Yes, Anthem commercial plans generally include substance use disorder treatment, and you can use those benefits at a program that offers a group or track for LGBTQ clients, the same as at any other in-network program. Anthem's own consumer guide lists substance use treatment such as rehab and counseling among the behavioral health services its Marketplace plans cover, while noting that benefits vary by state and plan. Before starting a program, confirm your benefits, network status and any approval requirements for your specific plan.
Anthem is a Blue Cross Blue Shield company in a number of states, so you may see "Anthem Blue Cross" or "Anthem Blue Cross and Blue Shield" on your card. This page is organized as questions and answers and covers employer and individual commercial plans only.
The short version
| Question | General answer for Anthem commercial plans |
|---|---|
| Is addiction treatment covered? | Generally yes; benefits vary by state and plan. |
| Is an LGBTQ group covered? | Anthem covers levels of care, not populations. A group inside an in-network program is generally covered like the rest of that program. |
| Is prior approval needed? | Often for structured programs; Anthem publishes requirements by state and plan type. |
| Where do I search? | Find Care on anthem.com or in the Sydney Health app. |
Does Anthem have an "LGBTQ rehab" benefit?
No insurer does. Health plans pay for levels of care: detox, residential, partial hospitalization (PHP), intensive outpatient (IOP) and outpatient therapy. When an in-network program runs a group for sexual and gender minority clients as part of one of those levels, that group is generally part of the care Anthem covers. The question to ask is whether the specific program is in network for your plan. To understand what these programs offer, see LGBTQ-friendly vs. LGBTQ-specific rehab and minority stress and addiction.
What does parity mean for me?
Federal parity law, as the U.S. Department of Labor explains, means a plan that covers substance use disorder care cannot apply stricter copays, deductibles, visit caps or approval rules to that care than to comparable medical care. HealthCare.gov adds that individual and small group plans must include substance use disorder treatment as an essential health benefit and cannot deny coverage or charge more because of an existing addiction.
What kinds of treatment might Anthem cover?
Depending on your plan, covered services can include:
- Inpatient care, including medically managed detox
- Residential rehab
- Partial hospitalization and intensive outpatient programs
- Individual, group and family therapy, in person or by video
- Psychiatric visits and medication management
- Psychological testing
If you are dealing with alcohol, drugs or a co-occurring mental health condition, our hubs for LGBTQ alcohol rehab, LGBTQ drug rehab and LGBTQ dual diagnosis list programs by focus.
Who is Carelon, and why does that name keep coming up?
Carelon Behavioral Health is part of the same parent company as Anthem. Anthem's employer materials say its behavioral health network is growing as Carelon providers are added, and describe Carelon support for members at high risk from substance use, including phone support, help arranging care and coaching.
For some employer plans, Anthem also describes add-on behavioral health packages. One, aimed at mid-sized employers, includes substance use disorder advocacy, concierge navigation and access to a high-performing substance use provider network. Whether you have any of this depends on what your employer bought, so ask HR or member services.
Do I need prior authorization?
Often, for structured programs. Anthem publishes its precertification requirements by state and plan type, so there is no single national list. In general, expect inpatient detox and residential stays to need approval before admission, and ask specifically about partial hospitalization and intensive outpatient. Routine therapy visits usually do not need prior approval.
An in-network treatment center will normally request authorization for you. If you are an Anthem member being treated in another state, the program works through that state's Blue company, and Anthem provides a lookup for out-of-area precertification rules that uses the first three characters of your ID number.
Talk with an independent helpline about detox and rehab options and what your insurance covers. Available 24/7.
Call 866-825-1171How do I find an in-network program with an LGBTQ group?
Anthem's mental health pages point members to the Find Care tool on anthem.com and in the Sydney Health app, where you can search by location or specialty. You can also chat with Anthem in the app or call Member Services at the number on your ID card. Your primary care doctor can make a referral.
Anthem's search will not usually show whether a program runs an LGBTQ group. Our directory lists programs that report a program or group for LGBTQ clients to SAMHSA, for example LGBTQ rehab in California or LGBTQ rehab in Los Angeles. Shortlist there, then check each program in Find Care and with its admissions team. When you verify benefits, ask whether the LGBTQ group runs at the level of care being authorized.
If your employer offers Anthem's Employee Assistance Program, you may have a set number of no-cost counseling sessions. Anthem also says therapists are available for video visits through Sydney Health and anthem.com, and that virtual visits are free on most of its Marketplace plans, although members of high-deductible plans with an HSA and catastrophic plans must meet their deductible first.
What about my name and privacy?
Your Anthem card and claims use the name on file with your plan. If that is not the name you use, ask the program how it handles chosen names and pronouns in care and on paperwork; our transgender rehab guide lists questions. If you are a dependent on a parent's plan, the explanation of benefits may go to the policyholder. Ask Anthem whether you can request confidential communications for your care.
What will it cost me?
Your cost depends on your deductible, coinsurance, copays and out-of-pocket maximum. Anthem notes that going out of network can mean a higher share of costs. Ask member services whether the program is in network, which levels of care need precertification, how much of your deductible is met and what your out-of-pocket maximum is.
What if Anthem denies my claim?
Ask for the denial reason in writing, have your doctor request a peer-to-peer review, and file an internal appeal. The Department of Labor says you generally have 180 days to appeal, can ask the plan for its medical necessity criteria, and can request an independent external review if the denial stands. Your state insurance department can also help with insured plans. See our Blue Cross Blue Shield guide or the full insurance section.
In a medical emergency or overdose, contact emergency services or go to the nearest emergency room.
Sources
- Understanding Mental Health Coverage in the U.S. (Anthem)
- Connecting to Mental Healthcare (Anthem)
- Group Behavioral Health (Anthem)
- Meeting the Challenges of Mental Health Care (Anthem)
- Medical Policy and Precertification Lookup for Out-of-Area Members (Anthem)
- Understanding Your Mental Health and Substance Use Disorder Benefits (U.S. Department of Labor)
- Mental Health and Substance Abuse Health Coverage Options (HealthCare.gov)
Free, confidential help finding treatment. Independent helpline, 24/7.
Call 866-825-1171Related guides
- Why LGBTQ-Specific Addiction Treatment Matters | LGBTQ Rehab
- Questions to Ask an LGBTQ Rehab Before You Enroll
- Transgender Rehab: Finding Addiction Treatment That Respects Your Gender
- Minority Stress and Addiction: How Stigma Affects Substance Use
- Family Rejection, Chosen Family and Recovery
- LGBTQ-Friendly vs LGBTQ-Specific Rehab: What's the Difference?
Find treatment
LGBTQ Rehab by stateLGBTQ-Friendly Rehab by stateLGBTQ Addiction Treatment by stateLGBTQ Detox by state