Anthem Blue Cross Rehab Coverage FAQs
How does Anthem Decide my Claim?
Blue Cross Blue Shield makes decisions about their rehab coverage based on your health plan. They comply with all Federal guidelines. Each claim decision is reviewed on a case by case basis. Anthem will look at services you use. They then follow national guidelines and other policies to determine if your alcohol or drug rehab claim is covered. Services that may be covered can include alcohol and drug rehab, blood-tests, surgeries, or hospital stays.
For Blue Cross Blue Shield drug rehab coverage, you may need a doctor’s evaluation and recommendation first. The doctor’s claim is then decided on the “severity” of your addiction. If Blue Cross Blue Shield does not consider treatment to be needed, they won’t pay for it.
If they will not pay, your claim is denied. Anthem Blue Cross Blue Shield will send you a notice. You DO have the right to appeal. If you use up your appeals, it is then possible to have an independent doctor review your denied claim in a process called an “external review.”
To start an appeal with Anthem Blue Cross Blue Shield, call their Member Services number on your Anthem ID card within 180 calendar days from the date of the initial payment or denial notice. If Member Services doesn’t resolve your issue, ask for an appeal.
Per Anthem’s website, you will be notified in writing of the appeal decision within 30 calendar days. To have your appeal expedited, or find more information, visit Anthem’s site.
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Does Blue Cross Blue Shield Cover Rehab?
Yes, Anthem usually will cover drug rehab as part of their behavioral health option. They base coverage on a number of factors which vary based on your plan. Anthem is licensed by the Blue Cross and Blue Shield Association and they label their plans accordingly.
Anthem Blue Cross Blue Shield Plan Levels Are:
- Bronze (approx 60% of medical expenses covered)
- Silver (approx 70% of medical expenses covered)
- Gold (approx 80% of medical expenses covered)
- Platinum (approx 90% of medical expenses covered)
Anthem usually doesn’t offer 100% coverage. You are responsible for the remaining balance. Also, you will likely have to pay your deductible amount first before your insurance coverage takes over.
Most Anthem plans have coverage for the following:
|Intensive Outpatient Programs (IOP)|
|Mental Health Programs|
|Behavioral Health Programs|
To manage your Anthem Health Plan, or learn more about it, you can visit Anthem’s Website and use their online tool. They also have a mobile app.
How Long Does Blue Cross Blue Shield Rehab Coverage Last?
Anthem coverage length varies. It is possible to be covered for several months. They base their coverage on a case-by-case basis.
Out-of-Network providers may incur additional costs.
Contact Anthem to confirm your level of coverage, if any, for out-of-network providers.
Does Anthem Allow Luxury Rehab Facilities?
Anthem allows certain, luxury and private rehabilitation centers. Luxury drug rehabs are often where wealthy people and celebrities will go for addiction help. They are often as nice as any hotel or resort you may use for a vacation spot. They usually have massages, acupuncture, hot-tubs, pools, and quality dining, in addition to other exclusive privileges.
Inpatient Addiction Treatment vs. Outpatient Treatment
This is one of the biggest choices a patient or their family will make when looking for addiction help.
Both options are better than not seeking treatment and could save your life. They each have their own strengths and weaknesses.
An outpatient facility is usually a local option. They give you the chance to meet with medical professionals like doctors, alcohol and drug counselors, or therapists, attend group sessions, and go to recovery meetings while being able to head home afterwards. Co-pays may be required for each visit.
Inpatient facilities, also called residential programs, are most often 28 day programs. They provide structure and are typically remote destinations where you stay in the facility for the duration of the program.
Do I need Insurance to go to Rehab?
You are not required to have insurance to get addiction treatment. However, without insurance, the cost of drug rehab facilities is usually very expensive and impractical for most people. You would need to pay out of pocket. You can certainly pay with a credit or debit card, work out a payment plan, or use other methods that each facility accepts.
Typical inpatient rehabs may cost anywhere from $6,000-$20,000 for a 28 day program.
Outpatient Rehab can range from $4,000-$10,000 for 90 days. The cost of outpatient rehab will vary and is mostly based on how many visits are made.
What Else does Blue Cross Blue Shield Rehab Provide?
Anthem has a global network of more than 89,000 doctors and providers
A variety of plans you can customize and the ability to manage and adjust your plan.
24/7 Customer Support
Anything that you say is kept confidential, so you don’t have to worry about everyone knowing you may have trouble with alcohol or drugs.
Get Approved for Blue Cross Blue Shield Rehab Coverage
Verifying what insurance will cover can be a time-consuming process. This hassle usually involves lots of waiting and multi phone calls back and forth. Our knowledgeable staff can verify your coverage for you and take the stress and annoyance out of this already difficult time. You have enough to worry about already. Verifying insurance coverage for rehab shouldn’t be an additional burden.
NOTICE: Step One Rehab works hard to make sure our information is accurate. Due to constant changes in insurance company policies, we suggest you contact your insurance company with your member ID ready to confirm your particular coverage or submit our free verification form to verify benefits.
Give us a call today and let us handle this step for FREE! We are 100% confidential. Our number is 877-348-7494