Meritain Health Insurance Coverage for Drug and Alcohol Rehab

About Meritain Health

Meritain Health is one of the nation's largest third-party administrators (TPAs), serving over 1.5 million members across the United States. As a proud subsidiary of Aetna and CVS Health, Meritain Health combines 40 years of experience in benefits administration with access to Aetna's extensive provider network of over 1.6 million healthcare providers nationwide, including more than 307,000 behavioral health providers.

As a third-party administrator, Meritain Health manages health benefits for employers who choose to self-fund their employee health coverage. This means your employer determines the specific benefits available, while Meritain Health handles the administrative aspects such as claims processing, member services, and network access. Despite this structure, you'll use your Meritain Health plan just like traditional insurance, with coverage for medical, mental health, and substance use disorder services.

Meritain Health offers flexible, customized benefit solutions designed to meet the diverse needs of different employers and their employees. Their partnership with Aetna provides members with access to the Aetna Choice POS II network, offering broad coverage and carrier-level discounts across the country.

Does Meritain Health Cover Addiction Treatment?

Yes, Meritain Health covers addiction treatment services. Under the Affordable Care Act (ACA), all major health insurance plans must include mental health and substance use disorder treatment as essential health benefits. This federal requirement ensures that Meritain Health plans provide coverage for addiction treatment comparable to coverage for other medical conditions.

Additionally, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires that financial requirements and treatment limitations for substance use disorder services cannot be more restrictive than those for medical and surgical benefits. This means your Meritain Health plan must apply the same standards to behavioral health care as it does to physical health care.

The specific coverage details—including deductibles, co-insurance rates, and authorization requirements—will vary based on your employer's plan design. However, most Meritain Health plans provide comprehensive coverage for medically necessary addiction treatment across multiple levels of care.

What Addiction Treatment Services Does Meritain Health Cover?

Meritain Health typically covers a full continuum of addiction treatment services designed to address substance use disorders at every stage of recovery:

Medical Detoxification

Medical detox is often the essential first step in addiction treatment. Meritain Health covers medically supervised detoxification programs where you can safely withdraw from drugs or alcohol under professional medical care. Detox services include 24/7 medical monitoring, medication management to ease withdrawal symptoms, and assessment for the appropriate next level of care. Medical supervision during detox ensures your safety and comfort during this vulnerable time.

Inpatient/Residential Treatment

Residential treatment provides intensive, structured care in a therapeutic environment. Meritain Health covers inpatient rehabilitation services that include round-the-clock medical and clinical support, individual and group therapy, evidence-based treatment approaches, and comprehensive case management. Residential treatment is appropriate for individuals who need immersive support to address severe addiction, co-occurring mental health conditions, or who haven't succeeded with less intensive levels of care.

Partial Hospitalization Programs (PHP)

PHP offers structured treatment during daytime hours while allowing you to return home in the evenings. This level of care typically includes several hours of programming five to seven days per week, providing intensive therapeutic support while maintaining some connection to daily life. Meritain Health covers PHP as a step-down from residential care or as primary treatment for individuals who need substantial support but can safely live at home.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs provide comprehensive treatment several days per week while you continue living at home and maintaining work or family responsibilities. Meritain Health covers IOP services including group therapy, individual counseling, relapse prevention education, and skill-building activities. This level of care allows you to apply recovery principles in real time while receiving consistent professional support.

Outpatient Treatment

Standard outpatient services offer ongoing support with weekly or bi-weekly sessions. Meritain Health covers outpatient counseling for individuals stepping down from more intensive treatment or those with less severe substance use who benefit from regular therapeutic support. Outpatient care helps you maintain recovery gains and continue personal growth.

Medication-Assisted Treatment (MAT)

Meritain Health covers medications approved by the U.S. Food and Drug Administration (FDA) for substance use disorder treatment. These medications include buprenorphine (Suboxone), naltrexone (Vivitrol), and other evidence-based medications that reduce cravings, prevent withdrawal, and support long-term recovery. MAT combines medication with counseling and behavioral therapies for comprehensive treatment that research shows improves outcomes.

