Does Anthem Cover Rehab Treatment?

If you or a loved one is struggling with substance abuse or addiction, seeking professional help at a rehab center may be the best course of action.

Published On

October 1, 2023

If you or a loved one is struggling with substance abuse or addiction, seeking professional help at a rehab center may be the best course of action. However, the cost of rehab treatment can be a major concern for many individuals and families. If you have an Anthem health insurance plan, you may be wondering: does Anthem cover rehab treatment?

The short answer is yes, Anthem does cover rehab treatment for substance abuse and addiction. However, the specifics of your coverage will depend on your particular plan and the state you live in.

Anthem Coverage for Rehab Treatment

Anthem offers different types of health insurance plans, including HMO, PPO, and POS plans. Depending on your plan, your coverage for rehab treatment may vary.

Generally, Anthem covers the following types of rehab treatment:

Inpatient rehab treatment

This type of treatment involves staying at a rehab center for a certain period of time, typically 30, 60, or 90 days. Inpatient rehab provides a structured environment and round-the-clock care for individuals recovering from addiction.

Outpatient rehab treatment

This type of treatment involves visiting a rehab center for therapy and counseling sessions, but not living at the facility. Outpatient rehab can be a good option for those who have already completed inpatient treatment or have a less severe addiction.

Medication-assisted treatment

This type of treatment involves using medications to help manage withdrawal symptoms and cravings. Medication-assisted treatment may be used in combination with inpatient or outpatient rehab.

What Your Anthem Plan Covers

To find out what your Anthem plan covers for rehab treatment, you have a few options.

One option is to review your plan documents to see what is specifically covered and what limitations may apply.

Another option is to call Anthem customer service and speak with a representative who can provide you with more information.

It's important to note that some Anthem plans may require pre-authorization for rehab treatment, while others may have specific requirements for the type of treatment you can receive. This is why it's important to review your plan documents or speak with a representative to ensure that you are receiving the appropriate care covered under your plan.

In general, Anthem plans cover rehab treatment as a medical necessity, meaning that it is considered a vital part of your overall healthcare. However, it's always a good idea to check with your plan to see if there are any limitations on the number of days or visits for rehab treatment, as well as the types of services that are covered.

At Anthem, we are committed to providing our members with the highest quality healthcare possible, and we want to ensure that you are getting the care you need to live a healthy and happy life.

In-Network vs. Out-of-Network Rehab Centers

When seeking rehab treatment, it's important to understand the difference between in-network and out-of-network rehab centers.

An in-network rehab center is one that has a contract with your insurance provider, such as Anthem, to provide services at a discounted rate. This means that if you choose an in-network rehab center, you may pay less out of pocket for your treatment.

On the other hand, an out-of-network rehab center does not have a contract with your insurance provider. This means that if you choose an out-of-network rehab center, you may be responsible for paying more of the cost of treatment yourself.

It's important to note that some Anthem plans may only cover in-network rehab centers, while others may offer coverage for both in-network and out-of-network options. If you choose an out-of-network rehab center, it's important to check with your plan to see what percentage of the cost will be covered and what your out-of-pocket expenses will be.

When choosing a rehab center, it's important to consider both the cost and quality of care. While an in-network option may be more affordable, it's also important to make sure that the center provides high-quality care and meets your individual needs.

If you're unsure about whether a particular rehab center is in-network or out-of-network, you can contact Anthem customer service or check their website for a list of providers in your area.

Pre-Authorization for Rehab Treatment

It's important to note that some Anthem plans may require pre-authorization for rehab treatment. Pre-authorization is the process of getting approval from your insurance provider before receiving certain types of medical care, including rehab treatment.

To get pre-authorization for rehab treatment, you will need to provide information about your diagnosis, the type of treatment you are seeking, and the length of time you will need to be in treatment. Your healthcare provider can help you with this process by submitting a request for pre-authorization on your behalf.

Once your request has been submitted, Anthem will review it to determine if the requested treatment is medically necessary and covered under your plan. If your request is approved, you will receive a notification from Anthem indicating that your treatment has been authorized.

It's important to note that pre-authorization requirements can vary depending on your specific Anthem plan and the state you live in. Some plans may require pre-authorization for all types of rehab treatment, while others may only require it for certain types or lengths of treatment.

If you're unsure about whether pre-authorization is required for rehab treatment under your plan, it's best to review your plan documents or contact Anthem customer service directly. By understanding the pre-authorization requirements of your plan upfront, you can help ensure that you receive the appropriate care covered under your plan without unexpected out-of-pocket costs.

