One of the most common myths about drug and alcohol addiction is that the condition is somehow the fault of the person who is debilitated by it.
Substance abuse is part of the disease of addiction, which should be treated by medical specialists who understand the impact of drugs and alcohol on the reward center of the brain.
Failing to see addiction as a disease that requires medical treatment affected insurance companies for a long time, which led to their refusal of coverage for drug and alcohol treatment centers. This is finally starting to change, though.
Those who have health insurance through a company called Anthem can often get help paying for drug rehab programs they may not otherwise be able to afford.
Does Anthem Cover Addiction Treatment?
Anthem is a subsidiary of Anthem Blue Cross Blue Shield company. It has many of the same health benefits as the larger insurance company, so its plans are structured in a similar way.
The first Anthem plan is called the bronze coverage plan. It covers about 60 percent of a person’s medical expenses. Most people choose it because it has low monthly payments. The deductible that goes with it is higher than for the other plans. Deductibles have to be paid before Anthem BCBS will begin to cover any of the medical bills.
The second plan is called the silver coverage plan. It is similar to the bronze plan, but it pays up to 70 percent of a person’s medical expenses.
The gold coverage plan is better since it pays 80 percent of the expenses. Its deductible is much lower. The platinum coverage plan is considered the best plan of all as it covers 90 percent of the medical expenses.
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But those who have a platinum plan often have the highest premiums to pay. Anthem customers who have plans with the highest amount of insurance coverage are more likely to have the majority of their treatment at a drug and alcohol rehab center covered.
Does Anthem Cover The Cost Of Inpatient Drug And Alcohol Treatment?
Blue Cross Blue Shield understands that mental health and substance abuse issues often go hand in hand, which is why its Anthem insurance policies cover the costs of inpatient treatment for addiction.
Inpatient treatment, or residential rehab, offers the most comprehensive care for addicted individuals. In inpatient rehab programs, patients can find ongoing medical care, therapy, counseling, case management, medication, and more. This well-rounded approach to recovery often results in the most successful treatment outcomes.
How much of your residential treatment stay will be covered by your Anthem insurance plan depends on your coverage tier. Bronze plans may cover a small portion with higher copays, while Platinum plans may cover the majority of inpatient treatment costs.
Because inpatient drug rehab programs can be costly, it’s a good idea to figure out how much your Anthem plan will pay toward treatment. This way, you understand your out-of-pocket treatment costs early on. Many rehab centers will work with you to develop a payment plan for any expenses not covered by Anthem BCBS.
Does Anthem Cover The Cost Of Outpatient Addiction Treatment?
Outpatient rehab programs are any treatments that do not require an extended stay at a rehab center and are covered by Anthem health insurance plans.
Addiction treatment programs vary in length and intensity, with each phase of treatment a different level of intensity from the next. Inpatient is the highest level of intensity, followed by partial hospitalization, intensive outpatient, and outpatient therapy and counseling.
As with inpatient rehab, outpatient treatment for drug and alcohol abuse is covered by Anthem, with coverage amounts based on your plan’s tier.
Each rehab program may be anywhere from 40 to 80 percent covered, depending on your plan. This means you will be responsible for paying the copay amount, though many rehab centers offer payment plans, sliding-fee scales, and other forms of assistance to ensure you get the help you need.
Does Anthem Cover The Cost Of Partial Hospitalization Programs?
Partial hospitalization programs (PHP) are the most intensive form of addiction treatment, next to inpatient treatment. PHPs are covered by Anthem Blue Cross Blue Shield insurance plans.
Certain restrictions may apply. For example, PHPs may only be covered by some insurance plans if inpatient treatment has been tried first. Your Anthem insurance company may also require prior authorization for you to receive treatment coverage.
The partial hospitalization program you choose may have to be approved as well, according to a list of preferred providers, if you have a preferred provider organization (PPO) or health maintenance organization (HMO) plan.
To know for sure, you can talk to your Anthem customer support representative to learn exactly which treatments are covered through your insurance policy.
Does Anthem Cover The Cost Of Intensive Outpatient Programs?
