Carelon Behavioral Health (formerly Beacon Health Options) Coverage for Drug and Alcohol Rehab

Does Carelon Insurance (formerly Beacon Health Options) Cover Drug and Alcohol Rehab?

Carelon Behavioral Health (Beacon) coverage for the treatment of substance use disorders varies by plan. Carelon is an in-network insurance provider at several American Addiction Centers facilities, including Laguna Treatment Center in Southern California, Desert Hope Treatment Center in Las Vegas, and River Oaks Treatment Center near Tampa, FL. Call one of our admissions advisors at or fill in our online verification form below to find out if your insurance plan may cover all or part of the cost of rehab.

Types of Addictions Treatment Carelon (Beacon) Typically Covers

Carelon  usually covers most types of addictions, including:

• Alcohol.
• Prescription opioids.
• Heroin.
• Cocaine.
• Methamphetamine.
• Marijuana.
• Benzodiazepines, such as Xanax and Valium.

Carelon (Beacon) offers a diverse array of substance use treatment programs designed to address various addictions. Recognizing that each individual’s journey is unique, these programs are tailored to meet specific needs and circumstances. The level of treatment intensity you may require is carefully determined based on a comprehensive assessment of your personal situation, including factors such as the type and severity of addiction, co-occurring mental health issues, and your support system. By providing a personalized approach, Carelon aims to ensure that each individual receives the most effective support on their path to recovery.

Types of Addiction Treatment Options Carelon (Beacon) Typically Covers

Types of programs Carelon may cover include:

• Residential and inpatient rehab, where you live at the treatment center and participate in a recovery program that may include individual and group therapy, 12-step meetings, and other group activities such as outdoor recreation. Inpatient programs may also offer medically supervised detox.
• Partial hospitalization, which meets several days a week, usually during the day, and involves treatment similar to a residential program. However, unlike inpatient services, you can go home or to a sober living environment in the evening.
• Intensive outpatient, which typically occurs for several days a week for a few hours at a time. This format provides treatment and support for those struggling with addiction who do not need a more restrictive environment. It usually consists of group therapy but may also include individual therapy. Participants may be able to continue attending work or school. American Addiction Centers provides room and board to clients from out of town who participate in its intensive outpatient and partial hospitalization programs.
• Outpatient treatment varies in its intensity and can occur at a range of frequencies, although typically less often than intensive outpatient.

Many people want to know which type of treatment they require for treating their substance use problem. There are many factors involved in determining your treatment needs, including:³

• Potential for withdrawal.
• General physical health.
• Overall psychological health.
• Readiness to change.
• Potential for continued use, relapse, or other continued problems.
• Environment.

A thorough assessment by a mental health professional can help determine what level of care you need.

Will My Employer Find Out?

Substance use disorder treatment providers, including American Addiction Centers, are required by law to keep your protected health information private. Information that’s protected includes any identifying information about you that is related to your physical or mental conditions, treatment you received, or your payment for services. In most cases, the information can only be released if you give written consent for the provider to release it.

Providers are only allowed to disclose information without your permission when certain conditions exist. Some of these conditions include:

• If you experience an emergency and your information is needed to facilitate care.
• If you have committed (or have threatened to commit) a crime on the treatment center property or against a treatment center employee and your information is needed by law enforcement.
• If the information is relevant to a suspected case of child abuse or neglect and is required by law to be reported.
• If a court order requires it.
• If the information is disclosed for research, an audit of a program, or for a program evaluation.

Read more about confidentiality of rehab treatment.

What Does Carelon Behavioral Health (Beacon) Specifically Pay For?

Carelon (Beacon) insurance plans typically provide coverage for a range of essential services that are integral to the treatment of substance use disorders. These services often include:

Comprehensive Assessment

This initial step involves a thorough evaluation by healthcare professionals to determine the severity of the substance use disorder and identify any co-occurring mental health issues. The assessment is designed to tailor treatment plans to individual needs.

Detox Services

Often referred to as detox, this process involves medical supervision for individuals undergoing withdrawal from substances. The focus is on safely managing withdrawal symptoms and preparing patients for ongoing treatment.

Medications and Medication-Assisted Treatment (MAT)

Coverage may include prescribed medications that help reduce cravings and withdrawal symptoms, thereby supporting recovery. MAT is often used in combination with counseling and behavioral therapies to enhance overall treatment effectiveness.

Therapeutic Services

Various forms of therapy typically covered may include individual counseling, group therapy, and family therapy. These interventions aim to address the psychological aspects of addiction and develop coping strategies for a healthier lifestyle.

Inpatient/Residential Treatment

If a higher level of care is needed, Carelon plans may cover the costs associated with inpatient or residential treatment facilities. These comprehensive programs provide a structured environment for individuals to focus on recovery.

Treatment for Co-Occurring Disorders

Individuals with substance use disorders often experience mental health conditions simultaneously. Coverage may extend to specialized treatment programs that adequately address both substance use and mental health issues, ensuring a holistic approach to recovery.

It is important to note that coverage specifics, including limits on the types of services and the duration of care, can vary significantly based on the individual plan. Always check the details of your specific coverage to understand what treatments and services are included.

How Much Will I Pay Out of Pocket?

The out-of-pocket costs to you will vary depending on your plan.

Your plan may have deductibles, copays, coinsurance, or a combination of these.

• A deductible is the amount you must pay for covered services before Carelon begins to pay any expenses.⁴
• A copay is a set amount that you pay for a covered service after you’ve met your deductible, though you may pay copays before you’ve met the deductible.⁵
• Coinsurance is the percentage of a covered service you pay after you’ve met the deductible, though you may pay coinsurance after you’ve met the deductible.⁶

You may also need to get a pre-authorization before you receive treatment. A pre-authorization is when your insurer makes a decision that a service, treatment plan, equipment, or medication is medically necessary. A pre-authorization is not a guarantee that your insurer will cover the service.⁷

What if the Provider Is Out of Network?

The coverage policies for out-of-network healthcare providers can differ significantly from those for in-network providers. Typically, insurance plans require patients to use in-network providers to enjoy lower out-of-pocket costs. If you choose to receive care from an out-of-network provider, you may encounter several financial implications, such as a higher deductible, increased copayments or coinsurance, or in some instances, you might be responsible for covering the entire bill without any insurance reimbursement.

If you decide to seek treatment with an out-of-network provider, it’s important to note that many providers offer flexible payment options. For instance, they may allow you to establish a payment plan that divides your total bill into manageable monthly installments. This can help you budget for healthcare expenses more effectively, ensuring you can receive the necessary treatment while gradually settling the outstanding amount over time.

How Do I Get Started?

The first step is to confirm your insurance benefits. One of our admissions navigators can verify your benefits for substance use treatment and help you determine a good place for you to obtain treatment based on your coverage and individual needs. You can contact them 24/7 at .