Does Anthem BCBS Insurance Cover Heroin or Drug Rehab?

Written by: Editorial Staff

Last updated on March 17, 2021

When you’re considering heroin rehab treatment, you might worry about the cost. The good news is that many insurance policies cover some level of drug rehab services. Anthem Blue Cross Blue Shield (BCBS) is one of them.

People all over the United States use Anthem BCBS. Anthem covers substance abuse disorders as well as any supporting treatments you may need to improve your recovery process beyond treating the symptoms of addiction.

While Anthem BCBS does cover heroin rehab, that coverage varies based on your policy. To find out how much your policy covers, talk directly with your chosen rehab center. If you call American Addiction Centers, we’ll ask you for some basic insurance information about your policy and we’ll look up whether you’re covered while you’re on the phone with us.

You can also call the number on the back of your insurance card to talk with a representative from Anthem BCBS. They can look up your information and tell you how what your policy will cover for your heroin or drug rehab treatment.

What Will Anthem BCBS Insurance Cover?

Anthem BCBS insurance offers both individual and family insurance plans. They also have Medicare and Medicaid options for qualified individuals. With Anthem, you can also get coverage if you’re unemployed.

Anthem BCBS serves the following states¹:

• Colorado
• Connecticut
• Georgia
• Indiana
• Kentucky
• Missouri
• Maine
• New Hampshire
• Nevada
• Ohio
• Virginia
• Wisconsin

As part of Blue Cross Blue Shield insurance, Anthem covers many of the same things as Blue Cross Blue Shield. That means it also has similar insurance plans to choose from, including: ^{2, Coverage and Costs}

• Bronze: With lower premiums and higher out-of-pocket costs, the Bronze plan covers about 60% of your costs.
• Silver: The Silver tier covers about 70% of your costs. Premiums are lower than Gold but higher than Bronze. You may also qualify for cost-sharing, which can lower your out-of-pocket costs.
• Gold: With the highest premiums, the Gold plan covers 80% of your costs.

Beyond these plans, you can also get Anthem BCBS Medicaid in California, Indiana, Kentucky, Nevada, Virginia, and Wisconsin.

Anthem insurance allows you to take advantage of the Blue Cross Blue Shield network. That means if you can’t find a facility in your home state that you want to use, you can go to one in another state and still be covered through insurance. Anthem covers many types of drug rehab treatment, including inpatient, outpatient, intensive outpatient programs (IOPs), and partial hospitalization programs (PHPs).

They also have specialized options for Medicare and federal employees through their Federal Employee Program (FEP). Options include Standard, Basic, and FEP plans. ^{3, pg. 6, table} With these plans, you can get inpatient and outpatient coverage, often with a $0 copay.

To find out whether you qualify for these plans and how much coverage you have, talk to your chosen rehab center or ask your insurance company directly about your policy.

Does Anthem BCBS Insurance Cover Mental Health Care?

Along with IOPs and PHPs, Anthem BCBS rehab insurance covers one-on-one therapy sessions that offer therapy modalities including cognitive-behavioral therapy and dialectical behavioral therapy. It also covers mental health care for co-occurring conditions like eating disorders, anxiety, depression, and other types of mental illness. ^{4, paragraphs 1-3}

When it comes to heroin and drug addiction, it’s important to pay as much attention to its cause and co-occurring conditions that come with it as to the substance use disorder itself. Substance abuse often co-occurs with other mental health disorders like ADHD, anxiety, depression, and bipolar disorder. A comprehensive treatment plan that addresses any co-occurring and underlying issues is more likely to result in a successful recovery.

According to the National Institute on Drug Abuse, 1 in 4 people with a serious mental illness will also have a substance abuse disorder, meaning their risk of substance abuse is much higher than it is for those without a mental illness. ^{5, end of paragraph 2} Acknowledging that mental illness is a factor in substance abuse will allow you to receive better and more comprehensive care. Your treatment will include long-term solutions that go beyond treating the symptoms of addiction.

