When you or a person you care about has developed an addiction to drugs or alcohol, it is essential that they get treatment. Addiction is not a moral failing or a result of weak willpower; it is a legitimate mental health condition. Treatment is available for those who are willing to seek outside help. However, even for people who recognize the necessity for treatment, the cost of treatment can seem formidable. Fortunately, few people need to pay out-of-pocket for their substance abuse treatment.
Health insurance companies are required by the Affordable Care Act to cover addiction treatment as they would any physical health ailment. If you or your loved one is covered by an Anthem health insurance plan, your policy should cover addiction treatment.
Does Anthem Insurance Pay For Rehab?
Anthem, which is the parent company for Anthem Blue Cross and Blue Shield, is a healthcare company that covers more than 70 million people throughout the United States. In fact, one out of every eight people in the United States are covered by one of Anthem’s countless insurance plans.
Anthem provides coverage for drug and alcohol addiction rehab, as well as many related services, including addiction therapy, medical detox, and medications. Anthem covers behavioral health and substance abuse services to ensure that policyholders can not only get sober, but stay sober. Anthem’s rehab coverage extends from addiction treatment to mental health treatment, and people who suffer from comorbid conditions can expect to receive the integrated treatment they need.
The extent of a person’s rehab coverage depends upon the nature of the patient’s substance use disorder as well as their particular health insurance plan. While Anthem does cover addiction treatment at rehabs, not all treatment providers are necessarily covered. NuView Treatment Center is in-network with a wide variety of insurance companies, including Anthem.
What Does Anthem Cover For Me?
Anthem offers four different levels of care, each with different benefits. Which level of care you have depends upon your specific health insurance policy as well as which state you reside in. Navigating the details of one’s health insurance plan can be intimidating. If you are interested in finding out exactly what you are covered for, NuView Treatment Center is available to help you find the answers — and treatment resources — you need. Contact us at (310) 984-1730, and our staff will help verify your Anthem coverage and answer any other questions you have.
What is Anthem?
Anthem is one of the foremost health insurance companies in the country. In 2004, Anthem, Inc and WellPoint Health Networks Inc merged to become WellPoint Inc. In 2014, however, they changed their name back to Anthem, Inc. Currently, Anthem is one of the top independent licensees of the Blue Cross and Blue Shield (BCBS) Association. Anthem provides coverage in 14 states, though people can also get Blue Cross and Blue Shield plans through other providers in other states.
Anthem Health Insurance and the Affordable Care Act
The Affordable Care Act was created to help more United States citizens get access to health insurance coverage. The Affordable Care Act, which is sometimes shortened to ACA, also makes certain kinds of treatments “essential health benefits.” Since the passing of the Affordable Care Act, the number of Americans who have health insurance plans has considerably expanded. Moreover, the ACA guarantees that addiction treatment and mental health treatment are essential health benefits. This means that people who have Anthem health insurance plans are guaranteed to have their conditions covered.
People with Anthem health care plans are covered from the first day that they sign up for their plan. The ACA ensures that addictions or comorbid mental health disorders are not considered pre-existing medical conditions. As a result, no one can be denied coverage due to their substance use disorder. Anthem health care plans are legally obligated to adhere to these rules.
Anthem Copay and Deductible
Before looking at Anthem health coverage levels, it is helpful to have a basic understanding of health insurance terminology. Hearing the terms “copay,” “deductible,” and “premiums” can be confusing to people who have never been insured — and they are sometimes even confusing to people who have been covered by health care plans for years! What do people mean when they use these terms?
A copay is the term health insurance companies like Anthem use to refer to the payment that individuals are responsible for when they get services from a health care provider. Going to an urgent care, for instance, might cost a patient up to $100. This is not the actual full cost of the medical services. The insurance company pays for the majority of the cost, while leaving the copay to the patient. The size of a patient’s copay depends upon their level of coverage. However, the average copay the most United States citizens pay is between $15 and $25.
