Elevance Health Insurance Coverage for Rehab

Elevance Health Insurance plans provide coverage for addiction treatment to policyholders, though what’s covered will vary by plan.

Knowing the scope of your plan’s coverage before going to rehab is important. Without proper coverage, you could end up with substantial costs after treatment, or seeking services at a treatment center of low quality or that isn’t your preference.

For a better understanding of your rehab coverage as an Elevance Health Insurance member, find out more about the healthcare services they cover for addiction treatment below.

Answer: Yes, Elevance Health Insurance does provide coverage for drug rehab, though this coverage will not be equal across all members and rehab facilities.

Elevance is a private insurance company formerly known as Anthem, and is a member of the Blue Cross Blue Shield Association.

It is one of the largest for-profit health plans in the United States, with around 47 million members.

Elevance currently offers insurance through Anthem Blue Cross and Blue Shield in 14 states, including New York, Nevada, and California, as well as through Wellpoint for their Medicare Advantage plan.

Because Elevance ecompasses so many different affiliated plans, there can be some variation in what is covered for substance abuse.

Answer: Elevance Health covers a variety of addiction treatment services, depending on the specific plan and the individual’s needs and level of care required by their treatment plan.

Medical Detox

Elevance covers medical detox, as long as it is deemed medically necessary. Because withdrawal can be fatal in some instances, it is usually not difficult for people to obtain this designation.

Medical detox is a very important step in the treatment process, and is especially important for people with life-threatening withdrawal symptoms from a substance such as alcohol.

Medication-Assisted Treatment

Many of the BCBS plans available from Elevance Health cover MAT, and members are encouraged, along with their physicians, to combine this treatment with behavioral therapy.

Medication-assisted treatment (MAT) is a type of treatment that is most often used for opioid use disorders. This type of treatment involves opioid replacement drugs to help ease people off their opioid use at a safe and comfortable pace.

Inpatient Rehab

Inpatient drug rehab is often covered by Elevance, although it will depend on a person’s length of stay and various other factors.

Inpatient treatment is known to be one of the most effective forms of substance use treatment, and with one of the highest success rates.

Dual Diagnosis Treatment

Dual diagnosis treatment is often covered by plans with Elevance, as it is considered a type of mental health treatment.

Many of the people who live with a substance use disorder also have co-occurring disorders in the form of mental health conditions like anxiety or depression.

Dual diagnosis care is targeted toward people with a co-occuring mental illness or behavioral health disorder and who could benefit from addressing this condition along with substance use.

Outpatient Treatment Programs

It is common to find outpatient addiction treatment covered by plans through Elevance, though members may still have copays or coinsurance to pay.

Many of the addiction treatment options that are available can be accessed in an outpatient rehab setting, which can be more convenient for people who cannot take time away from family or work.

It is also possible to find intensive outpatient programs (IOP) and partial hospitalization programs (PHP) for people who need a more intensive form of outpatient treatment.

Counseling & Behavioral Therapy

Counseling and therapy are integral components of any substance abuse program, and can include individual, group, family, and couples therapy.

This type of treatment is almost guaranteed to be covered by Elevance, although members will need to seek in-network providers, and may still have small copays.

Members may also be limited in the number of therapy sessions they are allowed within a given time period.

Continuing Care

It is rare for continuing care to be covered by insurance, as this is not a service that is considered medically necessary. It is also not categorized by the Affordable Care Act as an official addiction treatment program.

However, it depends on the type of continuing care, as sober living homes are usually not covered, but peer support groups or group therapy may be.

The amount of coverage that a person receives as a member of Elevance can vary based on a few different factors.

Factors that can affect your Elevance Health coverage for alcohol and drug rehab include:

• The state where you live
• How long your treatment program is
• The level of care you need
• Whether the rehab center is in-network or out-of-network
• The specific benefits and offerings of your plan
• The amount of your plan’s deductible, copays, coinsurance, and out-of-pocket maximum
• The specific healthcare provider that you see

With all of these factors in mind, it is usually possible to find treatment nearby that can be completely or at least partially covered by an Elevance plan.

Answer: Yes, Elevance Health does cover out-of-network addiction treatment, however, the extent of this coverage is limited when compared to that of in-network care.

Plans with Elevance that are HMO will not allow for any out-of-network care, and other types of plans that are PPO may only provide for out-of-network care in the event of emergencies or unusual circumstances.

Those plans that allow out-of-network care may charge members a significant portion of the costs, and possibly all costs for treatments that are non-emergency or do not receive prior authorization.

The most affordable and convenient care is always with healthcare providers that you are in-network with.

There are a few different options for members with Elevance Health insurance plans.

Anthem Blue Cross Blue Shield

A significant portion of health plans for Elevance are provided through Anthem as a part of the Blue Cross Blue Shield Association.

Types of plans offered through Anthem include:

• HMO (Health Maintenance Organization) — this type of plan provides coverage for in-network care and out-of-network care only in emergencies, has lower monthly premiums, and requires people to have primary care physicians (PCPs).
• PPO (Preferred Provider Organization) — this type of plan allows members to see specialists without a referral from their PCP and to seek out-of-network care, but at higher costs.
• EPO (Exclusive Provider Organization) — a hybrid of the two previous types, this type of health insurance allows people to see specialists without a referral but prefers that members seek in-network care.

Wellpoint

Wellpoint offers Elevance’s Medicare Advantage plan, which is available to older American adults who qualify.

Medicare Advantage is sometimes referred to as Medicare Part C, as it combines Medicare Parts A and B, and usually Part D for prescription drugs.

No matter what type of addiction you have, there is likely to be a rehab center that provides treatment for it that is covered by Elevance Health.

Some of the addictions that may be covered by Elevance Health Insurance include:

• Heroin addiction
• Alcohol addiction
• Cocaine addiction
• Methamphetamine addiction
• Prescription drug addiction
• Opioid addiction
• Benzodiazepine addiction
• Marijuana addiction

You can also contact us for assistance if you are looking for rehab treatment for a specific kind of substance addiction.

If you are an Elevance Health member, it is important to know where you can access substance abuse treatment and other services that are in-network for you.

One of the first options that members can take is to utilize the search tools available through either Anthem or Wellpoint. These tools can direct you to healthcare providers and treatment facilities near you depending on your plan.

Members always have the option to call the member helpline number on the back of your ID card as well, and you may want to ask for a referral from their primary care physician (PCP).

You can also browse our list of rehab facility options by state and find information about accepted insurance plans, program costs, and more.

It is never too late to begin your recovery journey, and your insurance coverage should never be an obstacle that comes between you and getting quality treatment.

Contact us today if you need help locating a facility in your area that accepts Elevence Health, or if you have questions about what is included in your insurance policy for rehab coverage.

With our help, you can receive the addiction treatment you need and that fits into your Elevance coverage with minimal personal costs to you.