Anthem insurance does cover intensive outpatient programs (IOP). To meet coverage requirements, IOPs may have to be in-network, be offered by a rehab facility that accepts commercial insurance, and occur for a certain number of days and hours per week.
Intensive outpatient treatment for addiction is usually a step down in care for recovering individuals who have completed residential treatment or partial hospitalization. Residents of sober living homes may attend IOPs while working on getting a job or going back to school in order to maintain their recovery goals.
IOPs tend to be programs for those who are in a transitional phase of recovery. For this reason, it’s important to understand what percent of outpatient treatment costs will be covered by your Anthem plan and what will be your out-of-pocket costs.
Does Anthem Cover The Cost Of Suboxone?
Suboxone is an opioid medication that works to block cravings and other withdrawal symptoms, helping addicted individuals stop use of opioids.
When used as part of a medication-assisted treatment plan involving therapy, counseling, and other treatments, Suboxone therapy can help people overcome opioid abuse and enter long-term recovery.
Since Suboxone is a medication, coverage through Anthem occurs as part of the insurance policy’s pharmacy benefits. Copays will be determined by your Anthem plan.
Does Anthem Cover The Cost Of Methadone?
Methadone is another medication used in opioid treatment programs and is also covered by Anthem BCBS insurance plans.
Methadone maintenance therapy helps block the action of opioids to help recovering individuals stay sober. This medication is often part of a larger, long-term recovery plan combined with counseling, behavioral therapy, and other treatment methods.
As with other prescriptions, methadone pills or injections may come with a copay. Learn what your copay amount will be and how much of your methadone prescription will be covered through Anthem by speaking to an insurance adjuster.
Does Anthem BCBS Cover The Cost Of Sober Living?
Sober living homes offer recovering individuals a place to stay surrounded by others in recovery while transitioning from inpatient treatment back to daily living.
As sober living is considered a form of outpatient transitional care, it may be covered through your Anthem insurance plan, though coverage may vary by state.
If you have Anthem sober living coverage, you may be required to participate in outpatient counseling or therapy as well, and therapy coverage may be limited to a certain amount of sessions per year.
Understanding exactly what is covered through your Anthem Blue Cross Blue Shield health plan is important for planning your treatment stay and in recovery. For help in reviewing your Anthem insurance policy, talk to an insurance representative or one of our treatment specialists who can review your plan and explain your coverage.
How To Use Your Anthem Plan For Addiction Treatment
Using Anthem insurance to pay for addiction treatment is a fairly easy process. All a person has to do is contact the insurance company to let them know that they need help.
Anthem will then review their policy to let them know how much of treatment they will cover. Some of the most common drug and alcohol rehab programs that the company allows include detoxification, inpatient and outpatient treatment, and partial hospitalization.
They also offer case managers for those who need assistance with finding doctors or medical resources. However, it is important to mention that using Anthem insurance to pay for addiction treatment may require approval from a doctor before the person can enter treatment.
Also called prior authorization, pre-approval may be required if the policyholder has never been to a drug and alcohol rehab center. This is because the insurance carrier will want to verify the validity of their current mental and physical health.
They may also ask for drug testing to be done. Usually, a person’s primary care physician can handle this as long as they are on Anthem’s list of approved physicians.
List Of Anthem Plans By State
Rehab centers that accept Anthem insurance are limited because the company only offers insurance plans in the following four states:
Finding A Rehab Center That Accepts Anthem Insurance
Finding rehab centers that accept Anthem insurance is difficult because of the limited amount of states Anthem plans are offered in. Unfortunately, this can make it take much longer for an addicted person to get the treatment that they need.
For this reason, we highly recommend a phone call to one of our representatives ahead of time, especially if someone is struggling with an addiction to a substance that could cause dangerous withdrawal symptoms.
By contacting us first, we can save an enormous amount of time by quickly matching an addicted person with a drug and alcohol treatment center that will accept their insurance.
That way, it will be easier for them to focus on their recovery without worrying about paying for drug rehab with Anthem insurance.
Those who need help sorting through their Anthem insurance information regarding what Anthem will cover can give us a call for help. Our treatment specialists can help with finding a rehab facility that will best fit their health and financial needs.
Updated on July 27, 2020
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