Mental health care can also make you feel more supported throughout your treatment and recovery. It shows that someone understands your experience. That support can, in turn, mean you’re less likely to turn to drugs in the future, as you’ll have resources for getting the help you need.

The Affordable Care Act mandates that insurance companies must provide mental health care coverage. That means Anthem BCBS will cover treatment for substance use disorders and co-occurring mental health disorders. However, the amount of coverage varies, so you should check with your rehab center or insurance company to fully understand what your policy covers.

How Long Does Anthem BCBS Insurance Cover Rehab?

AAC and Anthem understand that everyone’s journey through recovery and rehab is unique. While Anthem BCBS heroin rehab insurance covers both inpatient and outpatient therapy, including treatment at an IOP or a PHP, the duration of your coverage depends on your policy. Different people need different treatment lengths, so it’s very important to know how long your particular policy will cover heroin rehab.

The goal of rehab is to show people they are capable of recovery and that they are more than their substance abuse disorder. A study from the Journal of General Internal Medicine shows that longer rehab treatment directly corresponds with longer abstinence from substances. ^{6, Key Results} People with substance abuse disorders often have a more successful and comfortable recovery with longer rehab treatment.

Longer treatment times come with many benefits. Those who receive treatment for at least 6 months often have a better experience with recovery, despite its challenges. A longer rehab experience helps them learn to create routines. It also provides a solid external support system so that they don’t have to feel alone. They learn to trust the recovery process—as well as the people helping them through it.

What if My Anthem BCBS Insurance Policy Does Not Cover Heroin Rehab?

In most cases, Anthem BCBS will cover at least some of your rehab treatment. If your insurance doesn’t provide enough coverage for you to afford rehab, you have other options. Many rehab treatment centers offer scholarships or financing to give you access to treatment without worrying about paying for it all at once.

Prolonged heroin and drug use can come with serious problems, including heart disease, injury, and death. Getting the right treatment sooner rather than later can make all the difference to your recovery from heroin addiction. The longer you go without treatment, the more challenging it will be to recover later. Early treatment can make the detox and rehab process easier. It can also give you the opportunity to improve your quality of life now.

At AAC, we can help ease the burden of withdrawal and help moderate symptoms in a controlled environment. When you work with us, we’ll ensure that you get the care you need from day 1.

In-Network vs. Out-of-Network Heroin Rehab Centers

When you go to an in-network heroin rehab center, that facility has accepted the costs associated with your insurance plan. The center may charge a fixed fee to provide care and services to people without insurance.

However, Anthem BCBS might ask them to agree to charge a lower amount. That means you save the difference between those two amounts. Plus, with an in-network provider, Anthem BCBS covers a portion of your care. While the amount varies based on your policy, it’s still less than if you were to pay all costs out-of-pocket.

With an out-of-network heroin rehab center, you don’t have as many benefits when it comes to coverage. Some Anthem plans do cover out-of-network providers, but they won’t cover as much of your care as they would if you went to an in-network provider.

Before you choose a rehab center, you should confirm whether it’s considered in-network or out-of-network on your insurance plan.

Check Your Benefits

American Addiction Centers will work with you to find a rehab facility that can best get you started on your recovery, based on your specific needs. We have many resources to help you find the right care for you.

Call our helpline today at 1-888-496-8059 Who Answers? to talk to a representative who will verify your insurance coverage and help you begin your journey to recovery from heroin and drug addiction.

Sources

1. Anthem (2021). About Anthem.
2. Blue Cross Blue Shield of Michigan (2021). What’s the difference between bronze, silver, and gold plans?
3. Blue Cross Blue Shield Federal Employee Program (2021). What you’ll pay when Medicare Parts A and B are primary.
4. Anthem Blue Cross Blue Shield (2021). Anthem’s behavioral and substance abuse services.
5. National Institute on Drug Abuse (2020). Common comorbidities with substance use disorders research report, part 1: The connection between substance use disorders and mental illness.
6. Wakeman, S. E., Metlay, J. P., Chang, Y. Herman, G. E., & Riggoti, N. A. (2017). Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. Journal of General Internal Medicine 32, 909-916.