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Anthem Blue Cross Blue Shield

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Anthem Blue Cross and Blue Shield insurance has behavioral health programs that provide specialized expertise and a unified approach to care. Having coverage for the treatment of mental health and substance use disorders are vital to employees and their dependents when they need help for:

  • Anxiety
  • Depression
  • Eating disorders
  • Drug and alcohol use disorders

This unified approach for medical and behavioral health treatment makes getting care easier from one source for all your needs.

What is Anthem Insurance?

Anthem insurance was formed in 2004 when WellPoint Health Networks Inc. and Anthem, Inc. merged to become the country’s leading health benefits company under the name WellPoint. In 2014 it changed the name to Anthem, Inc. Through its associated health plans, Anthem companies provide many health benefit solutions through their integrated healthcare plans. As of 2018, Anthem had about 40 million members.

Is Anthem Blue Cross a PPO or HMO?

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the two most common types of health insurance plans. Anthem Blue Cross is an HMO plan with a Medicare contract.

Provider networks are different for each plan:

HMO—You need to use a certain provider network and choose a primary care physician (PCP) with a traditional HMO. Some might require a referral from your PCP before you can see a specialist. If you decide to see a doctor or another health provider who is outside your network, you will be responsible for higher fees.
PPO—With a PPO, you are not required to have a PCP and you can make an appointment directly with any specialist you want without a referral if they are in the PPO network. Both plans can be “open access”. You can choose to see an out-of-network doctor without a referral but you’ll pay more when you receive care from a doctor who isn’t in the network. However, seeing a doctor outside of your network will probably mean a higher fee and a separate deductible.

anthem insurance for drug rehabAnthem Blue Cross Rehab Coverage

Generally, Anthem Blue Cross does cover drug and alcohol rehab. However, the amount of coverage depends on:

  • the client
  • their insurance plan
  • the provider they are seeing

Since Anthem licenses with Blue Cross Blue Shield, it offers only its own health insurance brands in some states which include California, New York, and a dozen others. New Directions for Women is in-network with Anthem Blue Cross, so your addiction treatment may be covered. Our admissions specialists can check your insurance to verify your coverage.

What is the Mental Health Parity and Addiction Equity Act (MHPAEA)?

Substance use disorder (SUD) is a serious condition and it affects a lot of people. Thanks to some federal laws, getting insurance to cover treatment has become easier. In the past, insurance companies provided little to no coverage for the treatment of substance abuse and other mental health conditions. But laws passed in 2008 and 2010 changed things.

The MHPAEA of 2008 is a federal law. The purpose of the law is to prevent group health insurance plans and health insurance companies that provide mental health or SUD benefits from putting limits on the benefits. Companies must provide coverage equal to the surgical/ medical coverage in the plan. In 2010, the Affordable Care Act (ACA) amended that law to include individual health insurance coverage.

Why This Coverage is Important


Substance and alcohol addiction is an expensive problem. The National Institute on Drug Abuse (NIDA) has revealed that substance use costs more than $740 billion per year in crime, healthcare costs, and lost productivity. Besides that, coverage for addictive disorders can help keep people from tying up emergency rooms and ambulances with overdoses. Getting individuals into recovery helps them stay out of jail and prevents other public health problems.

Substance Use and Mental Health

Substance use disorders and mental health influence each other. Very often, people with mental health disorders will use substances as a way to ease their mental illness symptoms. On the other hand, people who become addicted to drugs may go on to develop a mental illness. The Substance Abuse and Mental Health Services Administration (SAMHSA) has stated that 7.9 million adults have a mental health disorder and a co-occurring SUD.

Protect Future Generations

Children who live with adults who are involved in drug or alcohol use are more likely to become involved in the risky use of substances themselves. Treating the parent’s problem will help prevent addiction in future generations.

Possible Treatment Settings

There are many settings where addiction treatment can take place. Physician’s offices and clinics are considered outpatient care. Live-in facilities like residential treatment facilities qualify as inpatient care. But, just because they are available, doesn’t mean your insurance will pay for them. Bear in mind that not every doctor, program, or facility is approved by every insurance company. Types of treatment that insurance might cover are:
Detox: Most people require a medical detox. This means that you will stay in a medically supervised detox center until the toxins are out of your system and you are prepared for treatment.

Residential Treatment: At the residential or Inpatient level of care, you live at the treatment facility with 24-hour medical monitoring. This is a very structured, intense program.

Outpatient Programs: Outpatient programs vary in intensity and are less expensive than residential programs. Insurance companies are more open to providing coverage for these programs.

Important Insurance Terms

It’s very discouraging to be denied treatment. One reason it’s stressful is because of the terminology they use. Here are a few terms you need to be aware of:

Medical Necessity

Insurance companies use medical necessity standards to determine if the treatment recommended is:

  • reasonable
  • necessary
  • appropriate

If it is deemed to be medically necessary, it will be covered.

Prior Authorization

Sometimes called pre-approval, your provider or you must request approval for a service, treatment, or drug before it will be covered.

Step Therapy

You must try a less expensive drug or treatment before you can move on to the more expensive service.

Denial and Appeal

If you are denied coverage, you can appeal the decision. Keep in mind that the equal coverage of mental health conditions, substance use disorder, and other health issues is called “mental health parity”. Most health plans are required to follow federal and state parity laws.

In-Network and Out-of-Network

Most of the time, insurance companies have special associations with certain care providers. These associations are the difference between in-network and out-of-network. This difference affects how much you will pay and how much your insurance will pay.

Anthem Blue Cross Rehab Coverage at New Directions for Women

No doubt, this is a difficult time for you. Whether you need treatment or you’re concerned about a loved one, New Directions for Women provides experienced professional care for all women because we treat only women. We understand the problems women face and focus our attention on them.

At New Directions, we know the responsibilities that are weighing on your mind. Contact us today and we’ll take it from there. Our admissions specialists will be glad to answer any questions, verify your insurance, and help in any way we can.

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