Coverage
Drug Rehabs That Take NYSHIP: Finding In-Network Addiction Treatment
Under The Empire Plan, substance use treatment is handled by the Mental Health and Substance Use (MHSU) Program, administered by Carelon Behavioral Health. A rehab is "in network" only if it participates in that MHSU network for your level of care. A center saying it "takes NYSHIP" is not the same thing, so confirm network status and certification before admission.
Published by the NYSHIP.rehab editorial resource · Updated
How does NYSHIP rehab network status work?
The Empire Plan has separate parts run by different administrators. Hospital benefits and medical/surgical benefits have their own administrators, while mental health and substance use care is managed through the MHSU Program, administered by Carelon Behavioral Health (PE and C-82 At A Glance, printed p. 11). See who administers each part of the plan.
For addiction treatment, the network that matters is the MHSU network. A facility that is in network for one Empire Plan program, or that takes other Anthem or Blue Cross cards, is not automatically in the MHSU network for detox or rehab.
Covered services must also be certified as medically necessary, in network or not. If care is not certified, the guides say you may receive no benefits (printed p. 11). Read how Empire Plan rehab coverage works for the full framework.
What should you ask a rehab center's admissions team?
Five questions before you commit
- Exact location: What is the facility's legal name, street address and tax ID? Network status applies to a specific provider and location, so give those details to the MHSU Program when you check.
- In network or billing as a courtesy? Are you in The Empire Plan MHSU network for this level of care, or are you a non-network provider offering to bill the plan for me?
- Practitioners: Will doctors or groups bill separately, and are they in network too?
- Certification: Who requests certification from the MHSU Program — you or me — and can I get the reference number?
- Charges outside the plan: Are there any fees you expect the plan not to pay, such as optional amenities?
Then confirm the answers yourself with The Empire Plan at 1-877-769-7447 (official plan number), pressing or saying 3 for the MHSU Program. Our treatment helpline, 516-219-1975, can help you review options first; it is not NYSHIP or your plan. Learn more about prior authorization with Carelon.
Which levels of care can an in-network rehab provide?
| Level of care | What it is | Network coverage in the guides | Read more |
|---|---|---|---|
| Medical detox | Supervised withdrawal management, inpatient or outpatient | Inpatient care: approved stays paid in full | Detox coverage |
| Inpatient or residential rehab | Living at a facility with daily treatment | Approved stays paid in full, subject to plan terms | Inpatient rehab coverage |
| Partial hospitalization (PHP) | Several hours of treatment most days, living at home | Outpatient programs may have a $25 copayment per visit | Outpatient, PHP and IOP |
| Intensive outpatient (IOP) | A few hours of treatment several days a week | Outpatient programs may have a $25 copayment per visit | Outpatient, PHP and IOP |
In-network costs count toward an annual out-of-pocket limit that differs between the PE and C-82 guides. See how much rehab costs with NYSHIP.
How do New York OASAS-certified programs compare with out-of-state rehabs?
In New York, addiction treatment programs are certified by the Office of Addiction Services and Supports (OASAS). OASAS certification is a state license to operate, not Empire Plan network membership. A certified program may or may not be in the MHSU network.
Out-of-state programs follow the same rule: what matters is whether the specific facility is in The Empire Plan MHSU network and whether the stay is certified. Otherwise non-network rules apply, including a deductible, coinsurance and possible balance bills. Ask the MHSU Program before admission, and see what to do if no network provider is nearby.
Travel, lodging and time away from work are usually not plan expenses. If you need time off, read medical leave for rehab.
What does "we accept NYSHIP" really mean?
- Ask for network status in writing, then confirm it with the MHSU Program yourself.
- Check every level of care: a program can be in network for one level and not another.
- Ask whether any doctor, lab or group bills separately and outside the network.
- Compare the math in our out-of-network rehab guide before choosing a non-network program.
- On Long Island? Read NYSHIP addiction treatment on Long Island.
Frequently asked questions
Does NYSHIP cover private rehab facilities?
Ownership does not decide coverage. What matters is whether the facility is in The Empire Plan MHSU network for your level of care and whether the stay is certified as medically necessary. Non-network private programs are paid under non-network rules (printed p. 11).
How do I know if a facility is in-network with The Empire Plan?
Call The Empire Plan at 1-877-769-7447 and press or say 3 for the MHSU Program. Give the facility's exact name and address and the level of care. Don't rely only on a website or an admissions call. See prior authorization.
Can I go to an out-of-state rehab facility using NYSHIP?
Possibly. Ask the MHSU Program before admission whether the facility is in network and whether the stay will be certified. If it is not in network, non-network cost sharing applies. See Empire Plan rehab coverage.
What out-of-pocket costs should I expect at an in-network rehab center?
The 2026 guides describe approved network inpatient stays as paid in full and outpatient visits as possibly carrying a $25 copay, up to an annual in-network limit that differs by group. See rehab cost with NYSHIP.
Related guides
- CoverageHow Empire Plan rehab coverage works in 2026How The Empire Plan's Mental Health and Substance Use Program covers rehab in 2026: who it applies to, network vs non-network rules, and what to confirm first.
- CoverageDoes NYSHIP cover detox and withdrawal management?Does NYSHIP cover detox? How Empire Plan MHSU rules apply to medically supervised withdrawal management, emergencies, network status and certification.
- CoverageNYSHIP inpatient and residential rehab coverageHow Empire Plan inpatient and residential rehab coverage works: certification, network stays paid in full, non-network 10% of billed charges and what to ask.
- CoverageOutpatient, PHP and IOP coverage under NYSHIPEmpire Plan coverage for outpatient rehab, PHP, IOP and virtual IOP: the $25 network copay, non-network 80% allowed amount and questions to ask.
- CoveragePrior authorization for NYSHIP rehab: who calls, and whenWhen Empire Plan substance use care needs certification, who requests it, what happens in emergencies and a call checklist for the MHSU Program.
- CostsHow much does rehab cost with NYSHIP?Estimate your Empire Plan rehab cost in five steps: network copays, the non-network deductible, coinsurance and balance billing.
Sources and source dates
- The Empire Plan At A Glance — Participating Employers (PE), January 2026 (opens in a new tab) — January 2026 (AAG-PE-1/26). Printed page(s) 2, 11, 12. New York State Department of Civil Service.
- The Empire Plan At A Glance — Council 82 (C-82), January 2026 (opens in a new tab) — January 2026 (AAG-C-82-1/26). Printed page(s) 2, 11, 12. New York State Department of Civil Service.
- NYSHIP — Employees of Participating Employers (official site) (opens in a new tab) — Accessed October 17, 2026. The former cs.ny.gov group benefits page now redirects here.
- New York State Office of Addiction Services and Supports (OASAS) (opens in a new tab) — Reference listed October 17, 2026
- FindTreatment.gov (SAMHSA treatment locator) (opens in a new tab) — Reference listed October 17, 2026
Plan guides are summaries and can change. Your Empire Plan Certificate and Certificate amendments control. This page is general education, not medical, legal or benefits advice. Read our editorial standards.