Does Anthem Insurance cover drug treatment?

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Anthem Blue Shield is a healthcare insurance provider in the United States. They cover over 70 million people in the country and work with a large network of providers. Anthem covers many drug and alcohol rehab expenses, so if you are insured by Anthem, finding a recovery option should be relatively straightforward.

Anthem is an independent licensee of the Blue Cross and Blue Shield Association. It currently serves members in the following states:[1]

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

The provider also serves some specialty plan members in other states.

The extent to which expenses are covered by Anthem depends on the plan you have and whether or not the rehab facility you choose is in- or out-of-network. If you would like to determine which rehab services and facilities are covered by your specific Anthem plan, you can call the number on the back of your insurance card.

Anthem Insurance Coverage

Anthem provides insurance coverage for the treatment of substance use disorder, including rehab. Depending on the state you live in and the type of policy you have, Anthem will work with different treatment centers to provide services for those looking to attend rehab for drug and alcohol addiction. A variety of levels of care may be covered by your policy plan.

Addiction treatment services that may be covered by Anthem policies include:

  • Inpatient hospitalization
  • Intensive outpatient rehabilitation
  • Outpatient rehabilitation
  • Partial hospitalization
  • Residential treatment
  • Detoxification
  • Dual-diagnosis care
  • Family counseling
  • Medication-assisted treatment

Seeking treatment for drug and alcohol addiction can save you or your loved one’s life. With Anthem, treatment costs may be fully covered or reduced. Typical services include inpatient treatment, outpatient treatment, and medication-assisted treatment.

Inpatient treatment

Many people benefit from inpatient drug and alcohol rehabilitation. Residential treatment involves living onsite for 24/7 care for 30-90 days on average, though some stays may be longer in duration. Inpatient programs include a variety of treatments, including individual and group counseling, medications to ease withdrawal symptoms and cravings, and dual-diagnosis treatment if needed. You may require pre-authorization from Anthem before signing into rehab, and that may require a referral from your primary physician to prove inpatient rehab is medically necessary. Some Anthem policies offer full coverage for a specified number of days per year. Other plans may not cover all costs for inpatient treatment. Your plan may require meeting a deductible before Anthem covers any costs or a copayment.

Outpatient Treatment

Because recovery is a lifelong process, many people who complete inpatient treatment may decide to enter outpatient treatment as the next step in their journey to recovery. Attending outpatient treatment involves counseling, support groups, and mediations that help keep a person on the right path and reduce their risk of relapse. Treatment is typically at a rehab facility for a prescribed number of hours each day, and usually lasts anywhere from 2-7 days a week, depending on the person’s needs and the level of care they require. Rehab facilities may offer outpatient services including day programs like intensive outpatient or partial hospitalization programs.

Counseling and other services can be accessed through your provider. Anthem can help members find patient treatment that is covered by their insurance policy. Out-of-pocket expenses vary, depending on the type of treatment, who is performing the services, and your specific plan.

Medication-Assisted Detox and Treatment

Withdrawal from some drugs and alcohol can be uncomfortable. The withdrawal process can be complex for some, impacting not just their physical health but their mental health as well. For them, detox is best done under medical supervision. Medications can be prescribed to help ease withdrawal symptoms and help you safely detox from substances. Medication-assisted treatment (MAT) may also be needed in combination with therapy once detox is completed.

Medications provided during detox and throughout the course of treatment may be covered by your Anthem plan. Information about which medications are covered by your plan can be found in your policy’s description.

No matter what treatment you need, Anthem must determine what your plan covers. That decision is based on what is called “medical necessity.” If something is needed from a medical point of view and the need for this treatment is confirmed, Anthem insurance is likely to cover some or all of your costs, depending on the plan you have.

