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Does WellPoint (WLP) Cover Drug Rehab?

WellPoint Health Networks is a health care insurance provider that merged with Anthem Inc., in 2004 and currently operates under the name of Anthem Inc. WellPoint changed its corporate name to Anthem Inc., in 2014, as it is a better known and well-trusted name among customers.
The company is one of the largest health benefits providers in the United States and operates as an independent operator within the Blue Cross and Blue Shield Association. Anthem Inc., is now the largest for-profit managed health care company within the Blue Cross and Blue Shield Association.

WellPoint in the News

WellPoint/Anthem Inc., has made headlines in the past for the large profits and low payouts it has historically made. As a for-profit company, many executives stand to benefit greatly from new deals, mergers, and policy changes. Following the merger of WellPoint and Anthem Inc., which created the largest health insurance company in the U.S., certain executives received bonuses worth tens of millions to hundreds of millions of dollars.

Customers criticize WellPoint for being focused solely on making a profit while increasing the costs of health care to individuals. WellPoint grew out of its parent company, Blue Cross, which is known for its nonprofit and charitable history. WellPoint, however, has a history of spending millions of dollars lobbying against health care reform or proposing rate increases that would affect thousands of customers. At the same time, stories have surfaced about million-dollar bonuses and many more millions being spent on extravagant executive getaways.

WellPoint also made headlines in 2010 for allegedly dropping customers with certain illnesses. The company illegally ended insurance policies for customers who were sick to avoid paying for health care services. More than 6,000 customers reported having their coverage canceled following a diagnosis of cancer, among other diseases.

Services Offered by WellPoint/Anthem Inc.

WellPoint is a large national company that offers many services. Health insurance plans are available through employers or can be purchased individually. Individuals can buy plans to cover themselves or their families. Medicare plans are also available through Anthem Inc.
The variety of insurance plans available include:

 

WellPoint/Anthem Insurance Plans Offered

  • Health
  • Dental
  • Vision
  • Term life
  • Medicare Advantage
  • Medicare Supplement
  • Prescription drug coverage
  • Employer group plans

If you are searching for new health coverage, it is important to know that Anthem Inc., operates only in some states across the U.S. The 14 states that Anthem Inc., covers are California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia, and Wisconsin. If you live outside of these states and are looking for health insurance, Anthem Inc., recommends visiting the Blue Cross Blue Shield website to find coverage where you live.

wellpoint insurance for drug rehab

WellPoint/Anthem Inc.’s Employer Health and Wellness Program

Anthem Inc., offers Employer Health and Wellness Programs that are aimed at supporting the physical and mental health and well-being of employees. These programs, also known as employee assistance programs (EAP), are designed to provide helpful services to employees to keep them productive at work, thus benefiting the employer as well.

EAPs were originally implemented in the 1940s as programs to address problems with alcoholism among employees. Since then, they have grown to provide more comprehensive services, and they are typically part of a larger health and wellness package offered by employers.

EAPs are usually short-term programs that offer confidential counseling services to employees about problems that could be affecting their performance and work. EAPs can help to address these issues:

Issues EAPs Can Help With

  • Personal and job stress
  • Relationship problems
  • Domestic violence
  • Dependent care
  • Parenting issues
  • Harassment
  • Trauma
  • Grief and loss
  • Financial planning
  • Legal problems
  • Alcohol and substance abuse
  • Diet and exercise programs

The services offered through EAPs are available to all employees of the given company and can be accessed without consulting your boss or upper management. Family members of employers also can access these services if needed.
Your company should provide online access to your full EAP. Many services will be available right there. You may, however, need to speak with a licensed clinician who works for the EAP. They can conduct a quick assessment and determine if an outside referral is necessary, as is often the case for people seeking substance abuse treatment.

Using Your Anthem Insurance for Drug Rehab

If you need drug rehab beyond the services offered through your EAP, you can use your Anthem insurance. Because Anthem is part of the Blue Cross Blue Shield network, you can take advantage of the huge network of addiction treatment facilities across the country that have been licensed by the Blue Cross and Blue Shield Association.

