Addiction is not selective. It can strike any age, race, nationality, sex or economic status. It can remain hidden or seemingly “under control” for years. It can feel like you’ve been punched in the face when reality hits.

When it comes to making the difficult decision to get help for yourself or a loved one, questions may flood your mind: Does my Wellpoint plan help with drug and alcohol treatment? How much will rehab cost me? Will Wellpoint cover treatment for my child?

We’ll help you to better understand your Wellpoint insurance for drug rehab by providing you with information on the following:

  • Government data on addiction trends in the U.S.
  • Wellpoint rehab insurance coverage for adults struggling with addiction.
  • Wellpoint coverage for children with substance abuse concerns.
  • Prior authorization and what it entails.
  • Out-of-pocket costs that you should be prepared for.
  • Who can help you in choosing the treatment that works best for your situation.

Government Data

Based on information gathered by the Center for Disease Control (CDC), beginning at the age of 12, a surprising 10% of adolescence admit to consuming illicit drugs in the past month. The government body reporting on substance abuse data in the U.S., known as SAMHSA, states that:

  • A shocking 20 million individuals carry the diagnosis of Substance Abuse Disorder (SUD)
  • This equals 1 out of every 12 people in the U.S.
  • 7.7 million people carry a diagnosis of a mental health disorder along with SUD.

A statistic taken from drugabuse.gov, reports that 1 in 15 individuals taking non-prescribed opioid pain medications will use heroin within 10 years.

Deducing from these statistics, it is safe to say that you are likely to encounter a circumstance shattered by addiction at some point in your lifetime. You can empower yourself by learning exactly what your insurance plan covers for drug and/or alcohol treatment.

Wellpoint Insurance for Rehab for Adults

Wellpoint will cover drug and/or alcohol treatment if the interventions have been authorized before treatment begins. Under the Affordable Care Act, insurance companies are mandated to cover substance abuse and mental health care.

Wellpoint coverage for chemical dependency interventions for adults varies based on the insurance plan you have, and typically includes:

  • treatment at an inpatient facility as ruled medically necessary
  • outpatient services
  • individual, group and family therapy
  • select aftercare resources and continuing services as deemed medically needed

The length of stay covered is decided throughout the course of treatment by therapists and medical professionals. The patient will be assessed, the recommendations will will be sent to Wellpoint, and may or may not be approved for the amount of days recommended. The most common number of days approved are 30, 60 or 90 days.

Wellpoint requires that the treatment be delivered at a standard facility, meaning a facility that utilizes practices that have been tested and proven for a substantial period of time. Wellpoint usually does not cover wilderness therapy for drug and/or alcohol rehab

Wellpoint provides plans with either in-network or out-of-network facilities, and also a national network, which may extend to contracted facilities in other parts of the country. For policies that just offer in-network benefits in the state where you live, you will not receive financial aid if you choose a treatment center in another state.

Wellpoint Coverage for Children

Because there are so many variables based on your specific plan, it is important to speak with your insurance company to find out exactly what your plan covers when it comes to children with substance abuse issues.

Prior Authorization

Prior authorization applies to most interventions offered for substance abuse treatment. This means that a patient must be evaluated by a medical professional, and the interventions must be ruled as a medical necessity. To know which services demand prior authorization, talk to your insurance carrier.

Out-of-pocket Costs

These costs include what you’ll be responsible for paying either before or during treatment. These expenses typically include:

  • Deductibles
  • Co-payments
  • Any additional charges

The amount can vary significantly depending on which insurance plan you have. Different insurance plans have different out-of-pocket expenses. It is important to know which deductible your plan has and what co-payments you might expect for services.

As an example, the person who selects the insurance plan with a $1,000 deductible will pay the full deductible, then Wellpoint will pay 70% of the remainder for that year. When this same person has paid more than $6,300 from his/her own reserves within the year, Wellpoint will cover remaining medical costs in full.

While Wellpoint covers medical costs at 100% after you’ve met your deductible, they do place a cap on how many days they are willing to pay for. You can choose to add more days of treatment if you pay for them yourself.

Support When You Need It Most

We at Adrugrehab.org know how stressful it can be trying to understand all the ins and outs of your insurance plan and what it covers. This is why we are here to support you with a free, national 24/7 helpline to arm you with information and options that best fit your situation. Our licensed therapists also offer confidential referrals, along with advice and answers to any concerns. Let us support you in this major life decision today!