Mental Health Coverage by Anthem

Many people who have substance use disorder also have mental health disorders such as depression, anxiety, PTSD, and mood disorders. These are known as co-occurring disorders or dual diagnoses. The 2016 National Survey on Drug Use and Health reported that more than 8 million adults aged 18 or older had both mental illness and substance use disorder.[2]

Treating co-occurring mental health and substance use disorders at the same time is important, as one can trigger the other. Both issues must be addressed concurrently in order for treatment to be most effective.

Under the Affordable Care Act, insurance providers are required to provide coverage for mental health care and treatment. Co-occurring disorder treatment and stand-alone rehab for drug and alcohol addiction fall under this mandate. Anthem understands that behavioral health is an important part of a person’s overall health and well-being, so their plans offer mental health and substance abuse benefits.

Anthem Insurance Rehab Coverage Duration

Longer treatment times are generally considered most effective, but of course, each patient’s individual needs are a little different. A longer stay in rehab generally means fewer instances of relapse and better rates for long-term sobriety. According to a recent study, better treatment outcomes are associated with a longer duration of treatment (3-6 months) and structured continuing care, such as outpatient treatment and counseling.[3]

Because there are many different types of policies and tiers of coverage, the length of time your policy covers will depend on your specific plan and your situation (e.g., how long you’ve been using, which substances are being abused, and any legal repercussions you may have faced). You can look up your plan information online or call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab.

In order for Anthem insurance to cover your rehab expenses, you must meet the criteria established by the company. Anthem considers the following when deciding if they will approve coverage:

  • Severity of illness
  • Intensity of service
  • Continued stay criteria

Before entering a rehab facility, you must contact Anthem on the number on the back of your insurance card. Alternatively, specialists at American Addiction Centers are here to help you. We can help you get a clearer picture of what your health plan covers in regard to drug and alcohol rehab. You can call us 24/7 at 1-888-287-0471 .

Rehabs Not Covered by an Anthem Insurance Policy

Because Anthem covers only services that are deemed medically necessary, some expenses associated with rehab may not be covered. These services include:

  • Private room
  • Spa services
  • Complementary therapies (e.g., reiki, acupuncture)

No matter what is or isn’t covered by insurance, getting treatment now is important and you or your loved one’s life could depend on it. If your insurance doesn’t cover everything, many rehab facilities will help you set up payment or financing plans or provide scholarship options to help cover your costs at a pace that works for you.

In-Network vs. Out-of-Network Rehab Center

If you are looking for a rehab facility for yourself or your loved one, first consider looking for an in-network facility. An in-network rehab facility is one that has an agreement with Anthem that allows for care at a lower cost than other providers. Many insurance companies will cover rehab expenses only for centers that are in-network to save on costs.

Receiving services from out-of-network facilities means the insurance company does not have an agreement with the provider and may not cover costs. If you choose an out-of-network facility, you may end up paying higher out-of-pocket costs and covering the entire cost of rehab yourself.

The difference in cost when selecting in-network or out-of-network care can be significant. Anthem may cover out-of-network costs in certain cases, particularly if you live in an area that does not have rehab treatment facilities or if you have specific needs that only an out-of-network facility can provide care for.

Check Your Benefits

It’s important to be armed with as much information about any costs or out-of-pocket expenses you may be responsible for when entering rehab. Check your Anthem policy benefits to determine what is covered by your specific plan and what you will pay yourself. Call the number on your insurance card or log in to your account on Anthem’s member website to determine if there will be copays. In some cases, depending on your plan, a deductible must be reached before coverage kicks in.

American Addiction Centers can verify your insurance coverage for you. Complete the form below to enter your information and learn if the center you are considering is in Anthem’s network. If you prefer, call our helpline at 1-888-287-0471 and speak to a specialist who can check your benefits while you’re on the phone.

Source

[1] Anthem. (2021). Company History.

[2] Center for Behavioral Health Statistics.SAMHSA – Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.

[3] Eastwood B, Peacock A, Millar T, et al. Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. J Subst Abuse Treat. (2018).