Evidence-Based Therapies

Coverage includes therapeutic approaches proven effective in treating addiction:

• Cognitive Behavioral Therapy (CBT) – Addresses thought patterns and behaviors that contribute to substance use
• Dialectical Behavior Therapy (DBT) – Builds skills for emotional regulation and distress tolerance
• Motivational Interviewing (MI) – Strengthens internal motivation for change
• Individual therapy – One-on-one counseling with licensed clinicians
• Group therapy – Peer support and therapeutic processing in group settings
• Family therapy – Involves loved ones in healing and recovery

Dual Diagnosis Treatment

Many individuals with substance use disorders also experience co-occurring mental health conditions such as depression, anxiety, PTSD, bipolar disorder, or other psychiatric conditions. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 8 million adults in the United States have both a substance use disorder and a mental health condition. Meritain Health covers integrated treatment that addresses both conditions simultaneously, which research shows leads to better outcomes and more sustainable recovery.

Specialty Programming

Many Meritain Health plans cover innovative and specialized treatment approaches, including:

• Gender-specific treatment programs
• Trauma-focused therapy
• Holistic wellness services such as yoga, meditation, and acupuncture
• Experiential therapies including art therapy, music therapy, and adventure therapy
• 12-step facilitation and alternative recovery pathways
• Continuing care and alumni support services

Understanding Your Meritain Health Coverage

Since Meritain Health administers employer-sponsored self-funded plans, your specific coverage will depend on the benefit design your employer has chosen. Common cost-sharing components include:

Deductibles

The amount you pay out-of-pocket before your insurance begins covering services. Some plans have separate deductibles for medical and behavioral health services, though mental health parity laws limit these differences. Deductible amounts vary by plan but typically range from several hundred to several thousand dollars.

Co-Insurance

After meeting your deductible, you typically pay a percentage of treatment costs while Meritain Health covers the remainder. For example, you might pay 20% while Meritain Health covers 80% of approved services. Co-insurance rates vary by plan tier—bronze plans typically cover around 60% while gold plans cover approximately 80% of costs.

Co-Payments

Fixed amounts you pay for specific services, such as $30 for a therapy session or $50 for a specialist visit. Co-payments may apply before or after you meet your deductible, depending on your plan design.

Out-of-Pocket Maximum

The maximum amount you'll pay in a plan year for covered services. Once you reach this limit, Meritain Health covers 100% of covered services for the remainder of the plan year. This protection ensures that even serious health issues requiring extensive treatment won't result in unlimited financial liability.

In-Network vs. Out-of-Network Coverage

Using in-network providers significantly reduces your costs. Meritain Health's partnership with Aetna provides access to a vast network of behavioral health providers who have contracted to provide services at negotiated rates. Out-of-network care typically results in higher deductibles, co-insurance percentages, and costs that may not count toward your out-of-pocket maximum. Some plans provide limited or no coverage for out-of-network services.

Does Meritain Health Require Prior Authorization?

Many Meritain Health plans require prior authorization (also called preauthorization or precertification) for substance use disorder treatment services. Prior authorization is a process where your treatment provider submits clinical information to Meritain Health for approval before you begin care. This ensures that the proposed treatment is medically necessary and appropriate for your specific situation.

The prior authorization process typically includes:

• Your treatment facility submitting a prior authorization request with clinical documentation
• Review by Meritain Health's behavioral health team to assess medical necessity
• Approval, modification, or denial of the requested services
• Ongoing concurrent reviews to evaluate continued need for treatment

At BriteLife Recovery, our admissions team handles the prior authorization process on your behalf. We work directly with Meritain Health to verify coverage, obtain necessary approvals, and manage continuing authorizations throughout your treatment, allowing you to focus on recovery rather than administrative paperwork.

Authorization requirements vary by plan and level of care. Some services may not require prior authorization depending on your specific plan design. It's important to verify these requirements before beginning treatment to avoid unexpected denials or out-of-pocket costs.

