Does Anthem Insurance Cover Therapy and Addiction Treatment?
Does Anthem Insurance Cover Drug treatment?
If you are thinking about getting help for yourself or a loved one for a substance abuse problem, you may have questions about cost and insurance coverage associated with treatment. Anthem insurance healthcare plan members may be wondering about Anthem’s coverage for drug treatment, mental health, and out-of-network services. This page will answer some questions about Anthem’s substance abuse treatment and insurance coverage.
If you are unclear about what types of services are offered in a substance abuse treatment facility and which of those are covered by insurance, you are not alone. Navigating the world of substance abuse treatment, mental health, and health insurance can feel overwhelming, but it doesn’t have to be. You can verify your Anthem insurance coverage by calling the number on the back of your insurance card. You can also contact the rehab center directly to check your coverage based on the information you provide.
Anthem Insurance Coverage
In the world of addiction and substance abuse treatment, a variety of services may be suitable for you. You and your substance abuse treatment provider will create a treatment plan based on your individual needs. While each treatment plan is individualized, there are common services that many people receive when they choose to enter a substance abuse treatment facility; these vary in intensity, duration, and cost. Common treatment services include detoxification, inpatient/residential treatment, intensive outpatient programs (IOP), partial hospitalization programs (PHPs), and outpatient therapy.
Detoxification is the process by which substances are eliminated from the body. It is designed to target the dangerous and acute physical and psychological effects of withdrawal.1(2nd paragraph) This experience can be risky and uncomfortable, depending on the person’s health concerns, type of substance used, duration of substance used, and other factors. Therefore, many people choose to complete detox in the controlled environment of a substance abuse treatment facility.
It is important to understand that detox is only the first step in a long process of recovery. Detox doesn’t address the psychological, emotional, social, or other factors that contribute to addiction.
After detox, the work of recovery often takes place in the controlled environment of an inpatient/residential treatment facility. The potential for relapse is an undeniable component of the recovery process; studies estimate that 72% to 88% of opioid users relapse after completing a detoxification program.2(introduction, 1st paragraph) Inpatient/residential treatment can be a deterrent for relapse due to its restrictive nature. You can’t leave the facility, and you receive 24-hour care from trained addiction and medical specialists. Your Anthem plan may cover some or all of the cost of services, such as individual and group therapy, medication management, case management, relapse prevention services, and room and board.
Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) are somewhat less restrictive than inpatient/residential treatment. You can expect to spend anywhere from 3–5 days a week and anywhere from 6 to 30 hours a week at a PHP or IOP, depending on the service provider and your treatment plan. Outpatient group and individual therapy are the least restrictive treatments and can range from an hour to several hours a week, depending on your specific needs. Again, Anthem’s coverage largely depends on your specific plan.
Mental Health Coverage by Anthem
Often, underlying mental health disorders contribute to the use of substances. Research demonstrates that people who suffer from anxiety and other mood disorders are nearly twice as likely to suffer from a substance abuse problem.3(page 2, right hand side) The Affordable Care Act, signed into law on March 23, 2010, requires most insurance providers and Health Insurance Marketplace plans to cover mental health and substance abuse services.4(1st paragraph)
Anthem recognizes that substance abuse and mental health issues can occur simultaneously (known as co-occurring disorders), and it’s important to treat them in tandem. More specifically, their mental health and addiction coverage can include:5(bottom of the page)
- Access to in-network behavioral health providers, including therapists and doctors.
- Utilization management by licensed and trained care managers.
- Access to in-network facilities, including free-standing and acute care hospitals.
- Residential treatment.
- Intensive outpatient and partial hospitalization programs.
Anthem Insurance Rehab Coverage Duration
Research has shown us that successful substance abuse treatment outcomes depend on a number of factors. These include making treatment immediately accessible, treating both mental health and substance abuse problems concurrently, using a variety of evidence-based treatment interventions such as medication and therapy, creating a personalized treatment plan based on the person’s unique needs, and spending an adequate amount of time in treatment.6(entire page)
The length of your treatment will be determined by your individual needs, your treatment facility, and your insurance provider. Keep in mind that the longer you stay in treatment, the greater your chances of a successful recovery. More specifically, research demonstrates that most people who suffer from addiction require at least 3 months in treatment to stop and reduce their drug use; the best outcomes occur with longer treatment times.6(5th bullet)
Insurance plans offer a variety of policies and tiers of coverage, so the duration of treatment covered by your insurance provider will depend on your specific plan. Remember, you can check the specifics of your Anthem insurance rehab coverage by calling the number on the back of your card.
Rehabs Not Covered by Anthem Insurance Policy
Every day in addiction is another day that is stolen from your life. Many treatment facilities will work with you to help you get the services you need to begin your recovery journey. If you have no insurance or if required services are not covered under your specific plan, you may be eligible for scholarships or financing. Some rehabs offer financing or scholarship options. They understand that it’s critical to get treatment now rather than pushing it off until later.
In-Network versus Out-of-Network Rehab Centers
To help manage the costs of substance abuse, physical health, and mental health services, many insurance companies contract with specific facilities, suppliers, and professionals. These providers are considered in network. 7(top of page) It is important to know whether your treatment provider is in network or out of network, as this could be the difference between being covered for substance abuse and mental health services or not. The rehab center you choose can confirm whether they are in or out of network, or you can contact Anthem directly to verify coverage at that facility.
Check Your Benefits
American Addiction Centers (AAC) is a leading provider of substance abuse treatment across the country. AAC offers rehabilitation facilities in Rhode Island, New Jersey, Mississippi, Nevada, Texas, Florida, and California. AAC understands how important it is to get help for your addiction now. Enter your information to immediately see if AAC is in network for your plan. You can also call AAC 24 hours a day, 7 days a week at 877-640-1943 and speak with one of our admissions navigators, who can check your benefits while you’re on the phone with them.
Most of our admissions navigators have a personal experience with addiction, so you can rest assured that you will be treated with respect and compassion and that your call will remain 100% confidential. In the world of addiction and substance abuse, time is of the essence. Don’t wait to seek treatment—contact AAC now and begin your journey toward a life worth living. You are not alone, and recovery is possible.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: a research-based guide (third edition) Types of treatment programs.
- Chalana, H., Kundal, T., Gupta, V., Malhari, A. (2016). Predictors of relapse after inpatient opioid detoxification during 1-year follow up. Journal of Addiction, 2016,
- National Institute on Drug Abuse. (2010). Comorbidity: addiction and other mental illness.
- US Department of Health and Human Services. (2019). Does the affordable care act cover individuals with mental health problems?
- Anthem Blue Cross & Blue Shield. (n.d.). Anthem’s behavioral health and substance abuse services.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition) principles of effective treatment.
- US Centers for Medicare & Medicaid Services. (n.d.). Network.