Does Anthem Blue Cross of California Provide Alcohol Rehab Coverage?
Anthem was established in 1936, and since then, it became one of the major health insurance providers in the U.S. Currently, Anthem Blue Cross is an independent licensee of the Blue Cross Association. This is the brand name of Blue Cross California.1
Anthem Blue Cross of California provides coverage for alcohol abuse disorders similarly to other healthcare plans. This is a requirement of the Affordable Care Act (ACA). Under this act, the same level of coverage must be provided for substance abuse and mental health issues as for other medical conditions. However, the coverage of specific treatment and services will depend on individual coverage levels and plans. Since 56% of California’s rehab facilities accept private insurance, including Anthem Blue Cross of California, you will be able to find an appropriate substance abuse treatment facility for yourself or a loved one.2
Aside from New York, California was the state with the largest numbers of both rehab facilities and clients in treatment from 2007 through 2017. Out of all US facilities, 10% were in California, as well as 9% of all admitted clients, according to the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS).2
The survey also reports that, during that same year, 19,820 clients older than 18 were in treatment for alcohol abuse only. This type of treatment is provided in 72.1% of California’s rehab facilities, while 90% of facilities treat patients with both alcohol and drug abuse. Since mental health issues often co-occur with alcohol abuse disorder and other SUDs, 89.3% of California’s facilities offer dual diagnosis treatment. As many as 54.9% of clients admitted to rehab for alcohol addiction suffer from co-occurring mental health issues.2
What Does Anthem Blue Cross of California Insurance Include in Its Coverage for Alcohol Treatment?
An important condition for getting Anthem Blue Cross substance abuse coverage is to use in-network treatment providers. That means that primary care physicians, addiction experts, hospitals, and other facilities, need to have a contract with this insurance company. This makes them ‘in-network’ providers. Substance abuse providers that don’t have a contract with Anthem Blue Cross of California are ‘out-of-network’ providers.3, 4
Additionally, most addiction center services are approved for coverage only if they are determined to be medically necessary. For example, medically monitored detoxification for alcohol, benzodiazepines, and opioids, is fully covered. However, to be completely sure that all the services you need will be covered, get in touch with Anthem Blue Cross of California directly and get accurate information.3, 5
Medically necessary services that are generally covered by Anthem Blue Cross of California, as well as all major health insurance providers are:6, 7, 8
- Screenings, assessments, and interventions.
- Medically monitored detox with withdrawal symptoms mitigation.
- Inpatient or residential treatment.
- Outpatient treatment or intensive outpatient treatment.
- Behavioral therapies, usually cognitive-behavioral therapy.
- Treatment for co-occurring disorders for patients with dual diagnosis.
What Parts of Alcohol Treatment Aren’t Covered by Anthem Blue Cross of California?
Even though everybody’s treatment plan may be different to accommodate their individual needs, not all elements of treatment are considered to be medically necessary. Most health plans won’t cover:7, 8
- Non-medical amenities, usually high-end ones, like spas and swimming pools.
- Holistic care services, like yoga, meditation, or stress reduction.
- Recreation programs, like equine therapy, outdoor or wilderness programs.
- Food delivery, or special organic meals prepared by professional chefs.
- Private treatment services like massage or personal training.
- Alternative therapies like acupuncture, energy healing, or hypnotherapy.
What to Know About Alcohol Rehab Cost
The price of alcohol rehab can often seem cost-prohibitive and prevent many individuals suffering from various SUDs from getting much-needed treatment. However, 56% of California’s rehab facilities accept private health insurance.2
Even if some costs of your individualized recovery plan are not covered, additional out-of-pocket expenses can be covered through private pay. Cash or self-payment is accepted in 85.5% of California’s substance abuse centers.2
The complete cost of treatment will depend on:9
- The number and quality of services offered.
- The intensity of provided services and level of care.
- Duration of treatment, whether inpatient or outpatient.
