In-Network Outpatient Treatment Programs That Accept Anthem
Here's the thing about finding Outpatient Treatment with Anthem coverage: every plan is different. But if a facility is in-network with Anthem, you're usually looking at lower costs than going out-of-network. This page helps you find those in-network options in your area, so you can spend less time searching and more time getting the help you need.
How Anthem Coverage Works for Treatment
What in-network means and why it matters for your costs
Here's what "in-network" actually means: the facility has a contract with Anthem to provide services at pre-agreed rates. For you, that usually translates to lower copays, lower coinsurance, and less money out of your pocket. Out-of-network care can cost significantly more—sometimes double or even triple what you'd pay at an in-network facility.
About Anthem Networks
Anthem is part of the Blue Cross Blue Shield network in many states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin). If you have Anthem, you may also be able to use facilities in the broader BCBS network when traveling.
In-Network Benefits
- ✓Lower copays and coinsurance rates
- ✓Pre-negotiated service rates
- ✓Counts toward in-network deductible
- ✓Streamlined billing process
Out-of-Network Considerations
- •Higher out-of-pocket costs
- •Separate deductible may apply
- •Balance billing possible
- •May require single case agreement
Prior Authorization Requirements
If you're looking at Outpatient Treatment with Anthem, you'll likely need prior authorization. Don't let that term intimidate you—it just means Anthem reviews clinical information to confirm the treatment is appropriate. Facilities do this all the time and usually have dedicated staff to navigate the process. Ask about it when you call.
Prior authorization is typically required for anything beyond standard outpatient therapy. If you're looking at residential or PHP, expect the facility to need clinical approval before you can start.
Understanding Outpatient Treatment in the United States
Understanding your treatment options
Outpatient Treatment(Outpatient)
Outpatient ProgramStandard outpatient treatment means you're meeting with a therapist or counselor once or twice a week while living your regular life. It's the least intensive level of care, but that doesn't mean it's less important—for many people, this is what helps them maintain long-term recovery. It works best when you have a solid foundation and are looking for ongoing support rather than crisis-level help.
Ongoing
1-4 hours
- People who've completed more intensive treatment and are stepping down
- Those with stable lives who need ongoing accountability
- Individuals managing recovery while working or going to school
- People with strong support systems already in place
Who decides what level of care is right?
When you call a treatment facility, they'll do an assessment to understand your situation— things like what substances you're using, how long, medical history, mental health, and your support system. Based on that, they'll recommend a level of care. Your insurance company also has a say—they use clinical criteria (like ASAM for substance use) to decide what they'll cover. Sometimes there's back-and-forth between the facility and insurance to find the right fit.
Find Anthem Outpatient Programs by State
Anthem network availability and coverage for outpatient treatmentcan vary by state. Select your state to see specific programs and coverage information.
What to Expect from Anthem Coverage for Outpatient
Coverage for outpatient treatment through Anthem depends on your specific plan, medical necessity, and network status of the treatment facility. Here are general factors that typically affect coverage.
Factors That Affect Coverage
- •Your plan type (PPO, HMO, EPO, etc.)
- •Whether the facility is in-network
- •Medical necessity determination
- •Prior authorization approval
- •Your deductible and out-of-pocket max
What to Verify
- 1.Call Anthem member services
- 2.Ask about behavioral health benefits
- 3.Confirm coverage for Outpatient
- 4.Ask about authorization requirements
- 5.Get cost estimates in writing
What to Ask When Contacting a Program
Be prepared with the right questions
That first phone call to a treatment facility can feel intimidating. Here's the thing: the people answering are usually experienced at helping nervous callers navigate this process. You don't need to have all the answers—just your insurance card and a basic idea of what's going on. But it helps to know what questions to ask them:
- 1Are you currently in-network with my Anthem plan? (Give them your insurance ID and group number)
- 2Can you verify my benefits and tell me roughly what my out-of-pocket costs would be?
- 3Do you handle the prior authorization process, or do I need to call my insurance first?
- 4Do you have availability right now? How long is the wait for admission?
- 5What does a typical day look like in your program?
- 6What credentials do your therapists and counselors have?
- 7Do you offer medication-assisted treatment (like Suboxone or Vivitrol) if that's appropriate for me?
- 8What happens after I complete your program? Do you help with aftercare planning?
- 9Can my family be involved in my treatment?
- 10What happens if my insurance stops approving coverage before I'm clinically ready to leave?
- 11Do you treat people with both addiction and mental health issues at the same time?
- 12How do you customize treatment plans for each person?
Before You Call
- Have your insurance card ready
- Know your policy number and group number
- Be ready to briefly describe the situation
- Have pen and paper for notes
What Intake May Ask You
- What substances or symptoms are involved
- History of prior treatment attempts
- Current medications
- Timeline for when help is needed
Here's something important to remember: calling a facility doesn't commit you to anything. You can (and should) call multiple places to compare options. The intake team is there to help you figure out if their program is right for your situation. If it's not the right fit, a good facility will tell you honestly and may even suggest alternatives.
"The only person you are destined to become is the person you decide to be."