your coverage, your costs, and your responsibilities
- Complete an assessment
- Start your program of care
Next Steps: Verify your PA Health & Wellness coverage or speak with an admissions specialist today.
Frequently Asked Questions
1055 S Perry Street
Castle Rock, CO 80104
877-593-2912
Coverage varies by PA Health & Wellness plan and state. Insurance verification is required to confirm eligibility and benefits.
Using Your PA Health & Wellness Benefits at Banyan
The specifics of coverage will depend on your plan type, individual eligibility and medical necessity guidelines.
Banyan Treatment Centers can assist you in confirming the details of your plan and explore treatment options that work best for you.
Banyan Facilities for Drug, Alcohol, & Mental Health Treatment
Banyan Castle Rock
Located in Castle Rock, CO
Substance Use Inpatient
Mental Health Inpatient
Telehealth Virtual IOP
Banyan Heartland
Located in Gilman, IL
Substance Use Inpatient
Mental Health Inpatient
Substance Use Outpatient
Telehealth Virtual IOP
Banyan Palm Springs
Located in Cathedral City, CA
Substance Use Inpatient
Telehealth Virtual IOP
Getting Into Treatment Is Easy. Here's How to Get Started!
Call Us Anytime
Speak with our compassionate admissions specialists to discuss your situation and explore treatment options.
Initial Assessment
We conduct a thorough evaluation to determine the best level of care tailored to your needs.
Financial Guidance
Our team will verify your insurance coverage and provide transparent cost information.
Begin Your Recovery
Once everything is set, you’ll be welcomed into our program and start your journey toward healing.