Anthem Insurance or Anthem Blue Cross Blue Shield is one of the largest insurance providers in the United States. It also has one of the clearest and most upfront rate schemes per insurance plan and metal level, meaning it’s extremely easy to figure out what your rates will be. Anthem currently serves over 78 million people across its many health plans. However, Anthem is a part of a larger group, belonging to Elevance Health. It’s also the primary Blue Cross Blue Shield supplier in multiple states in the United States. However, you could be working with Anthem if you have Blue Cross Blue Sheild, Amerigroup, America’s 1st Choice, Aspire Health, CareMore, Freedom health, HealthLink, HealthSun, Optimum Healthcare, Simple Healthcare, IngenioRX, and Unicare.
This means you can go to mental health and substance abuse rehab at Compassion Recovery with full coverage from your Anthem or Blue Cross Blue Shield insurance provider. This includes employer-sponsored and private plans. If you’d like to learn more, contact us at 909-314-1097 or keep reading.
In each case, your actual coverage will depend on your plan and plan type. In addition, coverage typically ranges between 40 and 90% for in-network providers. However, if you go to an out of network with a PPO, you’ll typically pay 50% + deductible.
In every case, you’ll need your doctor to recommend you to treatment before Anthem will offer coverage. However, providing your doctor authorizes the treatment, you can get almost any kind of substance use disorder treatment covered by Anthem.
Again, your mental health will only be covered if you get a referral from your primary care provider. This means that any talk with Anthem should begin with a consultation at your doctor and a referral from your primary care provider.
Anthem offers full support for dual diagnosis programs. This means you can treat mental health and substance use disorders via a combined trajectory, with a treatment plan that incorporates both. That allows you to get a broader treatment plan that tackles mental health and substance use disorder symptoms where they might interfere with treatment, helping you to improve your total mental health rather than focusing on one issue at a time. That can dramatically improve the quality of your treatment. Like with other behavioral and mental health coverage, Anthem’s only requirement is that you be recommended to the program by your doctor.
Anthem Insurance uses a very straightforward rates. However, it has a large number of plans spread across a large number of subsidiaries. Therefore, your actual costs may vary depending on where you’re coming from and what specific plan you have. For example, Anthem has over 20 plans under the Anthem brand alone.
For example, you would see the following rates with some of Anthem’s plans:
Anthem Blue Cross Blue Shield Broze HMO – $4,300 deductible for personal plan $8,600 family deductible (Does not apply to copayments). You pay 20% coinsurance + deductible on both inpatient and outpatient treatment for in network providers. You receive no coverage for out-of-network providers.
Anthem Blue Cross Blue Shield Silver HMO – $3,700 deductible for individuals/$7,400 deductible for families. 20% coinsurance + deductible for inpatient or outpatient services. No out-of-network services are covered.
Anthem Blue Cross Gold HMO – You have a $500 per person deductible or a $1,500 family deductible. You’ll pay a $20 copay for the first three office visits for outpatient care after which you’ll pay a 20% copay. You’ll pay a 20% copay for all inpatient services. No out-of-network services are covered.
Anthem Blue Cross Gold Priority Select HMO 30 – You have no deductible. You pay $30 per day for outpatient office visits and $300 per day for detox and clinic visits. You pay $600 per day for the first four days of inpatient care + admission. No out-of-network services are covered.
Anthem Blue Cross gold PPO – You pay a deductible of $500 for individual/$1,500 for family for in network providers and $2,000 for individuals / $4,000 for family for out of network providers. The out-of-pocket limit also doubles for out –of-network providers. Rates are 20% coinsurance for inpatient or outpatient services (after deductible) for in-network providers and 50% coinsurance for inpatient or outpatient (after deductible) for out-of-network.
Anthem Blue Cross Platinum PPO – You have no deductible for in-network providers but a $2,000 individual and $4,000 family deductible for out of network providers. All in-network services have a 10% coinsurance with a $3,800 out of pocket limit for individuals. Out of network providers have a 50% coinsurance after deductible with a $7,600 out of pocket limit, meaning that the maximum you can pay for treatment is $9,600.
Anthem charges you the full rate of your deductible before paying for any services. This means that if you have a Bronze plan, you’ll pay the first $4,300 of treatment out of pocket and then your 20% copay.
Therefore, you’ll always want to check your specific plan with Anthem before moving forward. You can also call Anthem at 1-800-331-1476 to ask for details if you can’t find your membership ID card.
You’ll want to know:
Once you have that sorted out, you can easily get started.
Compassion Recovery is in network for Anthem, meaning we are in network for all of Anthem’s subsidiaries including Blue Cross and Blue Cross Blue Shield. This means you can maximize your coverage for mental health services, substance abuse rehab, and dual diagnosis tracks by going to treatment with us.
Compassion Recovery can also help you figure out what your costs are, what your program will cover, and help figuring out insurance for your program. Contact us at 909-314-1097 for a consultation.
If you’re ready to get mental health help, your insurance provider is on your side. Anthem offers 40-90% coverage for in-network providers like Compassion Recovery, minus deductible on all behavioral health treatments including substance use disorder treatment and mental health treatment.
You don’t need pre-approval for emergency treatment, however, you will have to submit your request for coverage ASAP after receiving it. If you want help, call Compassion Recovery at 909-314-1097, we’re here to help.
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