Carelon Insurance Coverage for Addiction Treatment

Using Carelon Insurance Coverage to pay for addiction treatment: One of the first things that someone thinks of when considering going to treatment for substance or alcohol abuse is the cost of the program. Substance abuse treatment can be costly. Fortunately, your Carelon health insurance plan will cover alcohol and substance abuse treatment. Treatment could be free or at a fraction of the costs that you would expect. Our addiction treatment specialists can help you find treatment options for substance abuse and mental health disorders that your insurance plan will cover. We work with programs that are both in-network and out-of-network with CarelonRX Health Insurance. You can call us to find out if there are any drug rehab centers nearby that take Carelon Insurance. If you would like to find out more about drug rehab programs near you, give us a call and we can get your insurance verified today.

1-800-513-5423

What you will learn:

• Does Carelon pay for drug and alcohol rehab?
• Types of substance abuse treatment programs that Carelon typically covers
• Addition types that Carelon will cover
• Understanding out-of-pocket expenses for rehab

Does Carelon pay for drug and alcohol rehab?

CarelonRx, formerly IngenioRx, will cover drug and alcohol rehab center programs. To check your eligibility and coverage amounts give us a call today. One of our insurance verification specialists will help you determine if your specific policy is in-network with one of our preferred providers.

Carelon will cover the following services relating to substance abuse disorders.

• Assessment
• Detox
• Medication-assisted treatment programs.
• Therapy programs
• Inpatient rehab center programs
• Dual diagnosis treatment/co-occurring disorder treatment
• What is the difference between in-network and out-of-network coverage?
• How to verify your insurance benefits
• How to get started

Types of substance abuse treatment programs that Carelon typically covers

Detox and medication-assisted treatment: Detoxification programs are the first step in the recovery process for many people who are entering into rehab for addiction. CarelonRX will cover part or all of your detox stay depending on the provider, type of drugs detoxing from, and co-payment of your policy. You may need to get a doctor’s approval before being covered just to make sure that it is necessary and medically needed to ensure your safety. Carelon uses ASAM criteria to determine which services are medically necessary including MAT services. MAT is approved by the (FDA) Food and Drug Administration and is used in conjunction with counseling and therapy to help address the underlying issues that have led to addiction in the first place.

Residential and inpatient rehabs: Carelon RX will cover residential inpatient treatment programs that are in-network or out-of-network depending on your insurance plan and location of provider. Individual coverage can vary by plan type, type of service, and your primary care provider's recommendation for outside treatment programs to treat substance abuse disorders.

Partial hospitalization programs (PHP) offer treatment for those who do not want to commit to a residential treatment program. Treatment at a PHP program will consist of treatment several times a week, typically during the day or several times a day. This type of program emulates residential treatment programs with being able to go home or to a sober living house during the treatment process.

Outpatient treatment programs: Outpatient can vary in frequency and intensity depending on the program you have chosen. Carelon insurance will cover outpatient treatment programs through their network of providers with treatment consisting of a few times a week or less. Intensive outpatient treatment programs usually consist of therapy and activities a few times a week for a few hours at a time. This type of program offers support and treatment for those who do not want to enter a residential program for their addiction. Some people who enroll in intensive outpatient treatment may choose to also enter a sober living house to offer additional support.

Addition types that Carelon will cover

CarelonRX will cover other addictive substances including opioids and other prescription medication in misuse. Many treatment centers are in-network with Carelon insurance group. Choosing the best program for your specific needs is the most important first step in the recovery process. No two people who enter treatment are the same, which is why there are different approaches used in the treatment of addictions.

Addictions covered by Carelon include most types of drugs and alcohol that can be habit-forming including:

• Alcohol
• Heroin
• Fentanyl
• Methamphetamine
• Cocaine
• Marijuana
• Benzodiazepines (Xanax, Valium)

Understanding out-of-pocket expenses for rehab

Your out-of-pocket expense for rehab will be determined 1st by the plan you have chosen, 2nd by the rehab you want to go to, and 3rd by whether the center is in-network or out-of-network. Below we will break down the types of expenses that you may have to cover before receiving addiction treatment.

• Co-insurance is a percentage of a covered service or procedure that you are responsible for. Example: If you have a "30% coinsurance" policy, it means that, when you have a medical bill, you are responsible for 30% of it. You may have to meet a deductible before you make the co-insurance payment depending on your policy.

• Deductible is the amount of money you must pay before Carelon will cover any expenses. Example: if you have a $5000 deductible you will have to pay that before they will cover the rest of your rehab stay.

• Copay is a set amount that you will pay for a service or procedure before you have met your deductible. You may have to make a copay even after you have met your deductible depending on your policy.

What is the difference between in-network and out-of-network coverage?

In-network coverage means that Carelon has partnered with drug rehab center programs to offer discounted rates for their clients. In-network providers of substance abuse treatment will have fewer out-of-pocket expenses you have to cover. 

Out-of-network coverage usually means that you will have less coverage and more out-of-pocket expenses. Out-of-network providers do not have an arrangement for services with Carelon insurance group and you may be subjected to higher coinsurance payments, deductibles, and or co-payments before approving treatment.

How to verify your insurance benefits 

To verify your benefits, you can call the number on the back of your insurance card or log into their portal HERE. 

We can help you understand your insurance policy and help you see if your specific plan is in-network with a drug rehab center near you. We are here to help you navigate and understand what exactly your insurance plan will pay for. You don’t need to get frustrated trying to understand your coverage. We will handle all the insurance company's questions and specifics when trying to enter a drug rehab center. Our staff has over 20 years of experience in the field of addiction and works with in-network rehab center programs that accept Carelon insurance. Your insurance provider will not be contacted or notified unless you decide to enter treatment and use your insurance.

How to get started

You already have taken the first step which is admitting there is a problem that needs to be addressed. The next step is to verify and confirm your benefits which will help you determine the best place for you to receive treatment based on your coverage and needs. You can contact one of our insurance navigators and see if one of the programs we work with is right for you. 

1-800-513-5423

Sources
Carelon Substance Use Disorder (SUD) services

Medications, Counseling, and Related Conditions

Mental Health Substance Abuse Coverage

Erik Epp – Content Author