How to Verify Your Meritain Health Coverage

Before beginning treatment, verifying your specific coverage details helps you understand what to expect financially and ensures you can access appropriate care without delays. Here's how to check your Meritain Health benefits:

1. Review your Summary of Benefits – This document, typically provided during enrollment or available through your employer's benefits portal, outlines your coverage details including deductibles, co-insurance rates, and covered services
2. Check your employee handbook – Many employers include health benefits information in employee handbooks or onboarding materials
3. Call Meritain Health member services – Use the phone number on your insurance card to speak with a representative about your specific behavioral health coverage
4. Contact BriteLife Recovery – Our admissions specialists can verify your coverage for you at no cost, explaining your benefits in clear, understandable terms
5. Review mental health/behavioral health sections – Look specifically for information about substance use disorder treatment, including inpatient and outpatient services

Essential questions to ask when verifying coverage:

• What levels of care are covered (detox, residential, PHP, IOP, outpatient)?
• Is prior authorization required? What's the process and timeline?
• What are my deductible, co-insurance percentage, and out-of-pocket maximum?
• Is BriteLife Recovery an in-network provider with Meritain Health?
• Are there limitations on treatment length or number of days covered?
• Does my plan cover medication-assisted treatment?
• Is family therapy or continuing care covered?
• What documentation is needed for authorization?

BriteLife Recovery Accepts Meritain Health Insurance

At BriteLife Recovery, we accept Meritain Health insurance at our treatment facilities in Pennsylvania, South Carolina, New York, and New Jersey. We offer comprehensive addiction treatment grounded in the understanding that substance use disorders stem from disconnection—from self, from others, and from meaning. Our treatment philosophy recognizes that healing occurs through rebuilding these essential connections in environments of safety, compassion, and respect.

Our Evidence-Based Treatment Approach

We provide trauma-informed, person-centered care that honors your unique experiences, needs, and recovery goals. Our integrated treatment model combines medical, psychiatric, clinical, and wellness services to support whole-person healing:

• Medical detoxification with 24/7 medical supervision and medication management
• Residential treatment in therapeutic, comfortable environments that feel like home
• Individual therapy with experienced, licensed clinicians
• Process-based group therapy addressing interpersonal healing and authentic connection
• Nature-Informed Therapy (NIT) integrating the healing power of nature with evidence-based therapeutic practices
• Adventure Recovery programming combining experiential outdoor activities with therapeutic processing
• Medication-assisted treatment including Suboxone, naltrexone, and Vivitrol
• Dual diagnosis treatment for co-occurring mental health conditions
• Family programming including BALM (Be A Loving Mirror) support groups
• Holistic wellness services such as yoga, acupuncture, meditation, and mindfulness practices
• Specialty groups addressing trauma, relationships, communication, and personal growth

What Makes BriteLife Recovery Different

Our approach is rooted in the belief that addiction is not evidence of moral failure or permanent brokenness, but a response to disconnection and often to trauma. We create safe, inclusive environments where you can explore the challenges that brought you to treatment with dignity and compassion. Our trauma-responsive approach recognizes that trauma and adverse life experiences often underlie the patterns that lead to substance use.

We offer distinctive programming not commonly found in traditional treatment centers. Our clinicians are certified in Nature-Informed Therapy, an innovative approach that integrates ecopsychology with evidence-based therapeutic practices. Our Adventure Recovery services provide transformative experiences in beautiful outdoor settings, including the Catskill Mountains of New York and the coastal environment of South Carolina.

We emphasize interpersonal healing through process-oriented group therapy, recognizing that addiction is fundamentally a disease of disconnection that heals through authentic connection with others. Our groups create space for exploring real-time interactions, developing self-awareness, and building healthier ways of relating to yourself and others.

Treatment Locations

Pennsylvania (Hanover)

Our Pennsylvania location offers comprehensive detox and residential services with robust psychiatric care, including access to psychiatrists and psychiatric nurse practitioners. We provide diverse therapeutic programming in a supportive community environment.

South Carolina (Hilton Head Island)

In South Carolina, we provide gender-specific residential treatment with dedicated facilities—Main Street for men and Ulmer House for women. Our coastal location offers opportunities for beach activities, community engagement, and healing in the beautiful Hilton Head area.

New York (West Kill)

Our New York facility in the scenic Catskill Mountains emphasizes Adventure Recovery programming and Nature-Informed Therapy in stunning natural surroundings. We offer detox and residential treatment with extensive outdoor experiential activities including hiking, rafting, and nature-based therapeutic groups.