Your individual health coverage plan will determine exactly which provider you have access to. If you have an HMO and are required to select a provider within your network, your options may be slightly limited. A PPO plan will give you the broadest range of facilities to select from. If you have an HMO but wish to attend a facility that is out of network, you will probably be able to do so, but you will have to pay a greater percentage of the fees yourself. Note that Anthem does require prior authorization for PPO and HMO policyholders to be admitted to a substance abuse treatment program.

The amount you have to pay for your rehab program depends on which health coverage plan you have been paying for. Anthem offers a range of coverage and cost options. The cheapest plan has the lowest monthly payments, but higher deductibles and only covers about 60 percent of medical expenses. Anthem’s middle range plans cover 70 percent to 80 percent of medical expenses, and offer mid-range monthly payments and low deductibles. Anthem’s premium plan has the highest monthly payment, but also the lowest deductible and covers 90 percent of medical expenses.

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Anthem has a set of guidelines it uses to determine the necessity of treatment for psychiatric and substance misuse disorders. It uses evidenced-based criteria to determine medical necessity based on the individual’s unique circumstances and what would be the most cost-effective services to provide.
The exact costs of attending rehab will vary depending on the coverage plan you have and the treatment facility you hope to attend. Anthem does provide coverage for inpatient programs, outpatient programs, hospitalization, and detoxification.

How to Access Behavioral Health Services

A good place to start to check what services are covered by your Anthem plan is through the online user portal. Once you have created a member account, you can view your current health care plans, find a doctor, manage prescriptions, make monthly payments, submit and review claims, and purchase new coverage, if necessary.

Anthem has an additional page that specifically offers resources about your behavioral health services. No referral is needed to access these services, and all inquiries are confidential. Resources are available to help people struggling with anxiety, depression, and substance abuse, among other conditions.
Mental health and substance abuse services are available through Anthem’s provider network. The network includes psychiatrists, psychologists, social workers, nurses, and additional mental health providers. Facilities that belong to the network include hospitals, residential treatment centers, partial hospitalization programs, outpatient services, and other substance abuse treatment programs.

In addition to your personalized online member account, Anthem provides a confidential helpline that is listed on the back of your insurance card. If you have misplaced your card, you can call 1-866-621-0043 to speak with clinical staff who can guide you in the right direction. The helpline provides the following support to determine which substance abuse services may be the most appropriate for you:

FAQs for Anthem

  • Clinical care managers to determine the best level of care
  • Referrals to substance abuse health care providers
  • Assistance in receiving preauthorization
  • Access to emergency mental health services
  • Information about mental health and substance abuse services

Trying to understand what behavioral health services are available to you and how to access them can be overwhelming. Fortunately, WellPoint/Anthem Inc., has many platforms available to assist you through this process.
If you are a WellPoint/Anthem Inc. customer, then you have access to substance abuse treatment. While WellPoint has received mixed customer reviews in the past, it works with a huge network of providers throughout the country to provide access to necessary mental health and substance abuse treatment services to its many millions of customers.

HELP YOUR LOVED GET ADDICTION TREATMENT

If your loved one is going through an addiction, know that not all hope is lost. It is important that they receive help now. There’s no need to delay. You don’t have to do this alone, and you’re just a phone call away from getting help. Learn more about the benefits of personalized treatment at a private facility by calling Delphi Behavioral Health Group today at 844-208-4761 to explore your options.

Treatment programs at Delphi Behavioral Health Group’s facilities provide unique therapy and counseling methods for certain addictions. They are designed to allow you to receive the daily support of the facility’s staff and your loved ones when you return home. Our treatment centers provide just what’s needed for community, counseling, and support throughout the day so clients can apply the lessons they learn to their lives everyday life. Give us a call to discuss your loved one’s options today.