Anthem Insurance Coverage For Alcohol & Drug Rehab

Anthem, Inc., is sometimes called Anthem Blue Cross Blue Shield because it is part of the Blue Cross Blue Shield Association, which is the corporate home of 36 companies.

As the largest of these companies, Anthem is the product of a merger with Wellpoint Health Networks but has a limited presence nationally.

Anthem health insurance plans can be found in 14 states, including:

• Wisconsin
• Virginia
• Ohio
• New York
• New Hampshire
• Nevada
• Missouri
• Maine
• Kentucky
• Indiana
• Georgia
• Connecticut
• Colorado
• California

Anthem offers a range of plans including Medicare and Medicaid, but Medicaid plans can only be found in eight of the 14 states.

Does Anthem Cover Rehab?

Anthem insurance covers many different aspects of addiction treatment including service types and levels of care.

This includes such levels of care as inpatient and outpatient programs, as well as treatment services like behavioral therapy and medication-assisted treatment (MAT).

Substance Abuse Treatment Services Covered By Anthem

All of the different addiction treatment settings and services available can be difficult to keep track of, so look to the table below for an overall breakdown of coverage provided by Anthem.

Anthem Coverage By Treatment Type

Take a closer look at the programs and services that are covered. Sometimes you need prior authorization for specific services, or there are limits or exclusions to take note of.

Anthem Plan Types

Anthem has four plan types consisting of three private plans in addition to public plans available through the government-sponsored programs Medicaid and Medicare.

Its private health insurance plans include:

• Bronze plans
• Silver plans
• Gold plans

There are variations within each of the plans, but here are the basics. Bronze plans are for people who require fewer doctor visits and need insurance for medical emergencies. As such, the premiums are low but the deductibles are high.

Sliver plans are for small families and individuals who have average healthcare needs but not a lot of chronic health problems. These plans strike a balance between monthly premiums and deductibles.

Finally, Anthem’s Gold plans are for people who have chronic health issues and are willing to pay higher monthly premiums for a lower deductible.

How To Use Anthem Coverage For Substance Abuse Treatment

Anthem is easy to use for substance abuse coverage. If you are working with a treatment provider who accepts Anthem, they will simply need the information on your card to get the coverage process started.

In-network providers know Anthem’s coverage limits and the conditions for prior authorizations. You may want to stay in contact with Anthem throughout the treatment process so there are no surprises.

Out-of-network providers may also accept Anthem, but you will owe a higher deductible, co-pay, or coinsurance.

Anthem Co-Pays And Deductibles For Addiction Treatment

Your deductibles and co-pays depend on what Anthem plan you have: Gold, Silver, or Bronze.

Bronze-level plans have the highest deductibles, which can be as high as $7,000 per person. Co-pay amounts can be as much as $65 per visit.

For Silver plans, deductibles are around $4,500, and co-pays are around $45 per visit.

Gold plans, which have much higher monthly premiums, have no deductibles and co-pays around $35 per year.

What Addictions Does Anthem Cover?

Anthem has made it a point to let its members know that it covers the treatment of opioid use disorder using medications like buprenorphine and naltrexone.

Anthem also covers treatment for alcohol use disorder, stimulant use disorder, and other forms of addiction.

What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?

The cost of addiction treatment may be the biggest barrier to care for people facing drug and alcohol abuse. Fortunately, other options in addition to insurance coverage can help you pay for substance abuse treatment.

Government-Funded Insurance

If you are over the age of 65, pregnant, or have little or no income, then Medicaid or Medicare might be good options for you to look into.

Medicare is funded by the federal government and is specifically for people who are age 65 or older.

Medicaid is funded by both federal and state governments for people with specific conditions or little or no income.

If you are looking into a treatment provider that accepts Medicaid, they may even help you determine your eligibility for Medicaid and enroll.

Government Grants

If you are unable to pay for addiction treatment, look into treatment centers in your area that accept grants from federal, state, or local levels of government.

The most common grants come from the Substance Abuse and Mental Health Services Administration (SAMHSA), which provides block grants for states to distribute to qualifying rehab centers.

Drug rehab centers that receive grant money (either from SAMHSA or other agencies) pass the savings onto qualifying people who need help paying for treatment.

Payment Assistance

Many drug and alcohol addiction recovery centers offer payment assistance in one form or another to clients who need financial help accessing rehab services.

This may include adjusting the cost of treatment through a sliding fee scale, offering scholarships, or providing a payment plan, which, like a loan, may include interest.

Finding A Rehab Center That Accepts Anthem

If you are looking for a treatment program that accepts Anthem, the easiest way to go about it may be to call Anthem’s customer service number and ask for help finding in-network providers.

Other ways to go about it include calling the treatment centers in your area and asking them, or looking them up online. Many rehab centers offer insurance verification on their websites.

Find Substance Abuse Treatment Today

If you are looking for substance abuse treatment for yourself or a loved one, call us today. We have more information about beginning the recovery journey.

Written by the Addiction Resource Editorial Staff