Anthem and Blue Cross Blue Shield
Anthem operates as a Blue Cross Blue Shield licensee in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Because Anthem operates in Nevada, BetterChoice has direct experience working with Anthem on a daily basis.
In some states, Anthem operates under different brand names:
- Anthem Blue Cross (California)
- Anthem Blue Cross Blue Shield (most other states)
- Empire Blue Cross Blue Shield (New York)
- Wellpoint (corporate parent, now Elevance Health)
Regardless of the brand name on your card, the coverage and authorization process for substance use treatment is generally consistent across Anthem plans.
What Anthem Generally Covers
Anthem plans typically cover the full continuum of substance use disorder treatment:
- Medical detox — covered when medically necessary
- Residential rehab — covered for clinically appropriate stays, authorized in increments
- Partial hospitalization (PHP) — covered as step-down or primary care
- Intensive outpatient (IOP) — widely covered
- Standard outpatient — covered under behavioral health benefits
- Medication-assisted treatment (MAT) — Suboxone, Vivitrol, and naltrexone generally covered
Anthem manages behavioral health through its own behavioral health division (formerly Beacon Health Options, which Anthem acquired).
In-Network vs. Out-of-Network
BetterChoice works with Anthem both in-network and out-of-network:
- In-network: contracted rates, typically lowest out-of-pocket costs
- Out-of-network: Anthem PPO plans generally cover OON treatment at 60-80% of allowed amounts after the OON deductible
- Single case agreement (SCA): we negotiate one-time agreements with Anthem when standard in-network access is not available for a specific plan
Because Anthem is the BCBS licensee in Nevada, our working relationship with Anthem is particularly close.
Prior Authorization
Anthem requires prior authorization for substance use treatment:
- Medical detox (typically 5-7 days initially)
- Residential treatment (7-14 days initially, with continued stay reviews)
- PHP and IOP (varies by plan)
We handle all authorization communication with Anthem. Our team is familiar with Anthem clinical criteria and documentation requirements.
Beacon Health Options
Anthem acquired Beacon Health Options, which previously managed behavioral health benefits for many employer plans. If your insurance card references Beacon Health Options or if your employer used Beacon as a behavioral health carve-out, the coverage process is similar to standard Anthem. We can verify benefits regardless of whether your card says Anthem, BCBS, or Beacon.
Common Anthem Plan Types
- Anthem PPO (Blue Access PPO): standard PPO with in-network and out-of-network benefits; most flexible for accessing BetterChoice
- Anthem POS (Point of Service): hybrid plan requiring primary care referral for some services; typically still covers substance use treatment with authorization
- Anthem EPO: network-restricted plan; may require SCA
- Anthem Blue Cross (California): operates with slightly different plan structures; verification confirms specifics
- Employer self-funded plans administered by Anthem: benefit levels set by employer; verification is essential
How to Verify Your Anthem Plan
Call us at (725) 550-5655 with:
- Your Anthem member ID
- Group number
- Date of birth
- The specific Anthem brand on your card (Anthem BCBS, Empire, Anthem Blue Cross, etc.)
We verify benefits within about ten minutes and call you back with confirmed coverage, estimated costs, and next steps. No commitment required.
Contact
(725) 550-5655 198 Ebb Tide Cir Las Vegas, NV 89123