Anthem, a subsidiary of Elevance Health, is one of the largest health insurance providers in the U.S.
Elevance Health is a health company that takes a holistic approach to improving the health of the people and communities they serve.
A portmanteau of ‘elevate’ and ‘advance’, Elevance weaves the meaning of both words together to reflect the company’s purpose of improving the overall health of humanity, including those suffering from substance use disorders.
Elevance Health overview
Elevance Health was originally established in 1944 as Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc. in Indiana.[1]
In June 2022, Anthem rebranded to Elevance Health to underscore its broadened focus on a larger range of health services beyond just health insurance.[1]
Today, Elevance Health partners with almost 102,000 associates to provide an array of healthcare services to over 45 million people.[1][2]Â
In addition to health insurance products, Elevance Health offers clinical, behavioral health, and complex-care solutions aimed at improving the overall health of their patients.[2]
It currently offers insurance plans through Anthem Blue Cross and Blue Shield in 14 states including Colorado, Nevada, and New York.
Anthem’s insurance plans are organized into four tiers: Bronze, Silver, Gold, and Platinum. [2]
The following table shows the percentage of your medical costs you pay and the amount your plan covers.
| Plan | Bronze | Silver | Gold | Platinum |
|---|---|---|---|---|
| What your plan pays | 60% | 70% | 80% | 90% |
| What you pay | 40% | 30% | 20% | 10% |
Does Anthem cover substance use disorder treatment?
Anthem does provide cover for some substance use disorder programs. Coverage will vary depending on an individual’s plan, their healthcare provider, and what state they live in.
What types of addiction does Anthem cover?
Anthem covers a range of addiction treatments. These include treatment for alcohol use disorder, opioid use disorder, and stimulant use disorder, among others.
Certain non-substance additions, such as gambling addiction or sex addiction may not be covered under insurance plans.
Do they cover medically-assisted treatment?
Yes, Anthem covers FDA-approved medically-assisted treatment (MAT) to help individuals recover from addiction and cope with withdrawal symptoms.
Examples of MAT that Anthem typically covers include:
Suboxone – a medication used to treat opioid addiction, suboxone reduces the impact of a patient’s withdrawal symptoms and combats cravings.
Naloxone – a medication that can reverse the effects of opioids, naloxone is often administered in the event of an opioid overdose.
Coverage can be verified by referring to the Preferred Drug List on the Anthem provider website.
Do they cover inpatient treatment?
Anthem covers several types of inpatient treatment for substance use disorders and other mental health conditions. These include residential treatment programs, inpatient rehabilitation, and partial hospitalization programs.
Anthem generally covers treatment it deems to be medically or therapeutically necessary. Non-essential treatment options are typically not covered. These include luxury rehab or long-term forms of residential care without clear medical justification.
Does Anthem cover outpatient treatment?
Anthem covers many outpatient treatments including intensive outpatient treatment (IOT), outpatient surgery, and a range of diagnostic tests.
What therapy, counseling, and aftercare services are covered?
Anthem offers therapy, counseling, and aftercare services for those with substance use disorders and mental health conditions. These include Cognitive Behavior Therapy (CBT), group therapy, and Dialectical Behavior Therapy (DBT).
Anthem only provides coverage for in-network therapists, meaning there is a pre-ordained list of therapy providers to choose from. Ensure you select a therapist from this list to be eligible for reimbursement.
Providing the in-network therapist provides an evidence-based treatment clinically approved for the condition in question, Anthem should provide coverage.
Anthem healthcare FAQs
What length of treatment does Anthem cover?
Anthem provides cover for residential and inpatient treatment, which typically lasts between 30 and 90 days. If your treatment plan outlines a longer period of treatment, contact Anthem to establish if they will cover this.
