Guide to Anthem Health Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023
Author
Claudia Rose
About
Clinically Reviewed
Edward Jamison, MS, CAP, ICADC, LADC
About
All of the information on this page has been reviewed and certified by an addiction professional.

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If you currently have health insurance coverage through Anthem and you are in need of drug or alcohol treatment, you may wonder whether or not you are covered. Anthem is a large insurance company with many providers in its network, all over our country. This means that finding a treatment center that accepts your policy should not be too difficult. The Anthem website itself has a comprehensive provider directory, or you can telephone the company directly and ask them.

Who Is Anthem, Inc.?

Anthem, Inc. is an organization that is part of the Blue Cross and Blue Shield Association. They currently serve some 70 million individuals. About 38 million of those are covered under Anthem. One in ever nine Americans has Anthem coverage. The company was originally founded in the 1940’s, after which it merged with WellPoint Health Networks, Inc. in 2004. Originally, it assumed the WellPoint name but in 2014, they changed it to Anthem, Inc. The company is now an independent licensee of the BCBSA.

Anthem is affiliated with the BCBSA and they have the same nationwide reach. To date, they have processed around 670 million individual claims. They have also paid more than 210 billion benefits. The company is made up of different elements, which are Anthem Life Insurance, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, Anthem Blue Cross, and Anthem Blue Cross and Blue Shield. They also have affiliations with a further 13 companies.

Which Rehab Centers Accept Anthem?

As part of the BCBSA, the treatment that Anthem covers is very similar to that covered by Blue Cross Blue Shields. These include:

  • Intensive outpatient treatment
  • Acute inpatient hospitalization
  • Partial hospitalization
  • Outpatient treatment
  • Detox
  • Residential treatment

Anthem has put certain requirements together that a treatment must meet in order for it to be allowed under their plan. The treatment that they cover will depend very much on your personal situation, where you live, and which plan you currently have. What you are covered for will depend on how bad your addiction is, what the cost effectiveness of the treatment is believed to be, and whether the treatment you seek for your condition is actually appropriate. How long you can stay in treatment will also depend on your personal situation. Your health care team may recommend an extended stay in rehab. If they inform Anthem of this need and explain why, then Anthem may accept the medical necessity for your treatment and continue to cover you.

What Your Anthem Policy Covers

Anthem is fully licensed by the BCBSA and they follow their categorization of health insurance plans. This is why they have different levels that people can sign up for. At present, those levels are:

  1. Bronze coverage, which covers around 60 percent of all your medical expenses. While this isn’t much and can lead to high medical bills, the plan does come with very low monthly payments. On the other hand, the deductibles are very high.
  2. Silver coverage, which covers around 70 percent of any medical expenses. The monthly payments remain on the low side, and the deductibles are also very low.
  3. Gold coverage, which covers around 80 percent of all medical expenses. These have high monthly payments but the deductibles are low.
  4. Platinum coverage, which covers around 90 percent of all medical expenses. This level of plan has the highest monthly payment, but it also has the lowest deductible.

If you live in Wisconsin, Virginia, Ohio, New York, Nevada, New Hampshire, Missouri, Maine, Kentucky, Indiana, Georgia, Connecticut, Colorado, or California, then your Anthem coverage will be provided by the health insurance plans family of Anthem, which are all licensed by Blue Cross and Blue Shields. There is significant information available online to enable you to see exactly what is and isn’t covered under your specific plan in the state where you live. If you have an Anthem policy you should be able to log in to your account on their website where you can find all the necessary information.

Types of Anthem Health Insurance

Powered by BCBS, Anthem Health Insurance can go by several other names;

  • Anthem Blue Cross and Blue Shield Kentucky
  • Anthem Blue Cross and Blue Shield Maine
  • Anthem Blue Cross and Blue Shield Missouri
  • Anthem Blue Cross and Blue Shield Nevada
  • Anthem Blue Cross and Blue Shield New Hampshire
  • Anthem Blue Cross and Blue Shield Ohio
  • Anthem Blue Cross and Blue Shield Virginia
  • Anthem Blue Cross and Blue Shield Wisconsin
  • Anthem Blue Cross and Blue Shield Connecticut
  • Anthem Blue Cross and Blue Shield Indiana

Questions to Ask

Admitting that you require some sort of treatment for a drug or alcohol problem is a huge step. In order for you to successfully recover, it is vital that you find the right treatment for your specific needs. Unfortunately, many of us look first at the financial aspect and only then at how effective the treatment will be. While finances are incredibly important, your health is even more so. Try to not base your decision solely on the price, in other words.

That being said, there are a couple of questions relating to finances that you may want to ask a rehab center you are considering. These include:

  • How much care for addiction treatment is covered under your plan?
  • What will your deductible or copay be for the treatment?
  • What is the highest amount you will be expected to pay out of your own pocket?
  • How does Anthem determine whether or not there is a medical necessity for your treatment?
  • Can Anthem refer you to any providers within your area?

Once Anthem has approved your request for treatment, you should contact them regularly while you are receiving the services. This will ensure that you are only using therapies and services that your plan actually covers. Do remember that there are always other financial resources out there should your insurance company not cover any or all of what you had expected.

Getting Help from the Care Managers

One of the unique things about Anthem insurance policies is that you can have access to their Care Managers. These managers are responsible for helping you find behavioral health and addiction resources that are relevant to your needs. Anthem has a huge network of providers that offer extensive coverage. This means that you should have no difficulty in finding a treatment center that will accept your policy. Do make sure to check the approved provider list on the company’s website. By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.