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June 15, 2024
If you or a loved one is struggling with a substance use disorder, you’ve probably heard about the fact...
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Carelon Beacon Rehab Coverage
Carelon Beacon Rehab Coverage (formerly Beacon) is a health insurance provider that focuses on holistic or “whole-person” behavioral healthcare. That makes the provider ideal for individuals seeking our rehab and addiction treatment, because it means the provider has a large amount of coverage for early identification, preventive treatment options, and follow-up care. This means Carelon will offer more coverage for your treatment plan earlier than many competitors. Their focus is on preventive care rather than waiting until it is medically necessary.
Carelon also fully supports evidence-based treatment programs such as medication-assisted treatment (MAT), making this a great provider to have if you need long-term care and maintenance for a dual diagnosis. However, understanding your insurance plan can help you get an idea of what Carelon will cover. Doing so can also help you factor in what steps you or your loved one may have to take to receive treatment coverage.
The Affordable Care Act requires most Americans to have insurance. Aside from Medicaid, Carelon is one of the largest health insurance companies in the United States. The insurance company serves over 40 million people. That also means it offers one of the largest networks of healthcare providers and some of the broadest Beacon Health options for treatment.
Addiction Treatment With Carelon Beacon Insurance
Carelon Insurance offers coverage for both behavioral health services and its members. In most cases, this means you’ll have options to seek out a Carelon healthcare provider or an in-network treatment center for substance use disorder treatment of any kind.
Inpatient Care
Patients requiring hospitalization or a longer-term level of care, such as residential treatment, can seek inpatient rehab or a residential program. These services are fully covered by Carelon.
Outpatient Care
If you are seeking flexible mental health treatment or outpatient programs for a more serious condition, an intensive outpatient program (IOP) or partial hospitalization program (PHP) may be right for you. Take comfort in knowing that Carelon has a large network of outpatient treatment providers who offer a range of outpatient services to support your recovery journey.
Medication Assisted Treatment/Medications for Opioid Use Disorder
Medical detox is one of the first steps to take before proceeding with substance abuse treatment. Carelon does not support detoxification or withdrawal services. Instead, it supports medications for opioid use disorder treatment (MOUD). This means that if you’re with Carelon, you will be moved into a program with medication to manage opioid use disorder.
Social Drivers of Health
Carelon offers coverage for programs improving social health and well-being.
Peer Support
Carelon covers wellness and recovery programs, including fitness, member-driven training, and outreach.
Specialty Programs
You can gain insurance coverage for a wide range of programs, including crisis management, child welfare, suicide prevention, and dual diagnosis treatment.
In most cases, you will only have Carelon through your employer. However, you will request and access care through Carelon directly, rather than through your employer. Carelon also supports long-term care and long-term medication management, with most programs being 18+ months.
Can You Go to the Network Providers?
Carelon allows out-of-network medical treatment. In addition, if you receive this on an emergency basis, you won’t be responsible for it. However, you can expect that there are additional cost-sharing (copay, coinsurance, and deductible) rates, which means that you will pay significantly more for your out-of-network rehab visit.
Therefore, it’s always best to verify that your alcohol or drug rehab facility is an in-network provider before moving forward.
What Does Addiction Treatment Cost With Carelon Behavioral Health?
Unfortunately, Carelon mental health plans are individually negotiated with your employer. This means that you may have a different rate depending on who you’re working with and your individual needs. For this reason, it’s always a good idea to use your HR portal and look at coverage and what your rates are.
Here, some important things to check include:
- Deductible (annual)
- Max out of pocket charge (typically does not include coinsurance)
- Coinsurance for in network/out of network providers
- Daily rate or admissions fee
- Whether you need preauthorization (normally you do)
- Specific rates for inpatient treatment vs outpatient treatment
Here, you can typically get a good idea of what you’re paying. However, it’s most likely to be in percentages of the end fee plus a deductible. This means your total rate could look like $2,800 of deductible plus 45% coinsurance plus $250 per day with a maximum out-of-pocket cost of $8,900 (not including coinsurance). That rate would not cover your medication.
Will My Employer Find Out I am Seeking Drug Addiction Treatment If I am Using Carelon Insurance Rehabilitation Coverage?
One of the largest concerns of using employer-provided healthcare for going to rehab is that your employer will find out. The good news is that your employer isn’t legally allowed to reach out to your insurance providers to know what your medical problems are. They are not legally allowed to ask you what you are seeking treatment for. In addition, all communications and payments are processed between you and your insurance provider and your health providers and your insurance provider – your employer will never be involved.
It is also illegal for them to be involved in any way. This means that you can safely seek out drug addiction treatment with your employer-provided mental health plan without your employer finding out.
Getting Started With Addiction Treatment With Carelon Insurance Rehabilitation Coverage
Going to addiction treatment with Carelon Beacon Rehab Coverage is a simple matter of going to your primary doctor. Your health care provider can refer you to a drug or alcohol rehab center, request preauthorization, and ensure that you’re ready to go to rehab with full insurance coverage. However, rates and coverage vary significantly depending on your plan with your employer. Your rates will almost entirely depend on what your employer has negotiated.
- Check rates and coverage with your employer via the HR portal or a fact sheet. You can request this data without saying what it’s for.
- Contact your rehab center and ensure they are in network for Carelon
- Request a referral and preauthorization request from your doctor
- Go to treatment
From there, Carelon will reimburse or cover your out-of-pocket costs just as they would if you were staying in a hospital for any other health condition. Because that’s what a substance use disorder is, a mental health condition.
If you’re struggling with substance abuse, receiving drug or alcohol addiction treatment services is important. Carelon Behavioral Health provides significant early treatment and early intervention. This means you can seek out behavioral therapy, such as group therapy, family therapy, or more. Preventive care or aftercare services are also an option with a referral from your doctor, and you still have that treatment covered. You don’t have to wait until you’re at rock bottom to move forward with substance abuse treatment. Your Carelon Behavioral Health Insurance benefits will help you get the evidence-based treatments you need to stay healthy and to get your life back on track. Good luck getting treatment and navigating your recovery journey.
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) 450-2701for more information.