How to Appeal a Denied Claim for Rehab Treatment

If your Anthem claim for rehab treatment is denied, you have the right to appeal the decision. Here are the steps you can take to appeal a denied claim:

  1. Review the denial letter - When Anthem denies your claim, they will send you a letter explaining why it was denied. Review this letter carefully to understand why they denied your claim.
  2. Gather supporting documentation - Collect any medical records, bills, or other documents that support your claim for rehab treatment. This information can help strengthen your case during the appeals process.
  3. Contact Anthem customer service - Call Anthem customer service and explain that you would like to appeal a denied claim for rehab treatment. They will provide you with instructions on how to start the appeals process.
  4. Submit an appeal request - Follow the instructions provided by Anthem to submit an appeal request. You may need to fill out a form or provide additional documentation.
  5. Wait for a decision - Once you've submitted your appeal request, Anthem will review your case and make a decision. This process can take several weeks or even months.
  6. Consider external appeals options - If your appeal is still denied, you may have additional options for external appeals through state agencies or independent organizations.

It's important to note that appealing a denied claim can be a complex and time-consuming process. However, if you believe that your claim was unfairly denied, it's worth pursuing an appeal to ensure that you receive the appropriate care covered under your plan without unexpected out-of-pocket costs.

Types of Therapy Used in Rehab Treatment

Rehab treatment for substance abuse and addiction often involves therapy to help individuals address underlying issues that may have contributed to their addiction. Different types of therapy may be used depending on the individual's needs and the type of rehab program they are in.

Cognitive-behavioral therapy (CBT)

CBT is a type of talk therapy that helps individuals identify and change negative thought patterns and behaviors. It can be particularly helpful for those struggling with addiction by helping them develop coping mechanisms and avoid triggers.

Dialectical behavior therapy (DBT)

DBT is a type of therapy that focuses on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It can be especially effective for those struggling with addiction who also have mental health concerns such as borderline personality disorder.

Group therapy

Group therapy involves meeting regularly with a group of individuals who are also in recovery from addiction. This type of therapy can provide a sense of community, support, and accountability.

Family therapy

Family therapy involves working with family members to address issues related to addiction and improve communication and relationships. It can be particularly beneficial for those in recovery who wish to repair relationships that were damaged due to their substance abuse.

By incorporating different types of therapy into rehab treatment, individuals can gain the tools they need to overcome their addiction and maintain long-term sobriety.

Finding a Rehab Center with Anthem Coverage

If you are looking for a rehab center that accepts Anthem insurance, you can use Anthem's online provider directory to search for in-network providers. You can also contact your local Anthem representative for assistance with finding a provider.

It's important to note that even if a rehab center is in-network with Anthem, you may still be responsible for out-of-pocket costs such as deductibles, copays, and coinsurance. The amount you pay will depend on your plan and the specific services you receive.

The Cost of Rehab Treatment

The cost of rehab treatment can vary widely depending on the type of treatment you receive. In general, inpatient rehab treatment tends to be more expensive than outpatient treatment due to the round-the-clock care and supervision provided.

The cost of medication-assisted treatment can also vary depending on the type of medication used and the length of time it is needed.

When considering the cost of rehab treatment, it's important to factor in any out-of-pocket expenses you may incur, such as deductibles, copays, and coinsurance. It's also important to consider the long-term benefits of rehab treatment, which can include improved physical and mental health, better relationships with loved ones, and a higher quality of life overall.

If the cost of rehab treatment is a concern for you or your family, it's worth exploring options for financial assistance. Some rehab centers offer sliding scale fees based on income, while others may offer scholarships or grants for those who demonstrate financial need.

You can also speak with your Anthem representative or check your plan documents to see if there are any programs or resources available to help offset the cost of rehab treatment. By taking advantage of these resources and planning ahead for potential costs, you can ensure that you receive the appropriate care covered under your plan without undue financial burden.

Final Thoughts

If you are struggling with addiction, seeking professional help at a rehab center can be a life-changing decision. While the cost of rehab treatment can be a concern, knowing that Anthem covers rehab treatment can give you peace of mind.

Remember to review your plan documents and contact Anthem customer service to find out the specifics of your coverage. And when you're ready to start your recovery journey, use Anthem's provider directory to find a rehab center that meets your needs.

Sources:

image
Senior Addiction Treatment

July 17, 2024

Discover the path to addiction recovery for seniors - specialized programs and support for senior addiction treatment.