Does Anthem Cover Rehab Treatment?

May 26, 2024

Does Anthem cover rehab treatment? Dive into coverage details, eligibility, and more in our guide.

Never miss an opportunity

Contact Samba Recovery Today

Anthem's Coverage for Rehab Treatment

Wondering if Anthem covers rehab treatment? You're not alone. Let's break down what you need to know about Anthem's rehab coverage, focusing on prior authorization and payment procedures for out-of-network providers.

Prior Authorization: What You Need to Know

Prior authorization, also called pre-approval, is when you need to get the green light from Anthem before certain treatments. This step ensures that the treatment is necessary and covered under your plan.

Providers can submit these authorizations digitally through Availity Essentials. Keep in mind, the need for prior authorization can vary based on your plan and where you live. For example, folks in California or Indiana might need this for Substance Use Disorder (SUD) treatments.

Paying Out-of-Network Providers

If you get treatment from a provider not in Anthem's network, the payment process can be different. Usually, payments go to you, the member, unless laws or agreements say otherwise. This means you might have to pay the provider directly. Always check with both Anthem and your provider to avoid any surprises.

Understanding these steps can help you navigate Anthem's rehab coverage. Always double-check with Anthem to confirm the details of your plan.

Substance Use Disorder Treatment Services

So, does Anthem cover rehab treatment? Yes, they do. Anthem offers coverage for medically necessary SUD treatments under non-Medicare plans in states like California and Indiana. This includes inpatient and outpatient rehab, detox, and Medication-Assisted Treatment (MAT).

Inpatient Treatment Coverage

Anthem often covers inpatient rehab, where you stay at a facility for intensive treatment. This is great for severe addiction cases, providing a structured environment focused on recovery. Coverage details can vary, so always verify your plan specifics.

Outpatient Treatment Coverage

Outpatient rehab is another option covered by Anthem. This allows you to get therapy while living at home and continuing your daily activities. Coverage usually includes individual therapy for substance use disorders and other mental health conditions. Again, check your plan for details.

Medication-Assisted Treatment (MAT)

Anthem also covers MAT, which combines medication and therapy to treat addiction. For example, Suboxone for opioid addiction can cost up to $200 a month without insurance, but Anthem often covers it. Coverage can vary, so make sure to check your plan.

In short, Anthem offers a range of SUD treatment services, but specifics can vary. Always verify your plan details before starting treatment.

Services Covered by Anthem

Anthem's plans cover various rehab-related services, including counseling, therapy, and aftercare programs.

Counseling and Therapy

Anthem covers a wide range of therapy options, including cognitive-behavioral therapy. These services are crucial for overcoming substance use disorders and maintaining long-term sobriety. Coverage can vary, so check your plan for specifics.

Aftercare Programs

Aftercare programs provide ongoing support after rehab, helping you stay sober. These can include therapy, support groups, and educational programs. Anthem's coverage for aftercare ensures you get the support you need, but specifics can vary by plan.

While Anthem's rehab coverage is extensive, always check your plan details and state-specific regulations.

State-Specific Coverage

Coverage can vary by state and plan. For example, in California and Indiana, Anthem covers medically necessary SUD treatments under non-Medicare plans. However, prior authorization might be needed.

State Coverage
California Yes (Non-Medicare Plans)
Indiana Yes (Non-Medicare Plans)

Anthem's rehab coverage can vary widely, so always confirm your benefits before starting treatment.

Verification and Details

While Anthem offers rehab coverage, specifics can vary. Understanding prior authorization, cost-sharing, and coverage duration is crucial.

Prior Authorization Requirements

For some treatments, Anthem may require prior authorization to ensure they're medically necessary. Failing to get this could result in a denial of coverage. Always verify these details before starting treatment.

Cost-sharing and Duration of Coverage

Anthem often covers some or all rehab costs, depending on your policy. This can include inpatient or outpatient treatment, detox, therapy, and medications. Some plans may cover up to 100% of costs, but others might require co-pays or coinsurance. Duration of coverage can also vary, so review your plan or contact Anthem for specifics.

In summary, understanding your Anthem rehab coverage involves knowing prior authorization requirements and cost-sharing details. Always verify these with Anthem before starting a rehab program.







start your recovery today

Samba Recovery never miss an opportunity

Substance abuse doesn’t have to be a life sentence! Sustainable recovery is possible and the best version of youself awaits at our Norcross addiction recovery center.

We’ll help you learn that the opposite of addiction is connection. We’ll give you skills to discover your self-worth and show you the tools for a life of hope and promise.

Contact us today!

Our team is ready to help!
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

We accept most major insurances

We partner with most major insurances, enabling you to access premier therapy services.