A deductible refers to the amount of money that a patient must spend before their insurance kicks in. If an insurance plan has a $1000 deductible, this means that the health insurance company will not pay for any medical services until this number has been exceeded. Anything less than the deductible must be paid for out of pocket. The dollar amount of a person’s deductible depends upon their level of coverage.
In general, people who pay higher premiums have lower deductibles and copays. A premium refers to the amount of money a patient spends each month to pay for their insurance coverage. While some plans may be quite affordable due to low monthly premiums, the cost can add up when it comes to paying high copays and having to handle out of pocket expenses until the deductible is exceeded. Just because a plan has a high premium, does not mean it is a more expensive plan — since people who need frequent medical treatment can actually end up saving money.
Anthem Coverage Levels
Anthem’s addiction and mental health treatment benefits vary from plan to plan. No matter which plan a person has, they are guaranteed to have access to some degree of treatment. However, the nature of the substance abuse treatment they have access to depends upon which Anthem coverage level they have. These tiers vary from one another in different states, though they are generally broken down similarly.
Anthem health insurance plans generally fall into four main categories:
- Bronze. Anthem Bronze plans have lower monthly premiums, but they have the highest copays and deductibles of all of Anthem’s plans. People with bronze plans can expect Anthem to pay for approximately 60% of medical costs.
- Silver. Silver plans have somewhat higher premiums than bronze plans, but they have lower copays and deductibles. People who pay for an Anthem silver plan can expect Anthem to cover approximately 70% of their medical fees.
- Gold. Anthem’s gold plan has the most expensive monthly premiums, but plan holders benefit from paying the lowest deductibles possible. Copays are also negligible compared to bronze and silver plans. Anthem covers approximately 80% of medical fees for gold plan holders.
- Platinum. Anthem’s platinum level is only available in California. While the premiums are higher, it has a very low or nonexistent deductible. It also has the lowest out-of-pocket copays and offers comprehensive coverage.
Anthem not only offers these plans on the marketplace, but they also provide Medicaid coverage plans in multiple states, including Indiana, California, Nevada, Wisconsin, and Virginia.
Does Anthem Cover Outpatient Rehab?
Anthem health insurance plans generally cover outpatient treatment for people who have been diagnosed with substance use disorders. Outpatient treatment is suitable for people suffering from addiction at any level of severity, since outpatient rehab comes in many levels of care. These levels of care include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), outpatient programs (OPs), and aftercare planning. Anthem often supports patients as they progress from one level of care to another.
Outpatient rehab allows clients to live at home while receiving addiction treatment. Because outpatient programs have no residency requirement, they are cheaper than inpatient treatment programs. This means outpatient programs tend to be covered more broadly by Anthem insurance plans than other forms of treatment. Clients can often expect to be covered for outpatient treatment for months at a time — or even years.
Outpatient treatment programs help people recover from addiction by working with clients to address the underlying causes and develop new coping tools. Clients at outpatient rehab develop new strategies and plans for avoiding relapse, while also building new skills for life in sobriety. They also have the opportunity to address issues in their lives that may be motivating their substance abuse problem. These include mental health disorders, interpersonal conflicts, and even financial and legal problems. Outpatient programs utilize a broad spectrum of evidence-based therapeutic techniques and treatment modalities to help clients achieve long term sobriety.
Anthem is also likely to cover one-on-one therapy on an outpatient basis. This allows individuals to meet with a professional clinician who can conduct dialectical behavioral therapy sessions, cognitive-behavioral therapy sessions, and other talk therapy treatments. Anthem often covers one-on-one therapy for extended periods of time, especially in the months and years after a person has graduated from a formal addiction treatment program.
Are Comorbid Mental Health Conditions Covered by Anthem?
