Does Anthem Cover The Cost of Alcohol or Drug Rehab?

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July 16, 2021 by
Does Anthem Cover The Cost of Alcohol or Drug Rehab?

What Benefits Does Anthem Offer For Treating Alcohol & Drug Addiction?

Anthem is one of the largest health insurance companies in the United States. It’s the parent company of the Blue Cross Blue Shield Association and has independent licensees in more than 15 states.

Insured Anthem customers are typically covered for some or most of the cost of alcohol and drug rehab depending upon their individual or group plan.

The amount of coverage that Anthem offers for treating alcohol and drug addiction is dependent on the insured person and their insurance plan. In order to be sure about what your benefits pertaining to substance use disorder treatment are with Anthem, it’s best to call the phone number on the back of your insurance card so you can speak to a representative about your coverage in more detail.

Your Anthem representative can provide you with information concerning addiction treatment benefits as well as giving you information on whether you need to use an in-network treatment center and therapists.

If you or a loved one are struggling with addiction, call WhiteSands Alcohol and Drug Rehab today at 877.969.1993 to learn how we can help.

Anthem’s plan networks can determine your choices of doctors, hospitals, and treatment centers for substance abuse disorder and mental health treatment in as much as how much you’ll be covered or reimbursed for services.

Preferred Provider Organizations (PPO), Exclusive Provider Organizations (EPO), and Health Maintenance Organizations (HMO) are examples of network plans that either requires you to choose from a selection of in-network providers or let you choose whichever provider you wish, depending upon the plan.

Does Anthem Cover the Cost For Rehab?

Anthem offers insurance coverage for alcohol and drug rehab treatment, including individual therapy sessions, such as cognitive behavioral therapy, and experiential therapy.

Although you may be covered for addiction rehab under Anthem, it’s also true that you can be responsible for some costs, such as co-pays and meeting deductible amounts before benefits can be paid. The coverage is dependent on your specific policy and the state in which you live.

It’s important to go through the details of your Anthem plan and see what the requirements are for coverage. You may find that you need pre-authorization before being admitted to an inpatient rehab program for coverage by Anthem. Always be sure to double-check on whether pre-authorization is required before enrolling in residential care. We can help you with this at WhiteSands.

You might discover that precertification requirements exist for any residential admissions for addiction treatment, an intensive outpatient program, or partial hospitalization programs that encompass mental health and substance abuse treatment.

How To Verify Your Anthem Insurance Benefits For Addiction Coverage

The intake coordinators at WhiteSands are happy to help you verify your benefits when you call (877)640-7820. We will help you determine approximately what your out-of-pocket cost will be.

There is a phone number on the back of your insurance card that you can call to speak to an insurance representative about your policy coverage in terms of addiction rehab treatment and care. You can also ask our intake coordinators at WhiteSands to verify your insurance benefits on your behalf.

Does Anthem Cover the Cost of Attending Rehab For Spouses or Children?

Your particular individual or group policy with Anthem will determine whether or not spouses and children are covered for rehab costs. A family policy, couples policy, or individual policy will list who is provided coverage for any healthcare needs.

Tiers of Anthem and Benefits of Each Package

Anthem offers a variety of health insurance plan packages that consist of different tiers affecting the monthly premiums and deductibles. The tiered plans include a Bronze, Silver, Gold, and Platinum Plan.

The Bronze package has the lowest monthly costs and comes with a high deductible. This plan is useful for individuals who don’t need medical help very often for need protection in case of sudden illness or emergencies.

The Silver plan has a higher monthly premium with a lower deductible than the Bronze plan. Anthem’s Gold plan comes with an even higher monthly cost but has a low deductible. This is a good plan choice if you visit the doctor often or know you’ll require a good amount of healthcare. Most medical care fees are covered with this plan.

The Platinum plan comes with the highest monthly payment, however, the deductible amount is the lowest. If you need medical care on a regular basis, this plan provides the most coverage.

Does Anthem Cover the Cost of Inpatient Rehab?

Anthem typically pays for drug and alcohol rehab therapy and detox services, which are performed in a residential setting.

Does Anthem Cover Substance Abuse & Mental Health Residential Stays?

The coverage you have under your Anthem insurance policy can be dependent on the state you live in, what the policy outlines, your condition, and which treatment center providers you wish to use.

Someone suffering from substance use disorder often also might have an underlying mental health issue that contributes to their addictive behaviors. If your substance abuse and mental health needs are medically necessary, then Anthem will likely cover a certain portion or even most of your cost for a residential stay at a treatment center like WhiteSands. If Anthem is your provider under the Affordable Care Act, you are entitled to coverage for your mental health care and treatment.

Anthem understands that addiction and mental health issues can co-exist simultaneously and that it’s vital to treat them at the same time. Anthem offers comprehensive Behavioral Health programs to provide holistic care for their customers. This is important for individuals requiring treatment for both a substance use disorder and a co-existing mental health disorder.

Anthem has behavioral health coverage that is similar to an insurance policy’s mental health coverage. If you need mental health and substance abuse treatment, the company’s Behavioral Health Managers specialize in coordinating your care to ensure you receive integrated treatment for your condition. Your care manager will help you connect with the appropriate health care services you need.

You’ll have access to in-network behavioral health providers, trained care managers, and various treatment program types.

In many cases, your Anthem policy can cover a partial hospitalization program, intensive outpatient program, and residential treatment.

Does Anthem Pay For Outpatient Rehab?

Anthem policies provide network options that include intensive outpatient programs for rehab.

How Long Will Anthem Cover the Rehab Stay For?

