Anthem Blue Cross for Medical Detox

It can be tough to find an alcohol detox, heroin detox or benzo detox  that accepts Anthem Blue Cross in California, but we are in-network with Anthem Blue Cross’s HMO and EPO plans. We accept ABC’s PPO insurance as well as an out-of-network provider at Solution Based Treatment. And, with Major Risk Medical Insurance Program (MRMIP) coverage, you should be able to receive a non-urgent mental health or substance use disorder appointment within 10 days. Inpatient detox requires prior authorization but is covered (with applicable co-insurance). You may pay 15% of the negotiated fee set by a participating provider or 15% of reasonable charges plus excess as set by a nonparticipating provider. 

Anthem Blue Cross Coverage for Residential Treatment

Residential treatment (inpatient) is covered by Anthem Blue Cross’s MRMIP plan as well as its HMOs, PPOs, and other policies. Hospitalization is covered as medically appropriate to remove the substances from the body (detox). Coverage is also provided for follow-up appointments. 

Anthem Blue Cross Coverage for Outpatient Treatment

Intensive Outpatient Programs (IOP)

Anthem Blue Cross does not mention intensive outpatient programs in their member’s benefits manual. However, they do cover follow-up appointments for substance use disorders with primary care and specialist providers. Solution Based Treatment can verify your benefits and let you know if Anthem Blue Cross will cover up to 100% of our Intensive Outpatient Program.

Partial Hospitalization Programs (PHP)

Anthem Blue Cross does not mention partial hospitalization programs in their member’s benefits manuals but may offer coverage. Our Admissions Department would be happy to verify your benefits to help you understand what care is covered.

Outpatient Treatment

Anthem Blue Cross does cover outpatient care when ordered and provided by participating mental health providers. While all plans are different, outpatient treatment is typically paid at least partially. Prior authorization is often required. 

Anthem Blue Cross Rehab Coverage FAQs

Does Anthem Blue Cross insurance cover drug and alcohol rehab?

At Solution Based Treatment, we are in-network with Anthem Blue Cross. We are in network with Anthem Blue Cross’s HMO and EPO plans and accept the PPO insurance as an out-of-network provider.

How can I verify my Anthem Blue Cross insurance benefits?

Call Solution Based Treatment to verify your benefits quickly or call Anthem Blue Cross at (888) 418-4709 or on their website at ABC.com/verifyinsurance.

Does Anthem Blue Cross cover outpatient addiction treatment?

Yes, Anthem Blue Cross does cover outpatient addiction treatment. Call Solution Based Treatment to verify your benefits quickly or call Anthem Blue Cross at (888) 418-4709 or on their website at ABC.com/verifyinsurance.

Does Anthem Blue Cross cover inpatient mental health?

Yes. Anthem’s plans do cover inpatient mental health care. Call Solution Based Treatment to verify your benefits quickly or call Anthem Blue Cross at (888) 418-4709 or on their website at ABC.com/verifyinsurance.

Do treatment centers need to be in-network?

For Medi-Cal, you must seek treatment through the approved county care provider. For MRMIP, you can see providers in or out of network with preauthorization. Providers who are in-network will be more cost effective in most cases. At Solution Based Treatment, we’re in-network with Anthem’s HMO and EPO plans. We also accept their PPO plans as an out-of-network provider. 

How much does Anthem Blue Cross insurance cover?

MRMIP has a lifetime limit of $750,000 per member for all covered services. The annual deductible is $500 and must be paid before the MRMIP health plan will pay for any covered services. There is an annual benefit cap of $75,000 per member. Medi-Cal will cover medically necessary services in full, but you must get them through your county. The Substance Use Disorder County Access Lines are the first place to begin for Medi-Cal coverage of substance use disorder treatment. 

How do I pay for costs not covered by Anthem Blue Cross insurance?

You will need to pay for costs that are not covered out of pocket. You can use a credit card, cash, check, or other method of payment. 

How is an Anthem Blue Cross HMO different from a PPO?

Preferred provider organization (PPO) and health maintenance organization (HMO) plans are different because PPO plans usually have higher costs and a wider selection of providers to choose from. HMO plans have smaller networks but tend to be more affordable if you stay in-network. 

Can you get a single case agreement with Anthem Blue Cross?

It may be possible to get a single case agreement with Anthem Blue Cross. Anthem will cover an authorized referral in some cases. An authorized referral happens when the member’s medical needs require a specific specialist’s services but that specialist isn’t a participating provider. It’s necessary to get approval prior to receiving services to get the care covered.

Sources: 

https://mss.anthem.com/california-medicaid/home.html

https://mss.anthem.com/california-medicaid/caca_caid_mrmip_memberhandbook_eng.p