We Accept Most Insurance. Please Call to Verify Yours.
June 15, 2024
If you or a loved one is struggling with a substance use disorder, you’ve probably heard about the fact...
Read More
Anthem Pathway Rehab Coverage
Anthem Pathway is a popular Anthem Blue Cross Blue Shield insurance option, offering HMO plans and POS coverage to patients across the United States. Anthem Pathway rehab coverage goes before the Affordable Care Act plan, which is available in some U.S. states, with further individual designations per state. For example, Anthem Pathway Guided Access serves Georgia, Anthem Pathway Essentials serves Colorado, Pathway X serves California, etc. If you or a loved one has this personal insurance and wants to attend drug and alcohol rehab for improved mental health, the good news is that you have a wide network to choose from for coverage.
However, as a relatively small program with limited coverage across each state, you’ll have to shop around insurance plans to ensure you’re going to an in-network provider, or you or a loved one may pay out-of-pocket for behavioral health services. This does mean that Anthem Pathway Insurance may require more research than some other providers, such as Medicaid or Medicare. Nonetheless, with a bit of care, you can easily get insurance coverage for your drug and alcohol rehab with this insurance provider.
Anthem Drug Treatment
Anthem Pathway insurance is required by law to offer coverage for your addiction treatment health plan. Blue Cross and Blue Shield is an Affordable Care Act plan, meaning that it fully conforms to the laws and guidelines set forth under the ACA. This means Anthem covers substance use disorder as a temporary disability and offers coverage for both inpatient and outpatient treatment. It also treats preexisting mental health conditions, meaning you’ll still get coverage from Anthem Insurance even if you start the insurance plan after being diagnosed with substance use disorder.
Anthem Pathway Alcohol Treatment
It can be tough to manage substance abuse or a co-occurring mental health disorder without support. However, Anthem pathway alcohol treatment is available to you, and the amount covered will depend on your plan. Pathway plans all offer three tiers of bronze, silver, and gold. In addition, they are either HMO, PPO, or POS healthcare plans. Both can offer benefits, but will impact your copay, premiums, and actual costs. Therefore, you’ll always want to refer to your actual health plan and different levels of care for eligibility.
What Types of Drug & Alcohol Treatment Programs Does Anthem Pathway Cover?
Anthem Pathway, your insurance company, will cover most types of drug treatment, provided you have a local provider in-network. Here, the network providers will be your largest limiting factor. It is good to speak to an expert at Anthem Insurance to understand their coverage details. However, Anthem Blue Cross and Blue Shield typically covers medical detox, rehab treatment, different outpatient programs, including a PHP or outpatient rehab, and medication-assisted treatment to help manage different health conditions.
In theory, Anthem Pathway covers:
Inpatient Treatment
You can seek out residential care to get coverage of up to 90% of costs after deductibles with your Anthem Pathway plan. This means that if you have a rehab center in your specific pathway plan, you can go to treatment to get coverage up to the amount listed by your plan. Anthem does not limit based on the type of treatment provided, as long as your service provider is in-network.
Outpatient Treatment
You can attend a wide range of in-network outpatient treatment centers for intensive care, partial hospitalization, or even long-term treatment. Coverage starts at 40% minus your deductible and increases up to 90% minus your deductible.
Detox
If you have a doctor’s reference, you can opt to attend a detoxification clinic or medical detox center. However, the clinic must be in network. If you’re referred on an emergency basis, your Anthem Pathway insurance plan will cover costs. This means you can get partial or full coverage in some scenarios, even if the detox center isn’t in your network. Keep in mind, it is still better to choose an in-network clinic.
Medication
Anthem Pathway insurance covers medication and medication-assisted treatment plans. Nevertheless, you’ll get different rates and deductibles based on whether you choose preferred or generic medication. If you want to reduce rates, talk to your clinic or therapist.
Complimentary Treatment
You or your loved one can attend any complimentary treatment program in Anthem’s network. This includes a range of treatment options, but you can typically expect to pay a significantly higher fee and deductible for your treatment. Therefore, most patients are recommended to stay in-network for treatment.
What Can You Expect to Pay With Anthem Pathway Rehab Coverage?
Anthem Pathway includes over 20 different specific healthcare plans, including HMO, PPO, and POS plans (POS is a middle ground between PPO and HMO). Here, your requirements and coverage rates will significantly change depending on what you have and where you live. You can look at your card and your health insurance plan, or call Anthem directly. You’ll want to know:
- Your plan and plan number
- What level is it? (Bronze, Silver, Gold)
- Whether it’s PPO, HMO, or POS
- If you can go to out-of-network providers, and if so, what are the rates?
However, Anthem Pathway is an ACA insurance policy. This means that its costs are relatively predictable. On average, you’ll pay:
- Bronze – 40% of total costs
- Silver – 30% of total costs
- Gold – 20% of total costs
- Platinum (sometimes called catastrophic) – 10% of total costs
Nonetheless, you’ll always have deductibles that kick in first. For example, with the Anthem Silver Pathway Essentials 4000, you can expect:
- $5,800 deductible
- $8,900 out-of-pocket limit
- Flat rate of $20 per pharmacy prescription in network and $80 per pharmacy prescription out of network
- 40% coinsurance for rehab services
- Out-of-network providers are not covered at all
Regardless, with 20+ plans in the Anthem Pathway network, you’ll want to individually check your rates, coverage, and deductibles.
How to Start Drug & Alcohol Treatment With Pathway?
- Contact your primary care doctor to get referrals and to help you find in-network treatment centers.
- Contact your rehab center before going to ensure they are in network for Anthem Pathway insurance. Some healthcare plans offer no coverage for out-of-network treatment.
- Check if you need precertification. If precertification is required, you must get it.
- If you have a blue card, you must get approval to use the provider before treatment is given. You’ll also need precertification.
- If you’ve been admitted to emergency services, the provider must call your insurance within 48 hours.
Depending on your plan, you may or may not need a referral. However, it’s always a good idea to do so.
Getting Started With Anthem Pathway Rehab Coverage
Anthem Pathway healthcare plans can be complicated. Therefore, it’s a good idea to double-check by calling Anthem directly from the number on your insurance card to speak to a specialist or going to anthem.com to verify your plan. You can then check your coverage and confirm in-network providers in the area.
Often, you’ll have to go through your healthcare provider to get a referral for healthcare services, and your doctor can also help you find in-network providers. For that reason, total costs, deductibles, and even whether your plan covers out-of-network providers will vary significantly, so you’ll always want to double-check your health plan.
Are you ready to get started on your journey to long-term recovery? Learn more about our admissions process or call now to speak with a treatment expert at (888) 450-2701 for assistance.