Research has shown that addiction treatment requires individualized care. The longer patients remain in treatment, the greater their chances for long-lasting sobriety in recovery. Most people need at least 3 months of rehab treatment to achieve a successful recovery.

With Anthem’s variety of tiered plans and coverage, your policy will determine the amount of time in rehab that will be paid for.

Call Us Now To Verify Your Insurance Benefits

Patients come to us from Tampa, Fort Myers, Orlando, Sarasota, Brandon, Gainesville, Drug and Alcohol Detox Center in Naples, and more. At WhiteSands, we will work with you to verify your insurance benefits with Anthem, ppo plans for drug rehab or determine which other providers we accept. Our trained counselors are highly experienced in this field. Call us today and let us help you begin your journey toward a life of sobriety.

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Frequently Asked Questions

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Anthem provides coverage for drug and alcohol rehab treatment under most of its health plans, as required by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. Coverage typically extends to behavioral health treatment including individual therapy, cognitive behavioral therapy, and experiential therapy. The exact services covered depend on your specific Anthem plan, the level of care needed, and whether the treatment facility is in-network. Reaching out to Anthem directly or working with an Anthem-accepting treatment provider can help clarify your specific benefits.

Anthem covers a broad range of addiction treatment services, including medical detox, inpatient residential rehab, partial hospitalization programs, intensive outpatient programs, and standard outpatient therapy. Medication-assisted treatment for opioid or alcohol dependence may also be covered when it is medically necessary under your plan. Coverage for individual and group counseling sessions, including evidence-based approaches like cognitive behavioral therapy, is also typically included. Your coverage depends on your specific plan, your state of residence, and the clinical criteria Anthem uses to determine medical necessity.

Anthem generally requires prior authorization for higher levels of addiction care, including inpatient rehab, partial hospitalization, and intensive outpatient programs. This means Anthem reviews the proposed treatment plan to confirm it meets medical necessity standards before coverage is approved. Starting treatment without obtaining prior authorization can lead to a denial of claims for those services. Treatment centers that work regularly with Anthem, like WhiteSands Treatment, are experienced in managing the prior authorization process on behalf of patients.

Even with Anthem coverage, you may be responsible for some out-of-pocket expenses depending on your plan design. These can include a deductible that must be met before coverage begins, a copay per visit, or a co-insurance percentage applied after the deductible. Choosing an Anthem in-network rehab facility significantly reduces these costs compared to using an out-of-network provider. Reviewing your Anthem Explanation of Benefits or speaking with a treatment advisor can help you understand your specific financial obligations before treatment starts.

Anthem covers inpatient rehab for alcohol addiction under most of its plans, provided the treatment is deemed medically necessary and prior authorization is obtained when required. Inpatient residential care offers 24-hour medical supervision and is typically reserved for individuals with severe alcohol dependence or those at risk of serious withdrawal complications. Anthem's behavioral health benefits are governed by federal parity laws, which require coverage for substance use disorders to be comparable to coverage for other medical conditions. Verifying your inpatient benefits with Anthem before admission ensures you understand what costs will be covered.

Anthem covers individual therapy sessions, including cognitive behavioral therapy, as part of its addiction treatment benefits under most plans. Cognitive behavioral therapy is considered an evidence-based approach to addiction recovery and is widely recognized by clinical guidelines as effective for treating substance use disorders. Coverage may also extend to group therapy sessions as part of a structured rehab program. Your specific benefit structure, such as the number of covered sessions or applicable copays, varies by plan.

Anthem generally covers dual diagnosis treatment, which addresses both addiction and a co-occurring mental health condition such as depression, anxiety, PTSD, or bipolar disorder. The Mental Health Parity and Addiction Equity Act requires Anthem to provide coverage for behavioral health conditions at parity with physical health benefits. Integrated treatment programs that treat addiction alongside mental health disorders may be covered under your Anthem behavioral health benefits. Confirming your dual diagnosis benefits with Anthem before beginning treatment is recommended.

You can verify your Anthem rehab coverage by calling the behavioral health or member services number listed on your Anthem insurance card or by logging into the Anthem member portal to review your benefits summary. Alternatively, contacting a WhiteSands Treatment admissions advisor allows Anthem to be contacted on your behalf to confirm your coverage, including the levels of care covered, any prior authorization requirements, and your expected out-of-pocket costs. Having this information in advance helps you focus on your recovery without financial uncertainty.

If Anthem denies your rehab coverage, you have the right to appeal the decision. The appeals process typically involves submitting clinical documentation to support medical necessity, and your treatment provider can assist with gathering this information. Anthem is required to process appeals within specific timeframes, and you may also request an expedited review if the situation is urgent. An external review by an independent third party is also available if the internal appeal is unsuccessful.

Anthem covers medication-assisted treatment for opioid use disorder and alcohol dependence under most plans when it is determined to be medically necessary. Medications such as buprenorphine, naltrexone, and methadone may be covered as part of a comprehensive addiction treatment plan that includes counseling and behavioral therapy. Coverage for MAT is supported by federal parity requirements, and Anthem-contracted facilities that offer these services can help coordinate your benefits. Verifying MAT coverage with Anthem ahead of treatment ensures you know what medications and associated counseling services are included in your plan.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.

About the Author

is a proud alumni member of WhiteSands Treatment. After living a life of chaos, destruction and constant let downs, Mark was able to make a complete turnaround that sparked a new way of life. He is serious about his recovery along with helping others. At WhiteSands Treatment, we offer support to you in your homes or when you are out living in your daily lives.

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