Rehab Centers That Accept Anthem BCBS

The cost of substance abuse treatment can be substantial, with some residential programs costing upward of $12,500 per month. But financial concerns shouldn’t keep you from seeking treatment. There are many options for affording rehab, and if you have Anthem BCBS insurance, it may cover a large portion of treatment.

If you’re ready to reach out for help, learning more about Anthem BCBS’ substance abuse treatment coverage, the types of plans available and how to verify your benefits can help you find a rehab that works for you.

Anthem BCBS, or Anthem BlueCross BlueShield, is part of the larger BlueCross BlueShield Association and is one of the primary insurance providers across the United States. The parent company, Anthem, Inc., changed its official name to Elevance Health in 2022, but insurance plans are still managed under the Anthem BCBS brand.

Anthem BCBS has more than 45.2 million members and is available in 13 states. It offers individual and family plans on the Health Insurance Marketplace, employer-sponsored plans and Medicare/Medicaid plans. Anthem BCB has Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Point of Service (POS) plans, depending on location.

The Affordable Care Act (ACA) names mental health and behavioral health services, including those for substance use disorder, as essential services. The Mental Health Parity and Addiction Equity Act (MHPAEA) also requires insurance companies, including Anthem BlueCross BlueShield, to cover substance abuse treatment the same way they cover medical care.

Anthem BCBS plans cover:

• Applied behavioral analysis (ABA)
• Case management services
• Crisis services
• Inpatient mental healthcare
• Intensive outpatient treatment
• Medication management
• Residential treatment
• Counseling and behavioral therapy

Exact coverage depends on your policy terms. Call Anthem Member Services to verify your benefits or have a representative walk you through eligible treatments and requirements.

Anthem BCBS insurance covers a broad range of addiction treatment services across the continuum of care, from detox and inpatient rehab to ongoing outpatient care.

Detox is often medically necessary to stabilize the client before they’re healthy enough to be able to go to a residential facility or participate in treatments such as behavioral therapy. Anthem BlueCross BlueShield sometimes refers to detox as withdrawal management in insurance documents.

Most Anthem plans cover detox that’s necessary, such as for alcohol, opioids and benzodiazepines, but there may be a cap on how long you can stay at this level of care. You’ll also likely need prior approval to attend detox before Anthem BCBS will pay because it’s considered acute inpatient treatment.

Medication-assisted treatment (MAT) helps manage withdrawal symptoms and reduce cravings. Because MAT is approved by the U.S. Food and Drug Administration (FDA) and is considered an essential health benefit, Anthem BCBS plans are required to cover it.

Your policy may require you to use certain formularies for the medication, and some of the coverage may come through pharmacy benefits instead of medical benefits. Some medications may require prior authorization.

Inpatient mental and behavioral health services are considered an essential health benefit. This means that any Anthem BCBS plans purchased through the Health Insurance Marketplace must cover these services.

Most other Anthem BCBS policies, including employer-sponsored plans, offer at least partial coverage for inpatient rehab. Some plans may require you to meet your deductible first, and others require prior authorization. However, most Anthem BlueCross BlueShield plans don’t require a referral to see a specialist or access substance abuse treatment.

Addiction often occurs alongside mental health disorders, such as anxiety, depression or post-traumatic stress disorder (PTSD). This is known as dual diagnosis or co-occurring disorders.

Dual-diagnosis treatment may be covered under medical benefits and/or behavioral health benefits, which can make determining your share of the cost a little more complicated. For many Anthem BCBS plans, medical benefits are subject to cost-sharing, including coinsurance, after you meet your deductible. Behavioral therapy and counseling may have a co-pay per visit if you’re seeing an outpatient provider.

Outpatient treatment programs provide care on designated days instead of requiring you to live on-site. Some outpatient programs may only require you to attend a group meeting once a week, while others, such as intensive outpatient programs (IOP) or partial hospitalization programs (PHP), are much more frequent.

Most Anthem BCBS plans cover outpatient treatment for substance use disorder to some degree, but exact details depend on your policy. Check your Summary of Benefits page for more information on your co-pay, coinsurance and deductible and whether there are any restrictions.

Counseling and behavioral therapy are covered under the mental and behavioral health benefits part of your Anthem BCBS plan. Some plans may require you to see an in-network provider, and there’s usually a co-pay for each office visit. Services that are part of a larger residential or outpatient rehab program may already be included in the overall cost of treatment.

After completing rehab, many people choose to take advantage of continuing care programs, which can range from peer support groups to sober living. Many continuing care services, such as sober living, aren’t usually covered by insurance. Always verify your benefits and coverage with Anthem BlueCross BlueShield directly to ensure you know what to expect.

What services are covered under Anthem BCBS, and how much your policy pays, depends on several factors, including:

• Where you live. Anthem BCBS offers policies in 13 states, and each state has different rules and regulations. What’s covered can vary greatly between locations.
• Your plan type and tier level. HMO and EPO plans only cover care from in-network providers, while PPO and POS plans pay for out-of-network care but to a much smaller degree. Tier level also makes a difference, with higher metal tiers, such as Gold and Platinum, generally offering more comprehensive coverage than lower tiers.
• The level of care you need. Anthem BCBS plans have different coverage depending on the level of care. Residential and inpatient programs often require pre-authorization or have limits on the length of stay before you need to show that continuing care is medically necessary.

