Carelon Coverage for Mental Health & Addiction Treatment
Carelon health plan members may be able to get coverage for rehab, whether it is a drug rehab, alcohol rehab, mental health rehab, or recovery services through their health care plan. Although it is not a guarantee, it is always a good idea to review your Carelon health care benefits before you start your rehab services so you can get a better idea of the options available for your care and rehab.
Carelon Behavioral Health offers behavioral health services and support for people who are struggling with substance abuse and mental health disorders. Many Carelon plans offer coverage for rehab services that are geared towards helping people get and stay well.
What Carelon members should know
- Verify Coverage Quickly
- No Obligation
- Confidential
Does Carelon Cover Drug & Alcohol Rehab?
The Carelon Behavioral Health plans usually have provisions that include coverage for behavioral health and substance abuse treatment services. Mental health and substance use disorder services have been included in the essential health benefits package under the Affordable Care Act.
The coverage for Carelon rehab may vary based on the specific plan, in-network status, and the specific care required. For example, services such as inpatient rehab and medical detox must be medically necessary and may be required to have prior authorization in order to be covered under a Carelon plan.
The Carelon rehab coverage may vary based on the specific plan and in-network status.
What Addiction Treatment Services May Be Covered by Carelon?
There are several services that can be included in the Carelon insurance coverage that can be helpful in overcoming an addiction.
Medical Detox
The first step in overcoming an addiction is medical detoxification. This is necessary for those who are suffering from withdrawal symptoms due to drugs or alcohol.
Inpatient / Residential Rehab
Around-the-clock care in a treatment facility is Inpatient rehabilitation. This type of treatment is useful in dealing with substance use disorders and mental health disorders. This depends on the severity of the disorder, history of treatment, and approval from an authorized source.
Partial Hospitalization Programs (PHP)
Partial hospitalization programs offer intensive treatment during the day while allowing patients to return home at night. Some Carelon plans may include PHP as a step-down level of care following inpatient treatment.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs offer therapy a few days a week within a structured environment. Carelon coverage may include IOP when inpatient treatment is not considered medically necessary.
Telehealth Intensive Outpatient Treatment (IOP)
Some health plans through Carelon may include coverage for medically necessary telehealth services for behavioral health. Telehealth IOP is a program that enables patients to engage in addiction or mental health treatment sessions through secure online sessions.
Banyan Treatment Center can help verify your Carelon health plan coverage for telehealth treatment services.
Standard Outpatient Treatment
The most common types of care provided in an outpatient treatment program include individual therapy and counseling. Many Carelon plans cover behavioral health care as part of the substance abuse treatment.
Aftercare / Continuing Care
The aftercare services that are provided are meant to assist the individual in their long-term recovery and may include relapse prevention therapy and support.
Note: Length of stay and level of care are typically determined by medical necessity and clinical evaluations.
Does Carelon Cover Mental Health Treatment and Therapy?
Plans offered by Carelon Behavioral Health generally cover mental health care. Mental health care may be needed if an individual is experiencing depression, anxiety, trauma, substance abuse, or other mental health challenges.
Coverage may include:
- Individual therapy and counseling
- Group and family therapy
- Family therapy sessions
- Co-occurring mental health disorder treatment
- Ongoing mental health support
Additionally, some of the Carelon plans may include coverage of inpatient mental health treatment or residential programs in cases where an individual may be experiencing severe mental health disorders or co-occurring conditions.
Inpatient Mental Health Coverage
The plans may also include coverage of various services related to psychiatry and medication management. These may include psychiatric evaluations, prescription medications, and monitoring in cases where medically necessary.
How Much Does Rehab Cost With Carelon?
The costs of seeking treatment for addiction with Carelon vary based on the specific plan and the level of care needed. Although the costs may be reduced with Carelon, there may be some costs for the patient, such as copays, coinsurance, and deductibles.
Factors That Affect Your Out-of-Pocket Cost
- In-network vs. out-of-network providers
- Deductibles, copays, and coinsurance
- Prior authorization and medical necessity review
- Level of care (medical detox, inpatient rehab, outpatient treatment)
- Specific Carelon plan structure
What You Can Do Right Now
At Banyan Treatment Center, we can help verify your Carelon insurance benefits prior to receiving treatment. Additionally, whenever possible, our team can give you an estimate of costs associated with treatment based on your health plan.
If You Call Carelon Directly, Ask:
- Is medical detox covered?
- Are inpatient or residential programs covered under my plan?
- Are PHP or intensive outpatient programs covered?
- Do I need prior authorization?
- Is this facility in-network?
- What are my deductibles, coinsurance, and copays?
Or, We Can Verify for You (Recommended)
- We contact your insurance provider directly
- We review coverage details and medical necessity requirements
- We explain the benefits clearly and confidentially
How to Find Treatment That Accepts Carelon
Searching for treatment facilities that accept Carelon Insurance can be done by searching for facilities that are part of the Carelon network.
Getting Matched to the Right Level of Care
A clinical assessment can be performed in order to identify an appropriate treatment program depending on the severity of substance abuse, mental health issues, and insurance.
Next Steps: Verify your Carelon coverage or speak with an admissions specialist today.
Frequently Asked Questions
- Banyan Boca
1000 NW 15th Street
Boca Raton, FL 33486
888-422-1651 - Banyan Pompano
950 N Federal Hwy
Pompano Beach, FL 33062
954-866-4486 - Banyan Stuart
201 SE Osceola St
Stuart, FL 34994
888-422-2139 - Behavioral Health of the Palm Beaches
7859 Lake Worth Rd
Lake Worth, FL 33467
888-432-2467 - Banyan Heartland
1237 E 1600 North Rd
Gilman, IL 60938
877-973-7262 - Banyan Chicago
2525 Cabot Drive, Suite 300
Lisle, IL 60532
888-245-0974 - Banyan Delaware
21 W Clarke Ave, #4001
Milford, DE 19963
888-900-9681
Coverage varies by Carelon plan and state. Insurance verification is required to confirm eligibility and benefits.
Verify Your Carelon Coverage for Treatment
The specific details of the coverage vary depending on the insurance plan and the medical necessity of the care. Banyan Treatment Center is here to assist you in learning more about your Carelon insurance benefits and the types of addiction and mental health care that may be most effective for you.
Banyan Facilities for Drug, Alcohol, & Mental Health Treatment
Banyan Castle Rock
Located in Castle Rock, CO
Substance Use Inpatient
Mental Health Inpatient
Telehealth Virtual IOP
Banyan Heartland
Located in Gilman, IL
Substance Use Inpatient
Mental Health Inpatient
Substance Use Outpatient
Telehealth Virtual IOP
Banyan Palm Springs
Located in Cathedral City, CA
Substance Use Inpatient
Telehealth Virtual IOP
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