WellPoint no longer exists. They are now known as Anthem, and their insurance plans can be applied toward drug rehab services. The extent of coverage will depend on the specifics of the individual plan.
WellPoint Health Insurance
Anthem is an independent provider under the Blue Cross Blue Shield Association umbrella that provides health insurance coverage and benefits for members in 14 states. Offering a wide range of products and services, Anthem serves over 40 million Americans through its family of health plans. This translates to one out of every eight Americans obtaining medical care coverage through Anthem and its affiliated plans.
Using Anthem for Drug Rehab
If you had a WellPoint plan, it was transitioned to Anthem. To use an Anthem-based health insurance plan for drug rehab, you will need to determine your plan’s level of coverage. Coverage often depends on the state where you live.
The Affordable Care Act of 2010 opened up health insurance coverage to more Americans. It listed 10 “essential health benefits” that must be covered under all plans that are sold on the federal marketplace. Drug and substance abuse treatment services are included in these 10 benefits. They fall into the same category with mental health and behavioral health treatment.
Drug parity laws ensure that drug rehab and addiction treatment services are treated the same as other medical and surgical services when it comes to health insurance coverage. This means that Anthem insurance plans can often be used to cover the costs of drug rehab.
Anthem offers many different types of coverage and levels of care. The type of plans you can choose from will depend on where you live and which subsidiary will be directly providing your coverage. This varies by state.
The following types of plans are offered by Anthem:
- Preferred provider organization (PPO): These plans give you the freedom to seek care from any provider. Costs will be lowest when care is provided by in-network providers. You will not usually need a referral for specialty services like drug rehab.
- Health maintenance organization (HMO): With an HMO, your care is generally managed by your primary care provider (PCP) who can offer referrals to services that are in-network.
- Exclusive provider organization (EPO): These plans have a specific network of providers that offer care. Only emergency services can be provided by out-of-network providers. Specialists that are in-network do not require a referral.
- High-deductible health plan (HDHP): Basics are covered at no cost, such as preventative care and wellness visits. Other services are covered after a high deductible is reached. These plans generally have low monthly premiums with high out-of-pocket fees for services like drug rehab.
- Point of service (POS): You can receive care from any provider, regardless of whether or not they are in-network, for a higher cost.
- Catastrophic plans: These are specialty minimum-coverage plans for people under 30 who meet specific criteria. Coverage is provided only after very high deductibles are reached. Monthly premiums are low, and preventative care is often covered in full.
Coverage options can vary within these types of plans, ranging from higher deductibles with lower monthly premiums and high co-insurance rates to the opposite. Co-insurance is the percentage of expenses you are responsible for after insurance coverage is used.
Specifics on Drug Rehab Coverage
To use Anthem (previously WellPoint) insurance coverage to pay for drug rehab, first, start with a call to your insurance provider for specific details about your plan and how your coverage works exactly.
Coverage is different in different states, and plans are variable based on their level. If you have a plan that requires you to use an in-network provider for treatment services, you may need to choose a drug rehab program that has a contract with Anthem.
Providers are often independent contractors or community-based. Plans may allow you to use a provider of your choice, even if they are not in-network, for a higher rate and a lower amount of coverage. This means that you will have higher out-of-pocket costs.
Plans may also require that you have a referral from your PCP, an evaluation, and a determination that the services are “medically necessary.” A pre-authorization is often required before drug rehab services will be covered through insurance. Insurance plans may also want you to try outpatient services before entering into a residential drug rehab program in some cases.
Limits And Services
Different levels of coverage and plan types will cover varying services and levels of care. There may be a limit on the number of days you can spend in a program in a year, or a lifetime, as well as a set number of office visits or therapy sessions.
In general, the following drug abuse and addiction treatment services are covered through Anthem insurance plans to some degree:
- Medical detox
- Crisis services
- Evaluations and assessments
- Medication management
- Outpatient drug rehab
- Group, family, and individual therapy
- Behavioral therapies
- Mental health treatment services
- Residential drug rehab programs
Insurance plans that are sold on the federal marketplace cannot put lifetime or annual monetary limits on substance abuse treatment coverage. They must only limit the number of days or visits in the same way that coverage is limited for other medical procedures or conditions.
Contact Anthem or the specific drug rehab provider for assistance with insurance-related questions.