- Rehab center amenities, like gyms, tennis courts, pools, jacuzzi, and sauna.
Inpatient Costs for Alcohol Rehab
The cost and Blue Cross coverage of undergoing treatment at an inpatient alcohol rehab center in California depends on several factors, the most important one being the duration of stay. Since inpatient treatment can be short-term (up to a month) and long-term (60-90 days, or even up to a year), this is the crucial factor to consider when determining the cost. Other factors include the level and quality of care, amenities, treatment facility, and additional services.10, 11
Outpatient Costs for Alcohol Rehab
Outpatient treatment is best suited for people with less severe addiction or those who are unable to take time off from professional or family responsibilities to attend inpatient treatment. Also, inpatient treatment patients may transfer to outpatient services after the detoxification process.10
The cost of outpatient treatment depends on the number of services provided, how often the patient visits the facility, and the number of hours of treatment. Treatment sessions are regularly scheduled and patients typically meet with treatment specialists for a few hours weekly.10
Partial Hospitalization Program (PHP) Costs for Alcohol Treatment
Partial hospitalization is the type of treatment that could be described as something between inpatient and outpatient treatment. The patient doesn’t live at the rehab facility, but they do spend a considerable number of hours receiving treatment services. They usually begin with a minimum of 20 hours per week.12
However, it is the severity of each client’s addiction, as well as everyday life circumstances, that determine both the duration and intensity of treatment. This type of program lasts for around two months.12
Most health insurance plans cover partial hospitalization programs when they’re determined to be medically necessary. Some additional costs may not be covered, like meals, transportation, and other additional services that could be part of an individualized treatment plan but are not considered medically necessary.12
Medication-Assisted Treatment (MAT) Costs for Alcohol Addiction
Anthem Blue Cross of California, like all major health insurance providers, covers medication-assisted treatment when it’s medically necessary, FDA-approved, and prescriptions are filled at in-network pharmacies. When it comes to FDA-approved medication for alcohol addiction, three medications are used, the most common one being naltrexone oral therapy, offered in 20.9% of California rehab facilities.2, 13, 14
Prescribed medication must be taken regularly since alcohol addiction is, like all SUDs, a chronic disease. The cost and coverage for prescription drugs will depend on the individual health insurance plan. There could be a fixed copay or the patient might need to cover a certain portion of the expenses.13
Alcohol Addiction: The Cost of Rehab & Societal Impact
Most people who need alcohol addiction treatment never get it because of the seemingly high cost. However, the cost of untreated addiction is much higher, not just to the individual but to the community and society as a whole.15
SUD-related costs to society are about $442 billion each year. This includes healthcare expenses, criminal justice costs, and productivity loss. Prevention and treatment are remarkably less expensive than substance abuse-related consequences.16
When it comes to the personal cost, before deciding that addiction treatment is too expensive for you, take into consideration these common expenses and repercussions:17
- Cost of alcohol itself.
- Cost of lost income, neglecting work responsibilities, and diminished productivity.
- Various alcohol-related physical and mental health issues.
- Violence, crime, and domestic violence.
- Overdose or suicide.
How Long Does Anthem Blue Cross of California Cover Alcohol Rehab?
The length of treatment that will be covered by Anthem Blue Cross of California is the program that is determined to be medically necessary, evidence-based, and provided at an in-network rehab center. Even though longer treatment times are typically more effective at achieving lasting sobriety, some approaches and elements of personally tailored treatment are not fully covered by insurance plans.7
Not all health insurance plans are the same, and different types of policies offer different tiers of coverage. So, the length of coverage for treatment is going to depend on your specific plan, above all other factors.4 If you want to check what kind of coverage and benefits your Anthem Blue Cross of California policy covers, find the needed information on your insurance card or call your provider to guide you through your benefits step-by-step.
Should I Choose an Inpatient or Outpatient Facility in the CA Anthem Blue Cross Network?