New Jersey

We offer intensive outpatient services in New Jersey for individuals who benefit from structured support while maintaining their daily work and family responsibilities.

What If Meritain Health Denies Coverage?

If Meritain Health denies coverage for addiction treatment or limits your care, you have the right to appeal the decision. Insurance denials can occur for various reasons—lack of medical necessity determination, insufficient documentation, or administrative errors—but many denials can be successfully overturned through the appeals process.

Steps to Appeal a Denial

1. Request written explanation – Ask Meritain Health for a detailed, written explanation of why coverage was denied
2. Review your plan documents – Check your Summary of Benefits and plan documents to understand your coverage and appeals rights
3. Gather supporting documentation – Collect clinical records, treatment recommendations from healthcare providers, and evidence supporting the medical necessity of treatment
4. Submit a formal appeal – File your appeal within the timeframe specified in your denial letter (typically 180 days), including all supporting documentation
5. Request external review – If your internal appeal is denied, you can request an independent external review by a third party
6. Seek professional assistance – Your treatment provider, patient advocates, or legal services can help navigate the appeals process
7. Document everything – Keep copies of all correspondence, forms, and communications with Meritain Health

Under mental health parity laws, Meritain Health must apply the same standards to substance use disorder treatment denials as they apply to medical and surgical denials. If you believe your denial violates parity requirements, you can file a complaint with your state insurance department or the U.S. Department of Labor's Employee Benefits Security Administration.

Mental Health Parity Protections

The Mental Health Parity and Addiction Equity Act provides critical protections ensuring that substance use disorder treatment is covered equitably. Under these federal protections, Meritain Health plans must ensure that:

• Financial requirements (deductibles, co-pays, co-insurance, out-of-pocket maximums) for behavioral health services are no more restrictive than those for medical/surgical benefits
• Treatment limitations (visit limits, day limits, authorization requirements) are no more restrictive than those for medical/surgical benefits
• Separate or additional financial requirements apply only to behavioral health benefits
• Network adequacy standards for behavioral health providers meet the same standards as medical providers
• Medical necessity criteria and utilization review processes are applied comparably

These protections mean that if your plan covers medical conditions without prior authorization, it generally cannot require prior authorization for substance use disorder treatment unless it can demonstrate the requirements are applied comparably. Similarly, if medical conditions receive coverage for extended hospitalization when medically necessary, behavioral health conditions must receive similar consideration.

Employment Protections During Treatment

If you're concerned about taking time away from work for addiction treatment, the Family and Medical Leave Act (FMLA) provides important protections for eligible employees. FMLA allows you to take up to 12 weeks of unpaid, job-protected leave for substance use disorder treatment.

Key FMLA protections include:

• Your employer must continue your health insurance coverage during FMLA leave, including your Meritain Health benefits
• You must be restored to the same position or an equivalent role when you return from treatment
• Your employer cannot retaliate against you for taking medical leave for addiction treatment
• FMLA leave can be taken intermittently for ongoing treatment needs

To qualify for FMLA, you must have worked for your employer for at least 12 months and worked at least 1,250 hours during the previous 12 months. Your employer must have at least 50 employees within 75 miles of your worksite. These protections recognize that addiction treatment is medical care deserving of the same workplace accommodations as treatment for any other health condition.

Financial Assistance and Payment Options

If your Meritain Health coverage is limited or if you have high out-of-pocket costs, BriteLife Recovery offers several options to help you access treatment:

• Payment plans – Flexible payment arrangements to spread costs over manageable timeframes
• Out-of-network benefits – Even if we're out-of-network, your plan may provide partial coverage; we can help you understand these benefits
• Financial assistance programs – Contact our admissions team to discuss available options based on your circumstances
• Alternative insurance verification – We accept many insurance providers beyond Meritain Health

Don't let concerns about insurance coverage prevent you from seeking treatment. Our team will work with you to find solutions that make treatment accessible. The cost of untreated addiction—to your health, relationships, career, and quality of life—far exceeds the cost of treatment.

