Rehab Helps Thousands of Addicts Quit. It Can Help You, Too.

doctor and patient talking to each otherAnthem Health Insurance provides drug and alcohol detox and rehabilitation coverage under its behavioral health care plan. This coverage is currently provided in all 50 U.S. states. Anthem covers both inpatient and outpatient substance abuse treatment for members who have behavioral health care coverage as part of their plan.

The level of coverage available to you under Anthem may vary, depending on the state in which you reside and the plan in which you are currently enrolled.1 At this time, Anthem provides insurance at the following levels, ranging from least to most coverage2:

  • Bronze.
  • Silver.
  • Gold.
  • Platinum.

If you currently have insurance coverage at the Bronze level, you will pay less for your monthly premium, but you will pay a certain amount out of pocket for an inpatient or outpatient detox and rehabilitation treatment center. On the other hand, if you have a Platinum insurance plan with Anthem, you will pay more for your monthly premium and less out of pocket for an inpatient or outpatient detox and/or rehabilitation treatment center.

Does Anthem Cover Detox Services?

Anthem does provide coverage for inpatient alcohol and substance abuse services – which often include detox services. But if you are interested a center that focuses strictly on the detox phase, then speaking with a care manager at Anthem will help you find out if the center is in your provider network and if your plan will cover your stay.

Does Anthem Cover Rehab?

Anthem Health Insurance does provide coverage for rehabilitation services. It is important to either contact one of our advisors at 1-888-341-7785 or contact Anthem directly and ask to speak to a care manager to get the most comprehensive information about your specific coverage – as the amount of coverage can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay and your insurance plan level.1

Addiction Treatment Length Anthem Will Cover

Doctor holding treatment patient's handThe expected or typical length of stay varies widely among treatment facilities. Some common lengths of inpatient treatment can be 30 days, 60 days, 90 days or longer. The length of stay will depend on your particular circumstances and needs.

When considering the length of stay that is appropriate for each person, the rehab facility and the insurance company will consider the following factors:

 

  • How long you or your loved one has been using the substance.
  • The type of substance that is being abused.
  • Whether or not there have been any legal repercussions so far for using the substance.
  • Problems at home, work or school.
  • Any coexisting mental health diagnoses.
  • Family history.
  • Whether there have already been less involved levels of addiction treatment – and what the outcomes were for such prior attempts.

Specialty Alcohol and Drug Treatment Through Anthem

Depending on your coverage under Anthem, you may be eligible to enter into a luxury or executive rehabilitation facility. Luxury and executive centers provide the same services as other treatment facilities, but in addition will provide amenities, such as:

  • Private rooms.
  • Spa services – including massage, acupuncture and chiropractors.
  • State-of-the-art gym equipment.
  • Gourmet food prepared by chefs.

Executive facilities additionally offer busy professionals the resources and program structure to maintain an active involvement at work during the recovery process.

Insurance for Inpatient Addiction Treatment vs. Outpatient Addiction Treatment

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Inpatient vs. Outpatient
When considering whether inpatient or outpatient treatment is best for you, it is also important to understand the associated costs for both.

When considering whether inpatient or outpatient treatment is best for you, it is also important to understand the associated costs for both.

For inpatient stays, the insured is typically responsible for a certain amount plus a specific percentage of the total cost. As an example, you may be responsible for $500 plus 10% of the total cost of the inpatient stay for an in-network provider. If, however, you choose to go with an out-of-network provider, you would be responsible for paying significantly more.

For outpatient levels of service, the insured is typically responsible for a certain percentage of the total cost plus a daily copay. For example, you may be responsible for 10% plus a $20 copay each day that you attend. It is important to keep in mind that your insurance company will approve a certain number of outpatient days and will consider your attendance record when deciding to either extend your approval or approve a longer length of stay.

Therefore, when considering the outpatient level of care, it’s important to factor in the affordability of your daily or weekly copay, and whether or not you can commit to the level of attendance advised.

How to Cover What Insurance Won’t

Covering the cost of treatment may feel like one of the biggest challenges for those seeking drug or alcohol treatment. But it doesn't have to be a challenge.Covering the cost of treatment may feel like one of the biggest challenges for those seeking drug or alcohol treatment. Most facilities will work with you, however, in coming up with a payment plan that works for you and your budget. Although the use of a payment plan may result in having to pay interest on the total amount owed, it may be the most feasible option for you or your loved one.

Some facilities may even consider taking on a certain amount of charitable or scholarship cases. This phenomenon is rare, but it is worth asking each facility if charity or scholarships are offered beyond what insurance will pay.

Verifying Coverage and Finding the Best Treatment

Seeking coverage for inpatient and outpatient drug and alcohol treatment can be a confusing and time consuming process. If you need further help in the process of sorting through insurance, you may call one of our recovery advisors at 1-888-341-7785 who will help steer you in the right direction.

Anthem Health Insurance also provides members with care managers who can assist in:

  • Explaining member coverage and benefits.
  • Finding in- and out-of-network providers.
  • Certifying various levels of treatment.

The certification approval of either inpatient or outpatient drug and alcohol treatment is determined according to your medical necessity. If you plan to contact your insurance company to seek approval for substance abuse treatment, it is important to understand the criteria that your care manager or utilization review specialist will be using when considering covering services for you or your loved one. Failing to address the issue of medical necessity could lead to being denied for the level of care that you need.

Calling Anthem Health Insurance

When contacting Anthem regarding coverage for substance abuse or dependence treatment, the first step is finding out if you are covered by Anthem or Anthem Blue Cross Blue Shield. If you have an insurance card, a customer service number should be located on the back of the card. If you do not have an insurance card, Blue Cross Blue Shield offers links to each state's website.3 Contacting the right customer service number can make your search for the right detox or rehab facility much more efficient and less frustrating.

During your phone call, you may want to obtain a list of in-network treatment centers. Once you have this list, you can research the various facilities and their costs, as these can vary widely.

When you have found two or three facilities that you are interested in, you can contact the facilities to ask if they have a utilization review department that can seek pre-certification for you or your loved one. If they do, this may be your best avenue when seeking coverage, as these are trained professionals who can speak directly to medical necessity when seeking authorization.

Contact Anthem

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Contacting the right customer service number can make your search for the right detox or rehab facility much more efficient and less frustrating. During your phone call, you may want to obtain a list of in-network treatment centers. Once you have this list, you can research the various facilities and their costs, as these can vary widely.

Find Help for Treating Your Addiction

What’s most important is that you are able to get the help you need to treat your addiction. There is a lot of information regarding health insurance that can be confusing and perhaps overwhelming. If you would like some help in sorting through this information to the get the addiction treatment you need, one of our recovery advisors would be more than happy to help assist you in this process. Call 1-888-341-7785.

Sources

  1. Behavioral health. (2016). Anthem.
  2. Health insurance marketplace opens. (2015). Anthem.
  3. About the Blue Cross Blue Shield companies. (2016). Blue Cross Blue Shield.

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