Anthem Blue Cross Blue Shield

How to Choose a Rehab If You Have Anthem Blue Cross Blue Shield

Key Content Summary

Anthem Blue Cross Blue Shield Coverage Basics

Overview of how Anthem Blue Cross Blue Shield covers rehab.

Types of Anthem Blue Cross Blue Shield Plans and Network Rules

Breaks down PPO, HMO, EPO, and POS plans, highlighting differences in out-of-network coverage, referral requirements, and flexibility when choosing rehab.

Costs & What You’ll Pay

Breaks down deductibles, coinsurance, and why in-network care is usually the most affordable option.

How to Choose Rehab with Anthem Blue Cross Blue Shield

Step-by-step guidance to find the right level of care, confirm your plan, and verify benefits with facilities.

Finding the right treatment can be overwhelming, but your Anthem Blue Cross Blue Shield insurance can make it easier to choose care. Most Anthem plans cover life-saving addiction services. This page will help you understand how Anthem coverage typically works so you can maximize your benefits and minimize your costs.

Anthem sometimes uses its partner company, Carelon Behavioral Health, to handle mental health and substance use benefits. If you see Carelon or a related behavioral health partner on your member portal or insurance card, that is why.

Note: Blue Cross Blue Shield is not one single insurance company. It’s a national association of independent, locally operated Blue plans, so your coverage depends on your local BCBS company, your plan type, and your specific benefits. Some BCBS plans also use a separate behavioral health partner or administrator to manage coverage.

What does your specific Anthem Blue Cross Blue Shield plan cover for addiction treatment?

Most Anthem plans cover addiction treatment, but benefits vary widely. Knowing the type of plan you have will help you narrow your search for the right type of care. Coverage can come through an employer, the ACA marketplace, Medicare Advantage, or Medicaid, and most Anthem plans use one of the network types below. Network types determine which providers you can use and if you need a referral for specific services.

Plan types and coverage

Plan Type	Out-of-Network Coverage	Referral Required?	What Does This Mean for How to Choose Care?
PPO (Preferred Provider Organization)	Yes but generally at a higher cost	No	Offers a lot of flexibility to choose programs outside your area, but out-of-network care usually costs more.
HMO (Health Maintenance Organization)	No (except for emergencies)	Yes	You must choose an in-network provider and out-of-network is probably not covered at all.
EPO (Exclusive Provider Organization)	No (except for emergencies)	No	Treatment is only covered if it is in-network and you usually don’t need a referral.
POS (Point of Service)	Yes but generally at a higher cost	Yes	Combines components of HMO and PPO plans. You might need a referral for out-of-network care.

High-Deductible Plans (HDHP): Some Anthem plans are high-deductible plans. HDHPs are not a separate plan type, and all the network rules for PPOs, HMOs, EPOs, and POS noted above still apply to HDHPs. HDHP plans generally impact how costs are handled and when you pay for care. Many HDHPs are often also paired with a Health Savings Account (HSA). With these plans, you could potentially pay more out of pocket before your coverage begins, but an HSA can help cover costs until you meet your deductible and once the deductible is met, your plan could cover a larger portion of treatment costs.

What if you didn’t purchase your Anthem plan through your employer?

The way you purchased your Anthem plan will also most likely impact your coverage. See details below on State Exchange (Marketplace), Medicare Advantage, and Medicaid plans and the changes to coverage based on which program you purchased your Anthem plan through.

State Exchange (Marketplace) Plans

You can get insurance coverage through the ACA marketplace via state or federal exchanges. Plans purchased through the marketplace use the same network types (HMO, PPO, EPO, or POS), but they often have some variations in coverage. Anthem only offers ACA marketplace plans in select states, including California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Because coverage can differ by state and may change yearly, it’s important to check your specific plan details and provider network for updated information.

Coverage details

Coverage Rule	What this means for choosing care
Out-of-network coverage	Generally not covered
Referral requirements	Depending on the plan type, a referral may be required for care
Network size	Generally smaller than employer-sponsored plans

Medicare Advantage Plans

Some people receive insurance through Anthem Medicare Advantage plans, but coverage rules can be different for these plans versus an employer-sponsored plan.

Coverage details

Coverage Rule	What this means for choosing care
Out-of-network coverage	Depending on plan type, out-of-network care may sometimes be covered
Referral requirements	Depending on plan type, a referral may be required
Network size	Depending on the plan’s provider options, the network size is potentially narrower than employer-sponsored plans

Medicaid Plans

For people with limited income, Medicaid plans are a great route to receive health insurance coverage. Anthem offers Medicaid managed care in select states, including California, Indiana, Nevada, New York, Ohio, Virginia, and Wisconsin. Coverage rules for Medicaid plans vary widely by state.

Coverage details

Coverage Rule	What this means for choosing care
Out-of-network coverage	Except for emergencies, out-of-network care is generally not covered
Referral requirements	Generally required depending on the care plan, provider, and county
Network size	Most likely only includes providers contracted with the state Medicaid program
Prior authorization	Quite common for detox, residential, and inpatient care

What does Anthem cover for rehab?

Anthem will review your specific care needs and your plan to make insurance coverage decisions like they would for other medical needs, such as a heart condition or diabetes. Because of federal parity law, coverage for addiction treatment cannot be more restrictive than coverage for other medical needs.

