Your Guide to Understanding Mercy Care Insurance

mercy care insurance

Starting addiction treatment can be a very daunting experience, which in some cases can be overwhelming. Compounding this feeling is the need to navigate medical insurance claims simultaneously. In such a difficult situation, you might be glad to hear that groups such as Mercy Care Insurance can help.

This guide explains how Mercy Care aligns with the Affordable Care Act and demonstrates how you can leverage both. Before you finish reading, you should know the next steps you need to take to engage with this provider. We want to ensure you have the peace of mind you need every step of the way.

What Is Mercy Care Insurance?

Mercy Care is a not-for-profit managed care organization. Their medical insurance covers a wide range of health services. This includes both general healthcare and more specialized treatments. 

They mostly offer coverage for those who qualify for the Arizona Health Care Cost Containment System (AHCCCS). This includes those who face low-income circumstances, as well as the elderly or disabled. The exact details of who can receive coverage can depend on many factors, including someone’s age, income, and specific health needs.

While these criteria are diverse, they broadly follow the limitations laid out in the Affordable Care Act.

What Service Plans Does Mercy Care Provide?

The range of services Mercy Care provides cater to many different segments of Arizona’s population. Each coverage plan thus meets specific medical needs. For example, physical and behavioral healthcare, or long-term care.

Accessibility and inclusivity are cornerstones of this insurance plan, and as such diverse groups can see a lot of benefit in Mercy Care. For example:

  • The elderly
  • The physically disabled
  • Those with mental illnesses
  • Children in foster care

This allows those who cannot support themselves to have a greater chance of receiving aid.

ACC-RBHA

This service stands for the “Arizona Health Care Cost Containment System Complete Care Regional Behavioral Health Agreement”. It provides health services with a focus on mental health and substance abuse, and can often help with the cost of rehab.

In some cases, it can support serious mental illnesses, offering more intensive support and resources.

Mercy Care Long-Term Care

This offers comprehensive healthcare coverage for elderly and physically disabled individuals. It also ensures someone receives long-term care as befits their unique healthcare needs.

Developmental Disabilities

Through DD, Mercy Care focuses on those who have developmental or cognitive disabilities. It can offer both long-term physical and behavioral healthcare.

This coverage works in conjunction with the Division of Developmental Disabilities and Arizona Long Term Care System.

DCS CHP

This form of coverage helps those who are in foster care receive the medical assistance they might need. It tailors itself toward children and youth in such a situation. At the same time, the grant works in collaboration with child safety services to ensure the safety of those it covers.

Mercy Care Advantage (HMO SNP)

This special needs plan combines many of the benefits of both Medicaid and Medicare and caters to those eligible for both.

It can cover Medicare A and B, which includes both hospital and medical insurance, as well as several other Medicaid benefits.

Instead of centering on post-illness care, it focuses on preventative action. The plan is also available for other specialized services. Examples include help for chronic conditions and rehabilitation.

What Else Does Mercy Care Insurance Provide?

As well as the above coverage, Mercy Care offers up to $500,000 to help those who are suffering from a range of other issues. This includes chronic conditions such as asthma and high blood pressure. It can also assist with substance abuse rehabilitation and mental health issues.

Substance Use Disorder Services (SUDS) Fund

This fund offers financial support related to substance abuse disorders, offering varied treatments. These include:

  • Detoxification
  • Residential treatments
  • Ongoing therapy
  • Outpatient programs

Mercy Care prides itself on its streamlined process for accessing these funds. The intent is to make the barrier to entry low enough to be able to help people with timely and effective treatment.

Substance Abuse Block Grant (SABG)

This is a federal grant program that Mercy Care allocates to help people in the state undergo substance abuse treatment. The program aims to expand access to such services, especially those in underserved communities. 

This grant also allows Mercy Care to start prevention and education programs. These can help prevent substance abuse at a community level.

State Opioid Response (SOR) Grant

The SOR aims to combat the opioid epidemic in Arizona and the larger United States. It offers opioid treatment and recovery services. It also supports innovative treatments, including medication-assisted treatment (MAT).

Much like the SABG, it also offers community-level support, aiming to reduce regional substance abuse.

Mental Health Block Grant (MHBG)

This grant offers funds to those who need mental health services, focusing on those with more severe mental illness. The intent is to engage in early intervention during childhood or adolescence, reducing the need for such support in later life.

Young Mental Health First Aid (Y/MHFA)

This is a mental health first aid grant, offering training for adults who interact with young people a lot. The intent is to empower them to recognize and address mental health concerns, as well as boost awareness in a community.

American Rescue Plan Act (ARPA)

ARPA offers enhanced access to health care, with the intent of helping those impacted by COVID-19. The grant is also available to healthcare providers, who can use it to ensure continuity of care for outpatients.

Behavioral Health Services

This grant allows people to access a wide range of behavioral health options. These include:

  • Therapy
  • Counseling
  • Psychiatric services
  • Integrating physical and behavioral health
  • Tailored treatment plans
  • Various specialized services

While many people use this service to help with anxiety and depression, it is also available for more complex disorders.

Medication-assisted treatment (MAT)

This grant supports long-term recovery by offering treatment for substance abuse disorders. Healthcare professionals integrate MAT with an overall care plan, using it to enhance other forms of therapy.

Therapy for Opioids and Substance Use

This grant offers a range of therapeutic services, allowing both individual and group therapy to occur. The intent is to offer professional holistic treatments in safe surroundings. This then reduces the likelihood of relapse.

Step-By-Step: Using Mercy Care to Cover the Cost of Rehab

The process of accessing Mercy Care’s coverage and benefits is not a simple one. Follow these steps, though, to ensure you stand the best chance of success.

Understanding Pre-authorizations and Coverage Limits

Research the coverage you have to understand what you are pre-authorized for when it comes to treatment and services. This information may be on your plan’s detail documents, or you can learn about it by contacting Mercy Care’s customer support. You should also speak with a rehab provider to ask which of their services demand pre-authorization. 

You should then collect all the medical information you have related to the service and treatment you need. This will include:

  • Medical records
  • Doctor’s notes
  • Detailed explanations of why the service is necessary

You can discuss the details with Mercy Care if you believe there may be more you should collect.

You can then speak with the rehab clinic to get them to initiate the pre-authorization request on your behalf. Ensure to provide them with all the necessary clinical documentation, and also ask if they need any more.

Once you have started the request, get a pre-authorization form from Mercy Care. This should be available on their website. When you fill it in, make sure to be accurate, as your coverage will depend on this information.

After submission, keep track of your request. You can either do this on a member portal on the site, or through several other mediums, including contacting Mercy Care’s support system.

After this, you will need to wait for their decision. You will then receive a notification of approval or denial.

You should use the opportunity to take note of any specific instructions they then give you. For example, they may ask for more information or deny you based on specific criteria.

Please be aware, though, that the above is not exhaustive. Always refer to your plan’s documentation or consult Mercy Care for the best advice.

Stay In Contact and Keep Records

Once you have received pre-authorization, work with the rehab center to schedule your treatment. You will also want to keep any records of documents and correspondence you receive, both from Mercy Care and the rehab location. These will be useful should you need to discuss what you expect to receive at any future time.

Choosing the Right Rehab Facility Within the Mercy Care Network

You should now have a good understanding of how to engage with Mercy Care Insurance to get the rehab services you need. Though, remember, the journey to recovery is not a sprint, nor is it identical for everyone. So, choosing the right insurance coverage is an important step you will want to do right.

Here at the Purpose Healing Center, we can offer advice on how to make good use of the coverage you already have and what your next steps should be. So, call us today and start your journey toward sobriety with the best help by your side.