For qualified plan holders, we accept Anthem insurance for alcohol, drug and substance abuse rehab, detoxification and therapeutic services. Trying to determine what your insurance policy covers when it comes to getting treatment for drug and alcohol abuse or addiction can be tricky. The language in insurance policies is not always straightforward, and in a time of crisis, you need everything to be as simple as possible.
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Anthem provides a number of different insurance policies that cover various drug, alcohol and other substance abuse treatment services. Both inpatient and outpatient care is covered depending upon the plan you purchased and the particulars of that policy as well as the specific needs of the patient.
Levels of care
At Anthem, the determination of whether or not a request for coverage for different substance abuse treatment services will be approved is based upon medical necessity as outlined in their guidelines. Three categories are used to define a patient’s medical need for services:
- Severity of Illness: The criteria for Severity of Illness include details of the circumstances and symptoms specific to the patient.
- Intensity of Service: Criteria for this category is based on the service being provided to the patient and whether or not the service speaks directly to the symptoms and condition experienced.
- Continued Stay: Eligibility is based on whether or not the criteria for Severity of Illness and Intensity of Service are met on an ongoing basis.
Each patient is approved on a case-by-case basis. Depending upon the symptoms (e.g., physical withdrawal, co-occurring mental health symptoms, related medical health problems, etc.), some patients may be approved only for certain services.
Covered substance abuse treatment services
Depending upon the type of insurance policy held by the patient and their ability to meet the criteria above, Anthem offers some form of coverage for the following drug and alcohol addiction treatment services:
- Outpatient detoxification services with or without extended monitoring on site
- Outpatient, office-based care that provides medication-assisted treatment for opiate dependence (MAT)
- Outpatient addiction treatment
- Intensive structured outpatient program (IOP)
- Partial hospitalization program (PHP)
- Inpatient care for detox only
- Residential treatment for addiction
- Residential detox and addiction treatment
- Residential treatment center (RTC) stay
Each one of these treatment services has a different set of criteria for the three categories described above that must be demonstrated by the patient prior to receiving coverage for care. The criteria for each level of care are very specific. Families and patients should take time to review the guidelines to determine whether or not they qualify for certain services.
For example, one of the criteria that must be demonstrated in order to receive approval for residential treatment is proof that there are psychiatric or medical symptoms that would make it impossible for the patient to find effective care or remain abstinent at an outpatient care facility. If authorization for coverage for residential rehab is given, patients must provide weekly evaluation reviews by a qualified physician and/or appropriate medical tests to show that the medical need is still in evidence. In addition, they must provide weekly treatment plan reviews that show progress toward treatment goals in order to meet Intensity of Service and Continued Stay criteria requirements.
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f you are unsure what your Anthem insurance policy will cover in terms of substance abuse treatment services, their confidential helpline is available to get the answers you need. If you have questions about how your insurance coverage will factor into your stay here at The Recovery Village, contact us today.
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We accept most major health plans. Please call for verification of benefits coverage or check with your health insurance carrier for final determination regarding specific covered services. All products, logos, and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement.