Anthem, Inc. has the distinction of being one of the largest health insurance providers in the US. The company headquarters is in Indianapolis, Indiana. It is an independent licensee for Blue Cross Blue Shield and serves members in several states.
Anthem Insurance for Drug Rehab: Available Coverage
Anthem Insurance offers PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) plans. The following are examples of the types of coverage available, and are not meant to represent a complete listing of the Anthem insurance for drug rehab options.
• PPO Bronze PPO 5000/30%/7150
The deductible is $5,000.00 for an individual and $10,000.00 for a family. Once it has been met, plan members pay 30 percent coinsurance for both in-network and out-of-network treatment.
This figure applies to inpatient and outpatient programs; however, inpatient treatment must be preauthorized by the insurer. Inpatient treatment is also subject to a $500.00 copay per admission.
• PPO Silver Advantage PPO 1250/40%/5500 Plus
The deductible for this plan is $1,250.00 per person and $2,500.00 per family. If you use a preferred network provider for substance abuse services, you pay 40 percent coinsurance (inpatient and outpatient services).
If you use an in-network provider, the co-pay for the first three visits is $25.00 per visit, then you pay 40 percent coinsurance for outpatient treatment. For inpatient treatment, there is a $250.00 copay and 40 percent coinsurance per admission.
If you choose to go outside of your network of providers, a substance abuse office visit for outpatient treatment is covered at the rate of 50%. Inpatient treatment is covered at 50% up to a maximum benefit of $380.00 per admission.
• PPO Gold PPO 20/30%/6500
The deductible is $250.00 per person and $500.00 per family for in-network providers and $2,000.00 per person and $4,000.00 for a family for out-of-network providers. In-network office visits are charged a $20.00 copay for substance abuse services. Other outpatient services are charged a 30% coinsurance fee. Inpatient treatment is also charged the same 30% coinsurance rate.
Out-of-network outpatient treatment for substance abuse costs 50% coinsurance after deductible is met. Inpatient treatment is covered at 50% coinsurance up to a maximum of $650.00 benefit per day.
• Anthem Platinum PPO 20/10%/4000
There is no deductible for in-network providers, and the deductible for out-of-network providers is $2,000.00 per person and $4,000.00 for a family. In-network office visits for outpatient substance abuse treatment are covered with a $20.00 copay per visit. Other outpatient services are covered with 10% coinsurance. Inpatient services are covered with 10% coinsurance.
Out-of-network outpatient substance abuse treatment is covered at 50% coinsurance once deductible is met. The inpatient facility fee for non-network providers is limited to $650.00 per day. No coverage is offered for inpatient physician care.
• Anthem Silver HMO 1500/35%/7150
The deductible for this HMO plan is $1,500.00 per person and $3,000.00 per family. In-network doctor office visits for substance abuse require a $40.00 copay per visit and a 35% coinsurance payment after the deductible is met.
In-network Inpatient services for substance abuse are covered at the rate of a 35% coinsurance payment after the deductible is met. No coverage is offered for out-of-network providers, either for outpatient or inpatient services.