Key Takeaways
- Anthem Health Insurance, part of Elevance Health and the Blue Cross Blue Shield Association, provides coverage for addiction treatment and mental health services under most plans.
- Anthem’s coverage typically includes medical detox, inpatient rehab, outpatient rehab services, medication-assisted treatment, and co-occurring disorder treatment.
- The Affordable Care Act requires health insurance companies like Anthem to treat mental health and substance use disorder treatment as essential health benefits.
- Your out-of-pocket costs depend on your plan tier, whether your treatment center is in-network, and your specific coverage details.
- Pre-authorization is required before starting a drug and alcohol rehab program with Anthem, so start that process early.
- The Lakes Treatment Center accepts Anthem and offers individualized treatment plans across detox, residential, and outpatient levels of care.
A common roadblock that can keep individuals from getting the substance abuse treatment that they need is the cost. That is where having health insurance coverage comes into play, allowing you to get the treatment you need at a more affordable rate. This is something that is possible with Anthem drug rehab coverage.
In this article, we will discuss what type of drug and alcohol rehab Anthem covers and the different health insurance plans you have access to. We will also discuss how you can choose the right rehab centers that will accept your Anthem insurance policy.
What is Anthem Insurance
Anthem is one of 36 companies that are within the Blue Cross Blue Shield Association. Now operating under its parent company Elevance Health, it is one of the largest health insurance companies in the country, covering a wide variety of healthcare needs and providing various plans to fit different individuals.
Anthem health insurance works in much the same way as any other type of insurance, providing different tiers or plans that will dictate the type of coverage you have access to. It can help to cover health services like primary care, behavioral health, mental health treatment, physical therapy, dental coverage under certain plans, and long-term wellness resources.
Anthem also offers different plan structures, including health maintenance organization (HMO) plans and preferred provider organization (PPO) plans. An HMO usually requires you to stay within a set network and get referrals from your primary healthcare provider, while a PPO gives you more flexibility to see out of network providers at a higher cost. Knowing which structure you have is an important first step in understanding your coverage details.
Does Anthem Cover Substance Abuse Treatment?
If you are looking for coverage that will help with the cost of substance use treatment, the good news is that this is something Anthem can help with. Anthem provides coverage for addiction treatment that spans substance use disorder care, mental health conditions, and behavioral treatment.
This is partly because of the Affordable Care Act, which requires insurance providers to cover mental health and substance use disorder treatment as essential health benefits. So whether you are dealing with a substance use disorder on its own or alongside mental health disorders like anxiety or depression, your plan should offer some level of support for seeking treatment.
This means that you can usually get substance use treatment if you have Anthem coverage, no matter what type of plan you are under. The different plans will just dictate how much Anthem will cover vs your out-of-pocket costs.
Here is a breakdown of the different plans Anthem provides for policyholders:
- Bronze: This plan has low monthly premiums but has the highest deductible and co-pays. So, about 60% of all of your medical costs will be covered by Anthem.
- Silver: This plan has slightly higher monthly premiums and slightly lower deductibles and co-pays. And about 70% of your medical expenses will be covered by Anthem.
- Gold: This plan has the highest monthly premiums but also has the lowest deductible and co-pays, with about 80% of your medical expenses being covered by Anthem.
What Types of Drug Rehab Does Anthem Cover?
Now that you know that you can use Anthem for drug rehab, what types of treatment will this insurance cover? Anthem’s coverage policies can be quite tricky, so you always need to do your research beforehand to ensure that your program will be covered.
Here is a breakdown of the common treatment modalities that Anthem’s coverage typically includes:
- Medical detox: Anthem will usually provide coverage for medically supervised detox programs that allow you to go through withdrawal symptoms under the medical supervision of trained professionals. This is often the first step in addiction care, especially for substances where withdrawal can be dangerous without support.
- Inpatient rehab services: Anthem coverage can help cover the cost of residential treatment, which is often the most expensive type of addiction treatment. Inpatient rehab allows you to stay on-site at rehabilitation facilities during your program, giving you 24/7 access to recovery resources and professionals.
- Outpatient treatment services: Anthem policyholders can also get coverage for outpatient services at several levels of care. Standard outpatient therapy involves regular sessions of individual therapy and group therapy while you continue living at home. Intensive outpatient treatment steps things up with more frequent sessions each week, and partial hospitalization programs offer full days of structured care without an overnight stay. These outpatient rehab options let you keep up with work, school, or family obligations while still getting consistent support.
- Medication-assisted treatment: Many Anthem plans include therapy coverage alongside FDA-approved medications that help manage cravings and withdrawal symptoms. Medication-assisted treatment pairs these medications with behavioral therapies and ongoing medication management from your care team.
- Co-occurring disorder treatment: If you are living with both a substance use disorder and other mental health conditions, Anthem plans generally cover integrated care for co-occurring disorders. Treating mental health and substance use together tends to lead to stronger, longer-lasting recovery than treating either one alone.
Keep in mind that what your Anthem insurance coverage provides will depend on your individual policy and plan. You should also research the treatment facility you are interested in to better understand how they manage expenses and insurance coverage.
