Does Anthem Blue Cross Blue Shield Cover Methadone Treatment

Anthem Blue Cross and Blue Shield provides insurance coverage to 45 million people in the United States. According to Anthem, nearly one in eight Americans are enrolled in one of their affiliated health plans. It also has a number of affiliated health companies, which serve more than 117 million, including employers, individuals, Medicare, Medicaid, and federal workers.

Anthem Blue Cross and Blue Shield offers a wide variety of plans with a large network of providers, a lot of tech tools, and resources for information.

They also have plans available in 14 states with many subsidiaries (Anthem Blue Cross Blue Shield of California, for example).

When a person is looking to get treatment for a substance use disorder or mental health concerns (or both), usually their biggest questions will be about the cost of treatment and whether their insurance will cover it.

Affordable Care Act

The Affordable Care Act (aka Obamacare) made substance abuse and mental health services into essential benefits, so most people will have coverage. However, the type of plan a person has will determine how much their copays, deductibles, and coinsurance will be. The rehab center they choose will also factor into costs since one facility might charge more for specific treatments.

To clear up any confusion and avoid billing surprises, it's a good idea to contact your insurance provider. They can tell you exactly what is covered and how much it will cost. The rehab center can also answer any questions about their services and what they normally charge.

Anthem BCBS Levels of Care

Like many health care plans found on the Health Insurance Marketplace or through employers, Anthem Blue Cross and Blue Shield offer several levels of plans (varies by state).

California, for example, will have four metals: Bronze, Silver, Gold, and Platinum.

• Bronze plans tend to have lower premiums but the highest deductibles. They're recommended for people who rarely go to the doctor.
• Silver plans have lower deductibles than Bronze, and the premiums are a bit more costly than those of Bronze. These are suggested for those with average health needs. Some Silver plans offer cost reductions (subsidies) to people who qualify.
• Gold plans have pricier monthly premiums but lower deductibles compared to Silver. They are recommended for people who need to have healthcare needs addressed or maintained regularly.
• Platinum plans have the highest premiums but the lowest deductibles (sometimes zero dollars). They're suggested for people who desire complete coverage or who have specialized needs.

Many plans require the deductible to be paid in full (which can be thousands of dollars, especially for Bronze and Silver levels) before mental/behavioral health outpatient services, inpatient mental/behavioral health services, and emergency care are covered.

Some plans also require 35% coinsurance for both inpatient and outpatient mental health care, or a set amount per inpatient or ER admission, after the deductible is met.

It's a good idea to check with your insurance company so you have a more apparent handle on what portion of the costs you will be responsible for.

Drug and Alcohol Rehab

Does Anthem Blue Cross and Blue Shield cover drug and alcohol rehab? Like all plans available on the marketplace, addiction treatment is covered. Rehab can include detox, an inpatient stay, and counseling or therapies. Medical screenings and medications may be necessary to manage withdrawal and underlying conditions.

How much insurance will pay for will depend on the type of plan. A Bronze plan would have a higher deductible and a higher coinsurance. Copays would be higher for Bronze plan holders than Silver or Gold. Inpatient hospitalization services (which could include detoxification and rehab) would vary, but the patient will be accountable for a higher amount with a Bronze plan and a lower amount with a Gold plan.

Prices can vary even among the various metal plans.

Going in-network can save patients a considerable amount of money. However, out-of-network care may not be covered at all, except possibly in emergencies.

Length of Treatment

The length of treatment Anthem BCBS allows can vary. The National Institute on Drug Abuse recommends considering the kinds of substances the patient is dependent on as well their medical (including mental health) needs when devising a treatment plan.

A patient's history of drug or alcohol abuse and if they have any medical, psychological, or other issues should all be addressed. So should details like gender, ethnicity, culture, and age.

A longer treatment stay—three months, at least—tends to produce better results.

Rehabs work closely with insurance companies, too, sometimes requesting more treatment time for the patient when it's needed, or the patient wants that.

Mental Health

Does Anthem Blue Cross and Blue Shield also cover mental health? The ACA has named mental health care an essential service, so Anthem BCBS behavioral health insurance covers treatment for mental health conditions. That's especially important since mental health and substance use disorders frequently co-occur.

Mental health care can take on many forms—including office visits, specialist appointments, inpatient and outpatient hospital services, and medications to manage conditions. Whether care can be offered on an outpatient or more intensive inpatient basis will depend on the patient's condition and needs.

