When addiction strikes, it packs a punch. A punch that hits more than just the addict. It hits spouses, parents, children, friends. It can completely knock you off your feet, and even feel like you’ve sustained a concussion from the sneak attack.

When the attack of addiction hits, it can feel intimidating to ask for help or feel scary to know who to confide in. You may also be wondering:

  • Does my insurance cover drug and alcohol rehab?
  • How much will I have to pay for this treatment?
  • Will my insurance cover help for my child?

In the following guide, we’ll help you to understand:

  • Government statistics for addiction.
  • Anthem coverage for adults with Substance Use Disorder (SUD).
  • Anthem coverage for children with substance abuse concerns.
  • Which treatment options, if any, require prior authorization.
  • Potential extra costs for you, as the insured rehab patient.
  • Where you can go for support.

Just as you would not avoid seeking help for a concussion, addiction can be just as deadly if ignored and left untreated.  Seek help today.

Government Statistics on Addiction

Based on information provided by the Center for Disease Control (CDC), beginning about age 12, a surprising 10% of adolescents have used illicit drugs within the previous month. SAMHSA, the governmental agency that reports on U.S. addiction trends, delivers the data that:

  • Over 20 million individuals meet the criteria for a substance abuse disorder
  • This is approximately 1 in 12 people in the U.S.
  • Approximately 7.7 million individuals are living with a mental diagnosis along with an addiction diagnosis

According to these statistics, you have a high probability of facing the heart-wrenching circumstances of addiction at some point in your life. It is crucial to know where your insurance provider stands on their willingness to cover costs for rehab.

Anthem Insurance Coverage for Adults with Addiction

Anthem coverage for mental health and chemical dependency issues as a component of their medical plans. Because mental health issues often coincide with substance abuse, Anthem provides full or partial coverage for interventions for anxiety, depression, eating disorders, as well as addiction.

Anthem uses an integrated method for care of substance abuse issues, with expert consultation. This means that the insurance provider will cover expenses for various interventions as they are deemed medically essential by a professional in the field of addiction.

The integrated approach addresses the entire person, particularly in the areas of medical, behavioral, nutritional, physical, somatic and spiritual needs. The coverage for adults with Anthem plans typically includes:

  • availability to a team of addiction counselors, psychiatrists and doctors
  • access to treatment facilities within network
  • an evaluation for potential placement in a residential substance abuse treatment facility or outpatient program
  • placement in any level of care at any age as deemed medically necessary

The levels of care covered by Anthem may include:

  • medically supervised detox in a contracted medical facility
  • medication and medication management
  • in-patient services at a contracted treatment facility, including individual, group, and family therapy
  • partial hospitalization for those not quite prepared to fully re-enter society within a life of sobriety
  • outpatient services as deemed medically essential
  • ongoing counseling and monitoring
  • case management services by licensed, professional care specialists

Anthem Insurance for Rehab for Children

Under the Anthem Blue Cross and Blue Shield plans, covered costs for children between the ages of 11 and 18  are treated similarly to those of adults. Both are covered in part or full as ruled a medical necessity. Much like the adult coverage, Anthem may cover the following services for children:

  • medically directed detox within a contracted medical establishment
  • detox medication and medication monitoring
  • residential services at a contracted treatment facility, including individual, group, and family therapy
  • “day treatment” at a contracted school or facility, primarily during the school days
  • outpatient programs as necessary for relapse prevention and building sober living skills
  • applicable and necessary counseling services
  • case management services by a qualified case management professional

Prior Authorization

Prior authorization refers to the requirement for a medical professional to determine whether or not certain interventions are medically necessary. This typically involves a medical assessment, with professional recommendations being sent directly to your insurance company.

The need for prior authorization is very common among insurance providers, but you’ll need to find out whether or not your particular plan requires it.

Out-of-pocket Expenses

Out-of-pocket costs refer to the amount of your own money you’ll need to contribute to the addiction treatment, on top of what the insurance covers. For many plans, this includes:

  • deductibles, or the amount you must pay before an insurance provider will cover the costs
  • co-payments, or the amount you must pay in addition to the amount covered by your insurance provider
  • extra fees for interventions that are not covered by your insurance provider

The amount of out-of-pocket costs is dependent upon the specific plan you hold. You’ll want to know what plan you have and find out the details on coverage.

Support is Just a Phone Call Away!

We at Adrugrehab.org know how overwhelming it can be to try to make this journey on your own. This is why we offer a free national helpline, available to you 24/7, manned by our licensed counselors and other mental health professionals to give you advice, answer your questions, and provide confidential referrals to the best treatment facilities your insurance will cover. Pick up the phone and let us help you reclaim your peace of mind today!