Using Anthem for Drug & Alcohol Rehab

Blue Cross Blue Shield (BCBS) is a global healthcare provider offering insurance coverage to over 106 million members in every state in the U.S. BCBS has 35 independent companies that are locally operated and community-based. In California, the BCBS providers are Anthem Blue Cross* and Blue Shield of California.^1–3

Keep reading to learn more about using Anthem Blue Cross to pay for drug and alcohol rehab and how to get help if you or a loved one is struggling with addiction.

Does Anthem Blue Cross Cover Addiction Treatment?

Yes, Anthem offers insurance coverage for rehab. However, the specific amount of coverage will depend on your individual plan.

Substance abuse treatment became much more accessible when the Affordable Care Act made it an “essential health benefit.” Because all marketplace plans must now provide coverage for this type of care, you should be covered in whole or in part for treatment if you hold an Anthem Blue Cross plan purchased on the marketplace. If you have a Anthem/BCBS plan through an employer, it is very likely you will have these benefits as well.⁴

The insurance provider is the best resource for determining what services are covered, to what extent, and how to use these services to pay for drug addiction treatment. Costs will vary based on whether you choose a facility that is inside or outside your plan’s network of treatment providers. Costs are generally higher if you choose to go out of network.⁵

Fortunately, Laguna Treatment Center is in-network with Anthem Blue Cross and many other BCBS plans offered in Southern California.

Which BCBS Plans Are In Network at Laguna Treatment Center?

Laguna is in-network with Anthem Blue Cross and other BCBS plans. Accepted plans include:

• Blue Cross of California d/b/a Anthem Blue Cross.
• Blue Cross HMO (CaliforniaCare).
• Blue Cross PPO (Prudent Buyer).

We are also now in-network with:

• Blue Shield of California.
• Some healthcare plans written or delivered in the State of California utilizing Magellan Health for behavioral health services, including the Summit Network (non-HMO), the Pinnacle Network (HMO), and the Navigator Network (customized network).

How to Use Anthem to Pay for Drug & Alcohol Rehab

To use Anthem/BCBS insurance coverage for addiction treatment, contact a treatment facility in your network which can, in turn, contact your insurance provider and determine the extent of your coverage and estimated costs.

Facility staff may also obtain pre-authorization (or pre-approval) for services when necessary. Generally, all inpatient/residential services require pre-authorization. This is a very important first step. BCBS providers may reduce or deny their payment for certain services that are provided without pre-authorization.⁶

Verify Your Anthem Blue Cross Benefits

An easy way to verify that Laguna or another American Addiction Centers facility takes your Anthem/BCBS insurance is to fill out this quick and confidential . You’ll receive an email with your results in just minutes after you provide some simple information, such as:

• Your name, phone number, and email.
• Your insurance carrier.
• Member ID.

Which Addiction Treatment Services Does Anthem Cover?

Anthem policies provide a range of coverage for the treatment of substance abuse and addiction. The drug and alcohol rehab options and services available to you will depend on your state and the specific benefits outlined in your individual plan.

Generally speaking, Anthem Blue Cross provides their policyholders with coverage for different types and levels of addiction treatment, such as:^7,8

• Medically supervised detox.
• Inpatient or residential programs.
• Partial hospitalization programs.
• Intensive outpatient programs.
• Outpatient individual or group therapy.

While some or all of the above services may be covered under your plan, the percentage of expenses that is actually paid by Anthem or Blue Cross Blue Shield will be based on the level of coverage specified by your policy.

At Laguna, our Orange County rehab offers both hospital-based medical detox and inpatient/residential rehab.

How Much Does Rehab Cost with Anthem Insurance Coverage?

The cost of rehab with Anthem Blue Cross insurance will vary depending on the plan. Some plans may require a copayment for office and outpatient office visits, for example. A copayment is a set amount that is paid up front for services.⁹

Different plans will also have different deductible amounts, coinsurance rates, and out-of-pocket annual maximums. These terms may be confusing. Here are some easy definitions:⁹

• Deductible: The amount that must be reached in a calendar year before coverage begins to kick in. For example, if your deductible is $500, you will need to reach $500 before your plan begins paying for most covered services.
• Coinsurance: The percent of costs for services you pay after you’ve met your deductible. For example, if your coinsurance for a hospital stay is 20% and you’ve met your deductible for the year, your insurance company pays 80% of the hospital stay and you pay 20%.
• Out-of-pocket maximum: The maximum amount you will be required to pay in a year for covered services. For example, if your out-of-pocket maximum is $5000 and you’ve paid a $1000 deductible and $3,800 for covered services, you would only need to pay $200 more until your insurance company begins paying 100% of the costs of covered services for the remainder of the year.

It is likely that you will be responsible for at least some of the costs of your addiction treatment. However, there are ways to make paying for rehab easier, such as flexible payment plans, financing, and loans. You may also explore options such as crowdfunding from people who love and care about you and want to see you recover.

Why Use Anthem Insurance for Addiction Treatment?

Anthem Blue Cross (Elevance Health) and and other BCBS companies provide the coverage you need to get lifesaving addiction treatment. Addiction is a chronic disease that usually requires professional treatment.¹⁰ By using your benefits to get the care you deserve, you can get admitted and begin your recovery today.

BCBS plans allow you to choose the right level of care for you, whether it is medical detox, inpatient rehab, or outpatient treatment. If you need more details on your plan’s coverage, call the number on the back of your insurance card or reach out to us directly at .

Our admissions navigators are available around the clock to discuss your treatment and payment options and more. If you or someone you love is struggling with addiction, don’t wait another day—reach out for help today.

*Recently, Anthem rebranded as Elevance Health. However, it is still operating as Anthem Blue Cross in CA and offering the same plans.