Anthem Coverage for Drug and Alcohol Detox & Addiction Treatment

Anthem Health Insurance began in the 1940s under the name WellPoint Health Networks before taking on the Anthem, Inc. brand in 2014. The company’s ongoing affiliation with Blue Cross/Blue Shield enables Anthem to offer a wide range of health care insurance options.

Drug and alcohol problems aren’t something that will just go away with time, but rather snowball into out-of-control forces in your life. Under these conditions, the last thing you need is to have to worry about how to pay for needed treatment care.

If you currently hold an Anthem health plan and are considering detox treatment, your insurance coverage can go a long way towards offsetting the costs of drug and alcohol detox treatment as well as the costs of drug/alcohol rehab in general.

Does Anthem Cover Drug & Alcohol Detox?

While the detox period may well be the shortest stage in the recovery process, it can also be one of the most expensive. Depending on your condition, medical withdrawal treatment and emotional/psychological care may both be necessary to help you adjust to the absence of drugs (or alcohol) in your system.

Fortunately, most all Anthem plans to cover a portion of your detox expenses. Detox treatment benefits cover the medically-managed withdrawal and psychosocial treatment interventions, such as psychotherapy, counseling and group therapies.

Anthem plan coverages break down as follows:

• Bronze coverage – covers 60 percent of medical expenses
• Silver coverage – covers 70 percent of medical expenses
• Gold coverage – covers 80 percent of medical expenses
• Platinum coverage – covers 90 percent of medical expenses

Does Anthem Cover Drug & Alcohol Rehab?

Recovering from a drug or alcohol problem seldom ends at the detox stage. In effect, the more severe the problem the longer the recovery will take. Most Anthem insurance plan types will pay for a portion of your drug or alcohol rehab.

Not surprisingly, the most expensive plan type (Platinum) will cover rehab expenses. Plan levels below Platinum provide increasingly less coverage protection but still may pick up some of your rehab costs.

Something else to keep in mind is any treatment services you receive must be considered medically necessary to be covered by your plan. Other factors that may affect your coverage benefits include:

• Length of treatment stay
• The type of substance (e.g. heroin, alcohol, cocaine) involved
• The presence of co-occurring mental health problems
• Your drug history or whether you’ve tried rehab in the past

How Long Will Anthem Cover Detox Services?

Anthem insurance may cover your detox, and help you get back on your feet.

The length of time you spend in detox should be based on the severity of your condition. Likewise, Anthem will cover your stay based on medical necessity in terms of how long it takes to ensure withdrawal effects no longer pose a risk to your overall health.

On average, most Anthem policies will cover detox stays that run anywhere from 30 to 90 days, through individual policy differences can still have a bearing on the duration your policy will cover. In cases where Anthem determines you no longer need continued detox care, but your treatment provider feels you do, your provider must justify why continued treatment is medically necessary.

Does Anthem Provide Coverage for Luxury Detox & Other Non-Essential Benefits?

Luxury detox programs (also known as executive programs) are known for their upscale treatment settings and plush accommodations. In addition to standard detox treatment care, these programs also employ alternative treatment approaches that make use of non-traditional interventions and services. Characteristics of luxury-type programs include:

• Scenic settings (e.g. mountain and ocean-side resorts)
• Alternative therapies, such as Reiki therapy and energy balancing
• Gourmet dining
• Private rooms

The better (and more expensive) your Anthem health plan, the more likely some or all luxury program costs will be covered under your policy. Still, it’s worth noting that services rendered must still be considered medically necessary in order for your Anthem benefits to take effect.

How Can I Cover the Excess Costs of Detox That Are NOT Covered by Insurance?

Most forms of health insurance require you to pay out-of-pocket costs, such as copayments and deductibles. The more inexpensive policy plans in particular typically come with high deductible payouts and sometimes, high copayments as well. The financial strain that drug and alcohol problems cause can make it difficult to cover out-of-pocket expenses, meaning you won’t be able to use your health benefits to cover treatment costs.

The good news is many detox programs offer payment assistance options that make these costs more affordable. Payment assistance options may take the form of:

• Paying on a sliding-fee scale that’s based on your monthly income earnings
• Making payment arrangements
• Third party financing
• Scholarship and grant opportunities