How to Start Drug Rehab With Anthem Coverage
Even if you have Anthem drug rehab coverage, there are certain steps you need to take before you join a rehab program so that you don’t get any unpleasant surprises later on.
Research Your Anthem Plan
Before you begin the process of looking for an addiction treatment program, the first step you need to take is to research your Anthem insurance plan. Health insurance coverage is notoriously complex, but you need to understand how this works so that you can choose a facility that is covered.
To better understand your plan and the addiction treatment coverage you have access to, you can call your health insurance to speak to an agent directly. Or, you can get on the website, where there will be resources regarding your coverage and treatment options.
Look For In-Network Facilities
Once you understand how your Anthem coverage works, you can begin looking for substance abuse treatment centers. It is generally recommended that you do this using Anthem’s website, which will have an in-network finder so that you can narrow down your options. This will help you to avoid making the mistake of joining a program that isn’t covered by Anthem.
Keep in mind that the treatment center needs to be in-network and the program you wish to join also needs to be covered by your plan. If you choose out of network providers, you will usually pay significantly more, and some plans will not cover out-of-network care at all.
Understand Your Out-of-Pocket Expenses
How much your out-of-pocket expenses will be for substance abuse treatment will depend on several things. This will depend on your specific Anthem plan as well as the type of treatment and the treatment center.
You also need to do your research to find out if you need to pay a deductible or co-pay, and if so, how much it will be. Depending on the type of treatment, you may also need to research whether or not any necessary medications will be covered by Anthem.
Initiate Pre-Authorization
Although not required by all insurance carriers, pre-authorization is mandatory for Anthem policyholders. Pre-authorization is when you get approval for a drug rehab program before you officially start it.
Anthem requires pre-authorization so that it can make sure the program meets its specific criteria for medical necessity and is also covered by your individual policy. Your healthcare provider or the treatment center’s admissions team can often help you get this process started.
Why Anthem Policyholders Choose The Lakes Treatment Center
At The Lakes Treatment Center, we understand how important it is for our patients to access affordable substance abuse treatment. That is why we accept a wide variety of insurance carriers, including Anthem.
We provide comprehensive services across the full continuum of care, whether you need alcohol, heroin, marijuana, fentanyl, or meth addiction treatment. We also build individualized treatment plans around your specific needs, which your policy may cover, including medically supervised detox, residential treatment, and outpatient programs.
The Lakes Treatment Center has a strong focus on long-lasting recovery by equipping patients with the tools and resources they need moving forward. Because of this, we also provide different types of therapies and recovery resources that you can access, such as:
- Family therapy
- Group counseling
- Life-skills training
- Art therapy
- Physical therapy
- Aftercare and support groups
So, no matter what type of addiction treatment you need, we are here to help.
Start Your Recovery Journey Today at The Lakes Treatment Center
If you have noticed that you are struggling with substance abuse, you need to look into joining a drug rehab program. And if you have Anthem drug rehab coverage, you will have access to a variety of treatment options. This can help you get the treatment that you need for long-term substance abuse recovery.
At The Lakes Treatment Center, we accept a wide variety of insurance carriers, making our drug and alcohol rehab programs accessible to many individuals. We also provide all of the treatment options you may need for long-term recovery, including different therapies, detox, and aftercare resources.
So, are you ready to begin your recovery journey and take back your life? Contact us today at The Lakes Treatment Center to learn more about our intake process and the insurance carriers that we accept.
Frequently Asked Questions
Does Anthem cover mental health treatment along with drug rehab?
Yes. Anthem plans cover mental health services alongside substance use treatment, including care for anxiety, depression, and other mental health conditions. If you are dealing with co-occurring disorders, integrated treatment that addresses both at once is generally covered and is considered the standard of care.
Does Anthem cover outpatient rehab services?
Most Anthem plans cover multiple levels of outpatient care, from standard outpatient therapy to intensive outpatient treatment and partial hospitalization programs. Outpatient rehab is often a good fit if you have work or family obligations, or as a step-down level of care after completing inpatient treatment.
Does Anthem cover medication-assisted treatment?
Anthem plans generally cover medication-assisted treatment, which combines FDA-approved medications with counseling and behavioral therapies. Your plan’s coverage details will determine which medications are included and whether ongoing medication management requires any additional authorization.
What is the difference between an HMO and a PPO plan with Anthem?
A health maintenance organization plan usually requires you to stay in-network and get referrals through a primary healthcare provider. A preferred provider organization plan gives you more freedom to choose your own providers, including out-of-network providers, though at a higher out-of-pocket cost. Both plan types can include coverage for addiction treatment.
Do I need pre-authorization before starting treatment?
Yes. Anthem requires pre-authorization for drug rehab programs to confirm medical necessity and verify that the program is covered under your policy. The admissions team at most rehab centers, including The Lakes Treatment Center, can help you navigate this process so that it does not delay your care.
How do I verify my Anthem coverage at The Lakes Treatment Center?
The simplest way is to contact our admissions team directly. We can verify your Anthem health insurance benefits, walk you through your expected out-of-pocket costs, and help you begin the pre-authorization process so you can start seeking treatment as soon as possible.
