Carelon Behavioral Health Insurance Coverage for Drug Rehab

Carelon Behavioral Health is a health insurance company specializing in covering mental health and addiction treatment. You may know them as Beacon Health, which was their former name.

When the Mental Health Parity and Addiction Equity Act passed in 2008, many health insurance companies didn’t have enough mental health and addiction coverage to comply with the law.

The solution for many was to subcontract for their mental health and addiction services. Carelon is one of the main companies that provide this service to other health insurance carriers around the country. They also contract directly with some employers.

Does Carelon Behavioral Health Cover Addiction Treatment?

Yes, in fact, it’s what they specialize in, but there’s a caveat. When they’re contracting with another health insurance company, many aspects of the coverage may still depend on that other company’s policies. That company can make decisions about what types of services they want in their network.

Many of their plans have residential drug rehab coverage. The characteristics of the network may depend on the plan they’re contracting with. If you’re considering a health plan that uses Carelon as a subcontractor, and you’re wondering what’s in network with that plan, you can look. They let you check their network coverage by which company you’re getting your main health plan through.

Does Carelon Behavioral Health Cover Methadone and Suboxone Treatment?

Carelon is a strong advocate for medication treatment for opioid use disorder. Methadone and Suboxone are two medications that treat opioid use disorder, but there are others too like buprenorphine and naltrexone. Most of their plans have this option.

You can also get medication assisted treatment (MAT) to help you overcome alcohol misuse. MAT is generally paired with treatment and counseling to help you lay a solid foundation for long term recovery.

How to Verify Coverage With Carelon

If your insurance company uses Carelon for behavioral health services, the way to check what services they have in their network is to visit Carelon’s website. Then look for the tab labeled “Find a Provider” near the top of the page. From there, they’ll ask you to enter the first three letters of the company you’re checking. When you do that, a list of possibilities will appear. Pick the one that you’re looking for from the list.

This will give you the details you need to understand your insurance coverage and find in network providers. If you have any additional questions, you can always contact Carelon directly over the phone.

What Special Features Do Carelon Behavioral Health Plans Have?

Carelon offers a list of special programs you can participate in. Here are some of the ones that people who have addictions might be the most interested in knowing about.

The Child, Young Adult, and Family Health Program uses care managers to help connect you with the right resources from Carelon’s network. Their goal is to intervene early. They use data to help them figure out who’s at the highest risk and then reach out to you proactively.

Carelon also has a network of certified peer support specialists you can access when you have a Carelon plan. A peer support specialist can support you in your recovery because they understand what it means to recover.

Finally, in the Social Drivers of Health Program, Carelon uses community resource navigators to help connect you with local resources. These might include things like food, transportation and help filing for social security.

What Types of Inpatient Addiction Treatment Are Covered By Carelon?

Carelon may cover several varieties of addiction treatments where you stay overnight to get care. The most common is residential rehab which usually lasts a few weeks. The exact length of stay may vary as your progress is reviewed. Once you get to a point where you’re ready for the next step you’ll move on.

Carelon may also cover medical detox. Inpatient medical detox is another type of addiction treatment where you spend the night at the treatment center. It’s usually shorter than residential rehab lasting about three to ten days. It’s appropriate for people who need help getting through the detox process safely and as comfortably as possible.

Inpatient mental health treatment is another benefit you may get access to through Carelon. This treatment is for people whose psychiatric disorder needs acute treatment. It’s very common for addiction and mental health problems to happen together and some people may need to go to an inpatient psychiatric unit to get help for a mental health crisis. Once you are stabilized you will be able to move to a more long term treatment program.

What Types of Outpatient Addiction Treatment Are Covered By Carelon?

Partial hospitalization and intensive outpatient programs are outpatient treatments that Carelon may cover if they’re appropriate for you. In these types of treatment, you spend a part of each day at the treatment center participating in therapy and support groups but you go home at the end of the day.

Standard outpatient treatment is also a benefit that most plans include when they contract with Carelon. This includes regular appointments with a counselor and with a provider who can do your medication management. You may also participate in group therapy sessions.

Does Addiction Treatment Need to Be In Network?

The answer to this question depends on your specific plan. There are many plans that won’t pay for services you get outside the network. For example an HMO generally does not cover care that is out of network. Also, your health insurance plan may only access part of Carelon’s network, so it’s important to verify your coverage before using a service.

There are some plans that allow you to go out of network for treatment. Usually, going out of network means you’ll have to pay a higher deductible and you may also have higher copayments as well. These costs can be much higher than staying in network would be so you would want to be aware of your plan limits before you make a decision to go out of network.

Does Carelon Cover Other Mental Healthcare?

Carelon specializes in covering mental health treatment. The benefits and programs they can offer are comprehensive. They have case management services to help people coordinate mental health treatment from several different providers. They can also offer you help proactively if they see that you’re likely to need a certain service based on your health data.

Does Carelon Have Specialized Support for Military and Veterans?

Carelon works with the federal government to connect military members and their families to a wide range of mental health and substance use treatment services. They also connect plan members to services that are sensitive to the needs of people in the military that aren’t traditionally considered health services but nonetheless support the special needs of military service people and their families. These include support for deployment and reintegration, non-medical counseling and lifestyle coaching that’s specific to military families.

Can I Get Carelon Through My Employer?

There are many employer sponsored health plans that contract with Carelon for their behavioral health coverage. Since this usually happens behind the scenes you may have Carelon and not know it.

You might realize you have Carelon if your employer is offering one of their employee assistance programs (EAP). An EAP supports you in areas of your life that aren’t always health related but that may get in the way of your work.

For example the Carelon EAP can help you with finding childcare or care for elderly relatives. They can connect you with free legal advice and financial counseling too.