Does Wellpoint Insurance Cover Addiction Treatment?

Wellpoint is an insurance company that offers an array of health plans. People can use these insurance plans to cover the costs associated with a rehab program. 

In 2004, Wellpoint Health Networks merged with Anthem. Through its affiliated companies, Anthem services approximately 47 million Americans.

Health insurance for substance abuse treatment may cover inpatient treatment, mental health services, detoxification, and outpatient services. 

How To Use Wellpoint Insurance For A Drug Rehab Program

People with Wellpoint insurance coverage can get some or all of their healthcare needs paid for through their plan.

Wellpoint is available in several states including California, Colorado, Georgia, Nevada, New York, Ohio, Virginia, and Kentucky. 

Types of insurance plans available through Wellpoint:

• bronze plan: covers 60% of medical expenses and features lower monthly premiums
• silver plan: covers 70% of treatment costs and has highly monthly payments
• gold plan: covers 80% of medical costs and features lower deductibles and higher premiums
• platinum plan: covers 90% of treatment costs and features the highest monthly premiums

Once a client has chosen a health plan, they can talk to their doctor or call a Wellpoint representative to learn more about the nearest in-network treatment providers. 

Some PPO or POS insurance plans may allow for out-of-network addiction treatment, but require policyholders to pay higher deductibles and copays. 

Behavioral Health Services Covered By Wellpoint Plans

Wellpoint insurance covers a wide array of inpatient and outpatient treatment services. The level of care received will be determined by the individual needs of the client. 

Addiction treatment services covered by Wellpoint may include:

• residential treatment
• intensive outpatient programs (IOP)
• partial hospitalization programs (PHP)
• outpatient treatment for chemical dependency
• support groups for people with opioid drug addiction
• 12-step programs for alcohol addiction
• family, group, or individual counseling
• behavioral therapy
• holistic treatment options
• co-occurring disorder care
• mental health services
• medically monitored detox
• medication-assisted treatment (MAT)
• aftercare services
• case management and wellness services

Before entering treatment at a detox center or inpatient rehab program, people may need to seek prior authorization from their primary care provider.

Once your doctor has shown that there’s a medical necessity for addiction treatment, Wellpoint will cover the costs outlined in the health plan. 

Questions To Ask Before Selecting A Rehab Program Covered By Wellpoint

Below are some of the common questions that a person may want to ask before choosing a treatment center. 

Questions about using Wellpoint insurance for drug treatment may include:

• How much will my copay and deductible be?  
• Will the location of the rehab center affect the level of coverage?
• Does my insurance provider have coverage limits?
• Do I need a referral from a healthcare provider before I can use my health benefits?
• Does Wellpoint offer Medicaid and Medicare plans? 
• Do all rehab facilities accept insurance plans through the Blue Shield Association?
• What is the difference between a PPO, HMO, and POS plan?
• Can I attend a free rehab center if my Anthem insurance policy is too expensive?
• Will my treatment plan be affected if I have a pre-existing condition?

Differences in coverage among policyholders mean that each person must examine their plans thoroughly before entering a drug and alcohol rehab program. 

A failure to fully understand what the insurance plan covers may mean substantially higher out-of-pocket costs. 

Find Substance Use Disorder Treatment Covered By Wellpoint Insurance

Call our helpline for more information about using your Wellpoint health insurance plan for addiction treatment. Our team can assist you or your loved ones in your journey to sobriety. 

Published on November 29, 2022

Written by the Free Rehab Centers Editorial Staff