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Anthem BCBS Insurance Coverage for Rehab

A man signing an Anthem BCBS insurance form after the agent explained the coverage for drug rehab

Published: September 6, 2023

Health insurance coverage can be confusing and overwhelming in any circumstance. When it comes to substance abuse coverage, it can be even more difficult to understand the parameters surrounding your coverage.

Anthem BCBS, or Anthem Blue Cross Blue Shield, is a common insurance company, covering about 47 million people. If you or someone you know is an Anthem BCBS policyholder, you may be wondering if the provider covers alcohol and drug addiction treatment.

Scroll on to learn more about addiction treatment and Anthem BCBS rehab coverage. You’ll find details about the kinds of treatment covered, the types of health insurance plans, and more.

Does Anthem BCBS Insurance Cover Drug Rehab?

Yes, Anthem insurance covers alcohol and drug addiction rehab. As a disclaimer, it’s important to note this coverage may be limited to certain parameters.

Checking with your provider is always the best step in understanding your coverage, but we’ve put together some key points for you to wrap your head around.

While coverage depends on the state you’re in as well as your insurance provider and many other factors, providers are required to cover mental and behavioral health services (including addiction treatment) as they are labeled essential health benefits by the Affordable Care Act (ACA).

Additionally, Anthem BCBS will not cover addiction treatment if the individual meets Voluntary Inpatient Detox (VID) criteria.

What Types of Addiction Treatment Does Anthem BCBS Cover?

Addiction treatment can vary from individual to individual based on their type of addiction and personal needs. As a result, there are myriad treatment options you may consider.

Medical Detox

Most plans with Anthem cover at least some of the costs associated with medical detoxification, though the level of coverage varies from plan to plan.

Medical detox is a service that helps detox the body from the addictive substance. While your body detoxes from the substance, you may experience symptoms of withdrawal due to substance dependency. This is why detox services help manage those symptoms as well as keep an eye on your vitals.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a common addiction treatment service. This FDA-approved treatment uses certain medications to help individuals recover from addiction and get through withdrawal.

Because MAT is not only FDA-approved but considered an essential health benefit, Anthem BCBS plans are required to provide coverage for it. However, this may be dependent on a referral from your primary care provider (PCP).

Inpatient Rehab

Inpatient treatment or residential treatment is a kind of rehab service that provides 24/7 care while the individual stays in a dedicated rehab facility for the length of their treatment.

Inpatient care is a great option for people who need around-the-clock care and may need to switch up their environment.

When it comes to Anthem BCBS, inpatient rehab is covered by most plans at least partially. Some plans may require you to meet your deductible first while others require a referral from your PCP.

Dual Diagnosis Treatment

Dual diagnosis treatment is another covered service that falls under addiction treatment. Addiction often occurs alongside mental health disorders such as anxiety, depression, or PTSD, which are known as dual diagnoses or co-occurring disorders.

Dual diagnosis treatment addresses the physical part of addiction while also addressing mental health conditions and how the two intertwine. Mental health disorder treatment can help individuals learn new coping mechanisms in place of substance abuse.

Anthem BCBS covers dual diagnosis treatment at least in part due to the ACA.

Outpatient Treatment Programs

Outpatient treatment programs vary, but involve care on designated days in a particular format. 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 a bit more strict and can be more frequent.

For most Anthem BCBS plans, at least some of the costs associated with outpatient programs are covered. This is based on ACA requirements as well as Anthem BCBS policies.

Counseling & Behavioral Therapy

Counseling and behavioral therapy are a big part of drug and alcohol addiction treatment. Therapy options may include individual counseling, group counseling, or specific therapy types like cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT).

Counseling and therapy are considered essential health benefits as mentioned above, so you should receive at least partial coverage through Anthem BCBS depending on your plan details

Continuing Care

After completing inpatient or outpatient treatment, some people choose to enroll in continuing care services to help ease their transition.

Continuing care can include counseling or even living in a sober living facility. Coverage for these services can be a bit more complex, but many are partially covered. Check with your plan for specific details.

Factors That Affect Anthem BCBS Coverage for Drug Rehab

There are many factors that go into addiction treatment coverage. For Anthem BCBS these can include where you live, your plan type, your metal level, and the level of care you need.

When it comes to your plan type, there are also several sub-factors. Plans vary in general coverage levels but also have different copay amounts, co-insurance amounts, deductibles, premiums, and even in-network treatment providers.

While all of these moving parts can be overwhelming, there are several resources you can use to help you understand your coverage. Try speaking with a representative from BCBS or checking through your patient portal.

Does Anthem BCBS Cover Out-of-Network Rehab Programs?

Some Anthem BCBS plans may cover out-of-network rehab programs at a lower coverage level. It’s important to note that some plans will not cover out-of-network programs, however.

As for the plans that have out-of-network benefits, the coverage is usually a lower percentage and the out-of-pocket maximum is usually higher.

It’s almost always best to stick to in-network facilities, but if you find a program that seems best for you and it’s out-of-network, don’t feel hopeless. Make sure to talk to someone at Anthem BCBS about your out-of-network benefits.

Types of Anthem BCBS Healthcare Plans

There is a wide variety of healthcare plans offered by Anthem BCBS.

HMO and PPO Plans

Anthem BCBS offers health maintenance organization (HMO) plans as well as preferred provider organization (PPO) programs.

The former requires you to pick a PCP and see them for any health-related concerns. If you need to see a specialist, your PCP will have to refer you.

The latter allows you to see any healthcare provider you want, in-network or out-of-network. However, not all out-of-network services may be completely covered.

Anthem BCBS also has medicare and medicaid programs.

Anthem BCBS Metal Levels

On top of the general plans, there are also differing metal levels within the types of plans. Metal levels include bronze, silver, gold, and platinum. As a result of the ACA, each metal level covers a percentage of your medical costs.

With Anthem BCBS bronze plans, your plan covers 60% and you cover 40%. Silver plans cover 70% and you cover 30%. Gold plans cover 80% and you cover 20%. Lastly, platinum plans cover 90% and you cover 10%.

As you can see, your plan type with Anthem BCBS can vary greatly. Even with these coverage percentages, it’s important to take into account copays and deductibles, both of which will differ between plans.

Types of Addiction Covered by Anthem BCBS Insurance

Anthem BCBS covers drug and alcohol addictions no matter the specific type of substance. That being said, there are several common addictive substances most treatment facilities offer rehab for.

Anthem BCBS may cover treatment for:

Where to Find Rehab Centers That Accept Anthem BCBS Near You

Once you have an understanding of your coverage for addiction treatment, it’s important to find a qualified, reliable treatment center that uses evidenced-based treatment approaches to help people through addiction.

If you’ve seen a physician for a substance use disorder diagnosis, you can always ask them for recommendations. However, not everyone sees a provider before going into treatment.

Anthem BCBS has a patient portal that allows you to view plan information as well as search for providers that are in-network.

The company also developed a designation program to identify Blue Distinction Centers, which you can find using the provider directory.

According to BCBS, these centers are “nationally accredited treatment facilities that are improving outcomes with evidence-based, patient-focused care.”

Find Drug & Alcohol Rehab Programs Covered by Anthem BCBS

Though it can be a little tricky to understand at first, Anthem BCBS offers a variety of coverage for addiction treatment so you or your loved one can get the help needed.

Ready to take the next step in substance abuse recovery? Give our helpline a call today to get help in finding treatment options near you that are covered by your insurance plan.

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