Your deductible, co-pay and coinsurance also play a major role in how much you could pay out of pocket for treatment. If you’re not sure whether a service is covered or you have questions about your policy, call the number on the back of your card to speak to an Anthem BCBS representative.

Whether your Anthem BCBS covers out-of-network rehab programs depends on the plan type. PPO and POS plans offer both in- and out-of-network coverage, but out-of-network care is subject to higher cost-sharing. This means you’ll likely spend a lot more out of pocket if you see an out-of-network provider.

HMO and EPO plans don’t cover out-of-network care unless it’s a medical emergency. If you decide to see an out-of-network provider, you’ll be responsible for the entire amount. You may be able to get financial assistance from the facility through payment plans, sliding-scale fees or third-party financing.

Anthem BCBS offers a wide variety of health insurance plans, and what’s available to you depends on whether you’re buying the plan yourself or through a group-sponsored plan and which state you live in.

Individual and family plans are for those who buy coverage directly through the Health Insurance Marketplace. Anthem BCBS plans are separated by tier:

• Bronze plans have the lowest monthly premiums but also the highest deductibles and cost-sharing percentages.
• Silver plans have moderate premiums, but you’ll usually pay less out of pocket for treatment. These plans also offer cost-sharing reductions for people with qualifying income, which can help make care more affordable.
• Gold plans have higher premiums than lower tiers, but cost-sharing percentages are lower.
• Platinum plans have the highest monthly premiums but the lowest deductibles and cost-sharing. They’re often a good choice for those with other health conditions or who frequently need medical care.

Employer-sponsored and group plans are those in which the employer or group pays part or all of the premiums. The employer usually selects the available plan types, but the employee or group members can choose from that list.

Most employer-sponsored and group plans must cover mental health and substance abuse treatment the same way they cover traditional medical care. For example, if your policy covers inpatient care for a physical medical issue, it must also cover inpatient care for substance abuse.

Anthem BCBS’ Medicare plans are for those aged 65 and older and people with a qualifying disability. It offers Original Medicare and Medicare Advantage plans.

Original Medicare is divided into Parts A and B. Medicare Part A covers inpatient treatment for substance use, including detox. Part B covers outpatient care, which can include intensive programs, such as partial hospitalization or ongoing care, such as therapy.

Medicaid plans offered through Anthem BCBS are income-dependent, and each state has different rules for what’s covered. Because Medicaid is a joint state and federal program, there are some mandated benefits for substance use disorder treatment, including MAT for opioid use disorder and any medically necessary screenings, assessments or treatments for substance use disorder for those under the age of 21.

Getting coverage for residential rehab treatment under an Anthem BCBS Medicaid plan can be more complicated. Whether your insurance will cover it depends on the type of facility, the length of stay and medical necessity.

• Coverage for addiction treatment doesn’t depend on the type of substance the person is using. It’s based on whether the service is medically necessary and falls under the covered treatments based on that specific policy.Anthem BCBS may cover treatment for:
  • Alcohol addiction
  • Heroin addiction
  • Meth addiction
  • Cocaine addiction
  • Prescription drug addiction
  • Opioid addiction

  Behavioral addictions work differently. You generally need to have a relevant diagnosis for treatment to be covered by insurance.

  Gambling disorder is a recognized behavioral addiction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), so it qualifies for treatment under behavioral health benefits. If you’re seeking treatment for another behavioral addiction, it’s only covered if you have another relevant DSM-5 diagnosis, such as an anxiety disorder or a co-occurring substance use disorder.

Finding a rehab center that accepts Anthem BlueCross BlueShield insurance can significantly reduce your out-of-pocket costs for substance abuse treatment.

To get help locating in-network rehab centers:

• Use Anthem BCBS’ patient portal. After logging in, you’ll be able to view your specific plan information and coverage and search for in-network providers.
• Search for a Blue Distinction Center. BlueCross BlueShield has a tool that lets you search specifically for Blue Distinction Centers, which are designated facilities that prioritize quality care, safety and evidence-based treatment.
• Talk to an Anthem BCBS representative. Call the member services number on the back of your insurance card to connect with someone who can help you find in-network substance abuse treatment that’s near you. You can also verify your benefits during this time.
• Call the rehab directly. Many treatment facilities offer free insurance verification. They’ll tell you whether they’re in-network with Anthem BCBS and explain what your benefits cover.

Remember that being in-network with your insurance is only one factor when choosing a rehab. Look for centers that are accredited, have licensed clinical staff and provide evidence-based care.

Anthem BCBS insurance can help you afford the treatment you need to take back control of your life and start moving in a positive direction. If you need help understanding your benefits, finding a rehab near you or preparing for treatment, we can help. Call our free, confidential helpline to talk to someone who can walk you through your next steps.