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Carelon Insurance (formerly Beacon) is a health insurance provider focusing on holistic or “whole person” 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, and follow-up care. This means Carelon will offer more coverage and earlier than many competitors, because its focus is on preventive care rather than waiting until it is medically necessary.
Carelon also fully supports medication assisted treatment (MAT) programs, which makes this a great provider to have if you need long-term care and maintenance. However, understanding your options, what Carelon will cover and what steps you have to take to get treatment coverage is important.
Carelon is one of the largest healthcare providers in the United States with over 40 million people served. That also means it offers one of the largest networks of health providers and some of the broadest solutions for treatment.
Carelon offers both behavioral health services and coverage to its members. In most cases, this means you’ll have options to seek out a Carelon healthcare provider or an in-network Carelon provider for substance use disorder treatment of any kind.
Patients requiring hospitalization or partial hospitalization can seek out care and treatment and get full coverage with Carelon.
Carelon has a large network of outpatient treatment providers.
Carelon does not support detox 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.
Carelon offers coverage for programs improving social health and wellbeing.
Carelon covers wellness and recovery programs including fitness, member-driven training, and outreach.
You can get coverage for a wide range of programs including crisis management, child welfare, suicide prevention, and comorbid disorder treatment.
In most cases, you will only have Carelon through your employer. However, you will request and access care through Carelon directly and not through your employer. Carelon also supports long-term care and long-term medication management, with most programs being 18+ months.
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 rehab center is in the Carelon network before moving forward.
Unfortunately all Carelon health plans are individually negotiated with your employer. This means that you may have a different rate depending on who you’re working with. For this reason, it’s always a good idea to use your HR portal and to look at coverage and what your rates are.
Here, you can typically very easily 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.
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 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 health plan without your employer finding out.
Going to addiction treatment with Carelon is a simple matter of going to your primary doctor. They can refer you to a rehab center, request preauthorization, and ensure that you’re ready to go to rehab with full coverage. However, again, rates and coverage actually significantly vary depending on what your plan is with your employer. Your rates will almost entirely depend on what your employer has negotiated.
From there, Carelon will reimburse or cover your healthcare 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 health condition.
If you’re struggling with substance abuse, getting treatment is important. Carelon also provides significant early treatment and early intervention. This means you can seek out therapy and preventive care with a referral from your doctor and still have that treatment covered. You don’t have to wait until you’re at rock bottom to get help and your insurance plan will still help you get the treatment you need to stay healthy and to get your life back on track. Good luck getting treatment.