Inpatient Rehab

Anthem Blue Cross and Blue Shield inpatient rehab would involve the patient checking into a facility and living onsite for 30, 60, 90, or more days. The rehab center will treat them for their substance use disorder and/or mental health issues. Inpatient rehab includes:

• Assessment: The patient is examined so the staff can diagnose the extent of their substance use disorder and any other co-occurring ailments or mental health conditions. That information will be used to create a treatment plan.
• Detoxification: Many patients must undergo detox before treatment can begin. That's when the body is rid of drugs or alcohol. Sometimes medication is provided to reduce the uncomfortable side effects that accompany withdrawal (vomiting, insomnia, anxiety) and to keep the patient safe. (That's because some substances, like alcohol, can be dangerous to quit cold turkey.)
• Treatment: Here, the patient attends behavioral therapy sessions. (Cognitive-behavioral therapy is a popular and practical approach.) Behavioral therapy works to uncover the underlying causes of a patient's addiction and teaches them to cope with stress and turn to healthier alternatives to substance use. Support group meetings and other activities may also be part of the program.
• Aftercare: In this stage, the facility's staffers help the patient get ready for life following rehab. That might include plans for regular check-ins with the rehab to track progress and review any wins or challenges a patient might face. Patients are encouraged to attend support groups and any other sobriety-supporting activities closer to home to prevent relapse.

The above steps make up much of what a person can expect from inpatient rehab. The specifics (including costs and copays) will vary by plan and facility.

Outpatient Services

Anthem Blue Cross and Blue Shield outpatient services sometimes can serve as an alternative to inpatient care, but they can also serve as an extension of it.

In cases of intensive outpatient programming, a patient will visit the rehab a few days a week, often for several hours at a time. There, they'll get therapy and continue to focus on maintaining abstinence. Sometimes a patient lives at a sober living facility nearby and treats IOP almost as a job (or a part-time job, depending on how much time is spent at the rehab).

Outpatient care can also include visits to a behavioral therapist or a counselor on an ongoing basis (weekly, monthly) to work on challenges and continue to build on healthier coping mechanisms.

Suboxone Treatment

Suboxone is the brand name of two drugs, buprenorphine and naloxone. Suboxone is often used for medication-assisted treatment (MAT), which combines counseling, behavioral therapies, and medication to treat addiction.

The combination of buprenorphine-naloxone can be beneficial in treating opioid use disorder. Suboxone produces some of the effects of opioids, but the high is less intense. That helps with withdrawal symptoms, so patients are more likely to avoid relapse.

Does Anthem Blue Cross and Blue Shield cover suboxone treatment? Some plans don't cover suboxone because it's the name brand, but many include coverage for the generic version, buprenorphine-naloxone. The formulation and copay will vary by plan.

Methadone Treatment

Methadone is another drug used as part of medication-assisted treatment (MAT). It's been found especially effective for opioid use disorders. Experts advise pairing methadone with counseling or therapy to better manage cravings and develop stronger mechanisms.

Methadone is an opioid but has a longer half-life, so its effects take more time to taper off. A patient takes methadone on a schedule to help manage withdrawal cravings and avoid relapse.

Does Anthem Blue Cross and Blue Shield cover methadone treatment? Methadone is one of the approved drugs on Anthem's list. The exact cost will vary by plan, but it is an authorized generic, so costs will be lower than name-brand or higher-tier drugs.

Paying for Rehab

Addiction rehab, especially when it involves inpatient care and hospitalization, is rarely cheap. The price can make some people avoid even considering rehab.

Depending on what insurance plan you have, however, can make it more manageable. Usually, the most a person is responsible for is meeting the deductible and then coinsurance. (Admittedly, that is not always a low cost.)

If you choose to receive treatments or services not covered by your plan, then costs will be much higher. They might not even be covered out of network.

A plan's deductible, coinsurance, and out-of-pocket maximum are three things to consider when trying to anticipate costs. Insurance providers can offer a lot of answers as to what you will be responsible for. Rehabs can also answer questions about the price of treatment as well as what insurances they accept. Again, going for treatment at places within an insurer's network can save a lot of money, too.

When it comes to paying for services not covered by Anthem Blue Cross and Blue Shield, there are other ways to make it more manageable. Not everyone has money on hand to pay down all costs. In such cases, rehabs can work out a monthly billing plan. Sometimes financing may be available, too.

Sources

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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Source: https://www.sunshinebehavioralhealth.com/insurance/anthem-blue-cross-health-insurance/

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