This choice is primarily made according to the severity of an individual’s addiction, but other factors are also important. For example, inpatient treatment is more suitable for individuals with multiple unsuccessful attempts to complete treatment and those with a history of multiple relapses. Patients without reliable support systems in their everyday lives, or with damaged family and friend relationships could also benefit from removing themselves from the unsupportive or triggering environment.18
Outpatient treatment works well for less severe addiction and more disciplined individuals with stable homelife and strong support systems. It may also be suitable for those who can’t take time off from work or be absent from family commitments.7
When deciding between Blue Cross inpatient and outpatient alcohol treatment programs in California, try to consider these factors too:12
- The quality of care. The top-quality treatment facilities are licensed and certified by the California Department of Health Care Services (DHCS), accredited by The Joint Commission, or CARF.
- The treatment setting created in inpatient facilities provides a safe, supportive environment through group activities and companionship, as well as individual, family counseling, or marital counseling for couples battling addiction together.
- Support groups are offered in 90.3% of California’s rehab centers.2
- A more focused environment and the intensity of treatment may be achieved through several types of therapy, with cognitive-behavioral being one of the most commonly used.
- A sense of accountability or adherence to the program depends on the personal characteristics of the patient. Some people can stay disciplined and motivated regardless of the type of treatment program they are attending.
What Are the Steps for Using Anthem Blue Cross of California Insurance for Alcohol Rehab?
When you decide to start addressing your alcohol abuse issues and begin looking for treatment, there’s an established process you should follow to get your rehab covered by the Anthem Blue Cross of California:3
- Contact your primary care physician who will evaluate your condition and decide if you need to see a specialist. If they authorize you for behavioral health services, they will also provide guidance and a referral to an in-network specialist.
- Find a suitable rehab program. In case you’re looking for a rehabilitation program yourself, you can find an in-network specialist in the Anthem Blue Cross of California directory.
- Determine the ability to use insurance. You can find details in your health plan documentation (Evidence of Coverage, Summary of Benefits, Certificate of Coverage)
- Anthem Blue Cross of California will work with a chosen rehab center to determine coverage and find the best possible treatment program with the maximum amount of coverage.
In case you opt for alcohol abuse treatment from an out-of-network treatment provider, you might need to get preauthorization for the service yourself, and you will most likely have to pay more for out-of-network services.3
How to Find Alcohol Rehabs That Accept Anthem Blue Cross of California Insurance
Although the process of finding the right treatment program for yourself or a loved one might seem quite stressful and overwhelming, there are several ways to obtain accurate information and get the necessary guidance.
Calling a Hotline
In case you’re still not comfortable talking to your doctor about your alcohol abuse issues and rehab, you can start by getting general information from one of the free 24-hour alcohol addiction hotlines.19
You don’t have to commit to anything by calling, or even provide your personal information. However, sharing as much as you’re comfortable with will help the alcohol addiction hotline advisor accurately evaluate your situation and provide you with useful advice.19 Conversations with hotline representatives are, just like all your medical information, private and confidential.20 You can also call the Anthem Blue Cross of California helpline.
Contacting a Treatment Provider
Anthem Blue Cross of California is in-network with the highest quality treatment providers, including American Addiction Centers (AAC), a nationwide network of top-rated rehab facilities. AAC has numerous helplines that can provide you with guidance regarding your Anthem Blue Cross of California insurance coverage.
You can call the AAC helpline and one of the admission navigators will verify your insurance and payment options while you’re on the phone. Just make sure to have your insurance card with you. You can also do this by submitting an online form on the AAC website.
They can also present you with the payment and financing options, further explain what to expect from the intake process, discuss same-day admission to treatment if necessary, or guide you through the other steps of addiction treatment.
The AAC’s Laguna Treatment Hospital is one of the leading substance abuse facilities in California. It provides a full continuum of care, and an individually tailored treatment program to each patient, according to their specific needs. You can also search for other in-network AAC facilities or look for available addiction treatment centers near you.