The Importance of Using Your Insurance Benefits

Substance use disorders are chronic medical conditions that respond to professional treatment. Your Meritain Health insurance benefits exist specifically to help you access this life-saving care. According to the National Institute on Drug Abuse, treatment helps people stop using drugs, avoid relapse, and successfully recover their lives. Research consistently shows that people who receive treatment reduce their substance use and improve their health, social functioning, and productivity.

Treatment outcomes improve with early intervention and comprehensive care. The longer substance use continues untreated, the more complex recovery becomes. Using your insurance benefits for addiction treatment is both your right and an investment in your future—in your health, your relationships, your career, and your capacity to live a meaningful life.

Next Steps: Getting Started with Treatment

If you're ready to explore addiction treatment using your Meritain Health insurance, BriteLife Recovery makes the process straightforward and supportive:

1. Contact us – Call our admissions team or reach out through our website; our team is available to answer questions and provide support
2. Insurance verification – We'll verify your Meritain Health coverage at no cost and explain your benefits in clear, understandable terms
3. Clinical assessment – Our team conducts a confidential assessment to understand your needs and recommend the appropriate level of care
4. Prior authorization – We handle all paperwork, documentation, and authorization requirements with Meritain Health on your behalf
5. Admission coordination – We arrange your admission, answer questions about what to expect, and coordinate travel if needed
6. Begin treatment – You start your recovery journey with comprehensive, compassionate care tailored to your needs

Recovery begins with reaching out. Whether you're seeking treatment for yourself or helping someone you care about, taking the first step requires courage. Our team at BriteLife Recovery is here to support you through every stage—from verifying insurance coverage to continuing care planning after treatment.

Frequently Asked Questions About Meritain Health Coverage

How long does Meritain Health typically cover residential treatment?

Coverage duration varies by plan and individual circumstances. Many plans initially approve 28-30 days of residential treatment based on medical necessity. Additional days can be authorized through ongoing review of your clinical progress and continued need for this level of care. Your treatment team works with Meritain Health to advocate for the length of treatment you need.

Does Meritain Health cover family therapy?

Many Meritain Health plans include coverage for family therapy as part of substance use disorder treatment. Family involvement can be crucial to recovery, helping to heal relationship dynamics and build sustainable support systems. Check your specific plan or contact us to verify family therapy benefits.

Will I pay the same amount for in-network and out-of-network treatment?

No, in-network treatment is significantly less expensive. Out-of-network care typically involves higher deductibles, higher co-insurance percentages (you might pay 40-60% instead of 20%), and costs that may not count toward your out-of-pocket maximum. Some plans provide limited or no out-of-network coverage.

Can I use Meritain Health insurance at any BriteLife Recovery location?

Coverage details can vary by location and specific plan. Contact our admissions team to verify coverage for the BriteLife Recovery facility you're interested in. We'll check your benefits and explain what's covered at each of our locations in Pennsylvania, South Carolina, New York, and New Jersey.

What if I'm not sure Meritain Health will cover my treatment?

Don't let uncertainty prevent you from seeking help. Contact BriteLife Recovery and we'll verify your coverage at no cost. Even if your benefits are limited, we'll work with you to explore all available options for accessing treatment. Many people are surprised to discover they have better coverage than they expected.

Does Meritain Health cover medications for addiction treatment?

Yes, most Meritain Health plans cover FDA-approved medications for substance use disorder treatment, including Suboxone, naltrexone, and Vivitrol. Medication-assisted treatment is widely recognized as an evidence-based, effective approach to treating opioid and alcohol use disorders.

Conclusion

Meritain Health insurance provides valuable coverage for addiction treatment services, helping individuals and families access professional care for substance use disorders. As a subsidiary of Aetna and CVS Health, Meritain Health offers access to an extensive network of behavioral health providers and comprehensive benefits for recovery services.

Understanding your coverage, verifying your benefits, and working with experienced treatment providers like BriteLife Recovery ensures you can access the care needed for lasting recovery. Our approach recognizes that addiction stems from disconnection and that healing occurs through rebuilding connections—to yourself, to others, and to meaningful purpose.

If you or someone you care about is struggling with substance use, reaching out for help is the most important step. Your Meritain Health insurance benefits exist to support this journey toward healing. BriteLife Recovery is here to walk alongside you, providing compassionate, evidence-based care that honors your dignity and supports your recovery at every stage.