Coverage through Anthem varies by the type of plan you have and the state you reside in. Two people with Anthem may have very different benefits, even for the same treatment program.

The following aspects of coverage usually vary by plan and state:

Deductibles, copays, and coinsurance
Prior authorization needs
How long treatment is approved for
Differences in coverage for levels of care
Out-of-pocket maximums that put a cap on how much you pay

Learn more about how insurance and out-of-pocket costs usually work for rehab.

Out-of-pocket costs for rehab

Choosing an in-network treatment facility is usually the best way to limit any out-of-pocket costs. We’ve provided the following illustrative example to show how Anthem could potentially handle coverage for a hypothetical residential treatment program using a PPO plan.

Note: This example is hypothetical and actual costs depend on your specific plan and provider.

Illustrative cost comparison

Cost component	In-network facility	Out-of-network facility (PPO example)
Facility list price	$50,000	$50,000
Anthem allowable amount	~$36,000 (negotiated rate)	~$30,000
Typical deductible	Generally lower, often ~$1,500	Generally higher, often ~$5,000
Coinsurance (your share)	$6,900 (~20% of remaining $34,500)	$10,000 (~40% of remaining $25,000)
Unexpected costs	$0 for covered services (non-covered services or limits could still apply)	$20,000+ (the amount not covered by insurance that you pay)
Estimated out-of-pocket cost	~$8,400	~$35,000
Annual out-of-pocket maximum	~$8,500	Often much higher and balance billing costs do not count toward the annual out-of-pocket maximum

How to choose the right treatment for you if you have Anthem

If you’re trying to pick the best treatment for you and you have Anthem coverage, the following steps can help you narrow your care options to make a final decision.

Step 1: Decide the level of care you need

Anthem will typically cover treatment based on medical necessity. Before you try to decide on a specific facility choice, it will help to understand what level of care you actually need. To help you determine the level of care that is best for you, you can speak to a medical professional.

Levels of care include:

Withdrawal management (detox): For people at risk of withdrawal symptoms
Residential or inpatient treatment: 24/7 care in a clinical or community setting. Inpatient programs include round-the-clock nursing care, and residential programs have 24/7 supervision and support.
Outpatient: For outpatient care such as PHP or IOP, you would live at home while attending therapy sessions throughout the week.

Step 2: Confirm your Anthem plan type

Your specific Anthem plan will greatly impact the level of coverage you’ll receive for different facilities. You can review your insurance card or member portal to confirm your plan type. Review the table above for details on each plan type and how different plans impact coverage at facilities both in-network and out-of-network as well as referral requirements and cost structures.

Step 3: Finalize your top list of in-network rehab options

Before reaching out to specific facilities to confirm coverage details for your plan type, it is a good idea to narrow your choices to only a few facilities that will meet your care needs and are most likely in-network with Anthem. You can filter facilities by treatment needs and location and see whether a facility commonly works with Anthem plans. Review the filtered results to compare programs based on your specific treatment needs.

Ghost networks

It’s important to know that some people may run into what is called a ghost network, which is when providers listed as in network are not actually available, no longer accept the plan, or have extended wait times. If you run into a ghost network, you can do the following:

Request your Evidence of Coverage: This will outline Anthem’s contractual obligations to you and if in-network options aren’t available, your plan may be required to cover out-of-network care at in-network rates.
Ask about who manages your benefits: Anthem often uses Carelon Behavioral Health to handle mental health and substance use coverage. Reaching out to Carelon directly can help provide clarity on ghost networks and next steps you can take to find care.

Step 4: Verify your insurance benefits (VOB)

It is also important to determine how your Anthem plan would apply to the facilities you are interested in. If you reach out, a majority of rehabs will verify benefits for you at no cost and they can tell you whether the program is in network, what your potential costs could be, and whether there are any limitations on length of stay for treatment.

Step 5: Confirm prior authorization requirements

Anthem will often require prior authorization for certain levels of care like detox, residential, or inpatient treatment. When you reach out, consider asking the facilities on your shortlist the following questions:

Is this program in network with my specific Anthem plan?
Do you handle prior authorization and ongoing insurance reviews?
What costs, if any, should I expect after my deductible is met?
If coverage changes, will you help plan next steps in care? If so, how?

Step 6: Decide on the program that is the best fit for you

After you create a narrow list of options with clear coverage details, you’ll most likely be deciding between just a few programs. To make a final decision, try to focus on whether the program is the best fit for you and where you are. There are many factors to consider, such as:

The facility’s experience with treating your specific needs
Family involvement in treatment and aftercare options
How the program supports care if insurance coverage changes

Learn how different treatment levels work and how clinicians determine the right level of care.

Rehab options that accept Anthem Blue Cross Blue Shield

See below for facilities that report accepting Anthem Blue Cross Blue Shield. Before you make a final decision about treatment, ensure you follow the steps above to confirm network status, coverage, and out-of-pocket costs.

Acceptance of Anthem Blue Cross Blue Shield does not guarantee coverage. A facility may say they accept Anthem, but coverage will still depend on your specific plan and your medical needs. If coverage is denied, ask about options for appealing the decision.

Find rehabs that accept Anthem Blue Cross Blue Shield