The Affordable Care Act stipulates that mental health conditions must be treated the same way as physical health problems. This means that a doctor’s appointment related to the flu must cost the same as a doctor’s appointment related to a mental illness like depression or anxiety. This policy, known as parity, applies to mental health disorders just as much as it applies to addictions. In fact, getting treatment for mental health disorders is often an essential component of addiction treatment.
Anthem offers mental health coverage through its Behavioral Health programs. These programs offer integrated care to policyholders. Policyholders can take advantage of Anthem’s extensive network of specialty behavioral and mental health care providers. These providers include physicians, therapists, and specialty psychiatrists. In many cases, outpatient rehabs and other specialized facilities have contracts with Anthem. This makes getting in-network treatment for mental health conditions simple and affordable for Anthem policyholders.
People who are covered by Anthem can work with Care Managers. Care Managers are responsible for helping policyholders get the mental health treatment they need. Policyholders do not need to figure out what treatment they need on their own. Instead, their Care Manager can connect them to the resources, services, and facilities that they require.
Does Anthem Cover Medications?
Yes, Anthem covers medications prescribed by physicians. Medications are often necessary during addiction treatment, especially for people with comorbid mental health conditions. They are also sometimes beneficial for people who are withdrawing from opioids or alcohol. Medications can reduce the severity of withdrawal symptoms and mitigate cravings. They are most commonly prescribed in the context of a medication-assisted treatment (MAT) plan, which combines behavioral therapies with medication. Anthem covers medication-assisted treatment, and it even supervises training for medical practitioners.
Does Anthem Cover Federal Employees?
Anthem has a number of plans specifically designed for federal employees, retired federal employees, and their family members. Anthem Blue Cross and Blue Shield (BCBS) covers them under the Federal Employees Health Benefits (FEHB) Program. This program offers coverage through Blue Cross and Blue Shield’s 36 participating companies, making it easy and affordable for federal employees, retirees, and family members to get insured. Anthem federal insurance comes in the form of 3 main plans:
- Standard. The standard plan provides policyholders with access to both in-network and out-of-network providers. Policyholders also pay a very low deductible.
- Basic. The basic plan has no deductible and covers a variety of preferred providers. However, policyholders are responsible for paying copays out-of-pocket.
- FEP Blue Focus. The FED Blue Focus plan is relatively new. It covers preferred providers and has a very low deductible. It also has lower copays than other plans.
How to Check Your Anthem Insurance Benefits
If you have Anthem insurance and you are unsure what your coverage is, it is generally best to speak to an Anthem insurance representative. You can do so by calling the number listed on the back of your insurance card or by checking your policy’s website. You can also check your benefits directly by going to Anthem.com and creating a profile connected to your specific plan. You can access a list of your benefits there by clicking “my plan” and then clicking “benefits.” Anthem’s website provides a tool to users to help them estimate what different treatments will cost them.
You can also reach out to an outpatient rehab directly. While Anthem is legally obligated to cover addiction treatment for those who need it, there is no guarantee that any particular outpatient treatment center will be covered. However, outpatient treatment centers, even treatment centers that are not covered, are generally willing to advise you on your options. They can help you get connected to the insurance or financial resources you need so that you can enroll in their treatment program. In the event that you are not covered, they can help connect you to a program more suitable for your current needs and circumstances.
Addiction Treatment at NuView Treatment Center
NuView Treatment Center, an outpatient rehab located in West Los Angeles, offers addiction treatment at all levels of care. NuView Treatment Center is covered by Anthem insurance plans. Our treatment programs help people recover from drug and alcohol addiction, and we also address comorbid mental health conditions. Making use of the latest evidence-based treatment modalities, our highly trained and qualified staff provide each client with an individualized treatment plan. We believe that addiction treatment should be compassionate, holistic, and comprehensive. For Anthem policyholders, NuView Treatment Center offers a chance to recover from addiction and rebuild one’s life.
If you are ready to make a change or have any questions about your current coverage, reach out to NuView Treatment Center today.