Most insurance plans will cover either all or a portion of the treatment.
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SUD treatment executive, national news contributor & keynote speaker.
- Overview
- Substance Use Disorder Treatment Coverage through Carelon Behavioral Health
- What Kinds of Treatment Services Does Carelon Behavioral Health Cover?
- A Holistic Approach to Member Wellness
- How Can I Tell What Carelon Behavioral Health Plan Covers?
Overview
Carelon Behavioral Health is an insurance provider specifically covering treatment for addiction and other mental health challenges. It was once known as ValueOptions and Beacon Health Options before an acquisition and rebranding in 2023. Now operating as Carelon Behavioral Health, the company provides a wide array of coverage products for substance use disorder and associated conditions.
If you’re one of the over 60 million members across all 50 states who are currently covered by Carelon Behavioral Health, you can get the coverage you or your loved one needs to make your alcohol or drug addiction treatment more accessible. Focusing on an integrated approach of member education, treatment coverage, and ongoing support, Carelon Health works with health plans, government agencies, employers, treatment providers, individuals, and families.
Substance Use Disorder Treatment Coverage through Carelon Behavioral Health
In addition to covering a wide range of treatment services, Carelon Behavioral Health claims to provide holistic support for members at every touchpoint of their recovery journey, including:
- Integrating and coordinating mental health, physical health, and pharmacy services
- Providing access to providers with clinical expertise and evidence-based treatments
- Closing gaps in patients’ care plans whenever and wherever they exist
- Connect members with local and online resources for ongoing support and education
The company offers a comprehensive directory of providers providing all types of treatment services for alcohol and drug addiction.
What Kinds of Treatment Services Does Carelon Behavioral Health Cover?
Whether you’ve been battling addiction for years or you’re just starting to notice the toll your alcohol and drug use is taking on your physical and emotional health, you can use your Carelon Behavioral Health insurance coverage to make treatment easier and more affordable. While the exact scope of coverage will vary based on your precise plan type, some of the more common services they may cover include:
- Inpatient Alcohol and Drug Treatment – Residential programs in which patients stay at their treatment center throughout the course of their program and receive group and individual counseling, along with supplemental therapy techniques. Inpatient programs last an average of 28-30 days, but your duration of coverage may vary.
- Outpatient and Intensive Outpatient Treatment – Daily treatment programs that allow patients to return to their homes every day. Outpatient programs provide comprehensive care while also offering the flexibility to maintain your life, career, and involvement with your family while you’re getting the help you need.
- Medically Supervised Detox and Withdrawal Management – Withdrawal treatment from experienced doctors and nurses who are trained to care for all types of physical and psychological symptoms.
- Medication-Assisted Therapy (MAT) – MAT incorporates the use of certain FDA-approved medications for opioid use disorder. These include Suboxone® (buprenorphine and naloxone), Vivitrol® (monthly injectable naltrexone) and methadone.
Carelon Behavioral Health’s Changing Pathways program encourages medications for opioid use disorder (MOUD), the most effective treatment for opioid use disorder (OUD). It is suggested as an alternative to detox and includes member education, peer support, provider consultation, and data-based quality management assistance.
Carelon Behavioral Health may also cover partial-hospitalization programs (PHPs) to offer customized treatment services for those who need a combination of ambulatory and outpatient care for substance use disorder.
A Holistic Approach to Member Wellness
Members covered by Carelon Behavioral Health can access a wide assortment of support services in addition to their treatment coverage. The organization combines substance use disorder treatment with education and support on social determinants of health to help members better understand the societal triggers of substance use; peer support services with member-driven training and outreach teams; and specialty population programs such as crisis, child welfare, intellectual or developmental disabilities, and suicide prevention.
Their Crisis Solutions service engages members in real time to de-escalate and guide them toward a safe and healthy resolution. It includes a designated 800 number and mobile crisis as well as:
- Community-based locations
- System oversight and management
- Stabilization centers or peer living rooms
- Providers for all levels of care who are available for urgent access
- Integrated medication-assisted treatment solutions
- Crisis collaboratives
The reality of addiction is that people struggling with it often find themselves in moments of acute crisis. When they overlap, it helps to have resources that can mitigate the threat of escalation and provide help and support in the aftermath of the crisis.
How Can I Tell What Carelon Behavioral Health Plan Covers?
The quickest way to determine what your plan covers is to speak with someone from member services or contact the facility you’re considering for a complete insurance verification. An admissions representative will be able to explain what services are covered, how much of your treatment you will have to pay for out of pocket ,and all other costs related to your care. The most important thing is to get help, and leveraging your insurance resources can help make that process easier and more affordable.
