Insurance can be confusing at the best of times. If you’re stressed, in pain, or dealing with withdrawal symptoms, it can be even more difficult to figure out. Here is some information to make things a little clearer for folks who are wondering what addiction treatment Anthem Blue Cross Blue Shield of Ohio will cover.
What services does Anthem BCBS Ohio cover for substance use disorders?
Anthem BCBS Ohio covers behavioral health services as well as physical health services. Behavioral health is the umbrella term for mental and emotional well-being as well as substance use disorders like opioid and alcohol use disorders. Behavioral health services that Anthem BCBS Ohio plans cover include, but are not limited to:
- Inpatient and outpatient behavioral/mental health services
- Substance use disorder (SUD) residential treatment (commonly known as “rehab”)
- Outpatient substance abuse services including intensive outpatient and partial hospital care
- Detoxification services (commonly known as “detox”)
- Psychiatry services
- Behavioral health and substance abuse counseling services
- Therapeutic behavioral services
- Opioid treatment programs
Does Workit Health accept my Anthem BCBS Ohio plan for substance use disorder treatment?
Yes, Workit Health accepts Anthem BCBS Ohio for our clinical programs for both opioid and alcohol use disorders in Ohio. Click here to use our insurance checker to find out if your plan is accepted, or call the number on the back of your insurance card.
How much will I have to pay for treatment with Anthem BCBS Ohio?
There are several factors that go into how much you will pay.
- Premium – Premiums are the amount of money you owe monthly for your insurance plan, even if you never go to the doctor. Anthem BCBS Ohio categorizes their plans as “Bronze,” “Silver,” and “Gold.” Bronze plans have the lowest premium but the highest deductible. Silver plans have a higher premium than bronze and a lower deductible. Gold plans have the highest premiums of the three, but the lowest deductible.
- Deductibles – The amount you pay for something before your health plan begins paying. If your deductible is $1,000, this means you will owe the first $1,000 before your plan begins paying the rest.
- Copays – A copay is the amount you owe upon each visit to your health care provider. This is typically a fixed amount that comes after you’ve completed payment on your deductible. Copays should be defined within an insurance policy, and might be listed right on your insurance card.
- Coinsurance – Coinsurance is the percentage of costs you are required to pay after you have met your deductible.
Use the Sydney Health mobile app to find out what your own premium, deductible, copay, and coinsurance are, or call the number on the back of your insurance card.
Does Anthem BCBS Ohio require prior authorization for me to see a provider who will treat substance use disorders?
In most cases, as long as you are receiving outpatient treatment from a provider who accepts Anthem Blue Cross Blue Shield, you will not need prior authorization to see a doctor who treats substance use disorders. This applies to telemedicine programs like Workit Health as well as to more traditional office-based care and outpatient treatment programs. Your Anthem plan may require prior authorization for inpatient (residential) treatment.
How can I find out if my Anthem BCBS Ohio plan covers my Suboxone (buprenorphine/naloxone)?
Health plans with prescription drug coverage publish lists of medications they cover. These lists are called their formulary or drug list. You can check the formulary for your specific Anthem plan on the Anthem.com website. Click through to the formulary that applies to your plan to view the searchable drug list. Be sure to familiarize yourself with the codes and icons Anthem uses, so you can be prepared for any restrictions on your prescription drug coverage. Note that on our search, generic options of the buprenorphine/naloxone sublingual tablets were preferred and had the most coverage, while buprenorphine/naloxone sublingual films (like Suboxone) were at a higher tier with more out-of-pocket cost. You can use the Sydney Health mobile app or call the number on the back of your insurance card to ask for clarification.
Will any pharmacy fill my Suboxone (buprenorphine/naloxone) prescription if I have Anthem BCBS Ohio?
No, you will want to check with the pharmacy to be sure that they accept your Anthem plan and also have the medication you need. Pharmacies have been known to run out of certain medications, and some pharmacies have been reluctant to dispense buprenorphine out of fear that it will be diverted. So your pharmacy may have additional red tape for you to navigate, despite the fact that Anthem prescription drug plans cover the medication. You will also want to check on what your prescription copay is ahead of time, so you’re not taken by surprise at the register.
