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 Hospital 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:
- Prescription opioids.
- Benzodiazepines, such as Xanax and Valium.
Many Carelon (Beacon) substance use programs are available to treat these addictions. No two people are the same, and the appropriate intensity of treatment depends on your situation as well as your needs.
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.
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.
What Does Carelon Behavioral Health (Beacon) Specifically Pay For?
Carelon (Beacon) plans may cover the following services, which are common parts of substance use disorder treatment:
- Medications and MAT.
- The overall cost of an inpatient/residential stay.
- Co-Occurring Disorder Treatment.
Again, the limits of coverage and types of coverage depend on the specifics included in your plan.
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?
Coverage for out-of-network providers varies. In many cases, you must go to an in-network provider, or you may have to pay a higher deductible and copay/coinsurance or even the entire cost.
If you are seeking treatment with an out-of-network provider, the provider may be able to set up a payment plan where you pay a set amount each month until the bill is paid off.
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 .
About Carelon Behavioral Health (formerly Beacon Health Options)
Carelon Behavioral Health (Beacon) offers behavioral health solutions to health plans; employers; federal, state, and local governments; and labor organizations. It serves more than 40 million people and has more than 260 clients, including Fortune 500 companies.1,2
- Bloomberg. Company Overview of Beacon Health Options.
- Carelon (Beacon Health Options). (2019). Our values.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine (Sixth ed.). Philadelphia: Wolters Kluwer.
- Healthcare.gov. (n.a.). Deductible.
- Healthcare.gov. (n.a.). Copayment.
- Healthcare.gov. (n.a.). Coinsurance.
- Healthcare.gov. (n.a.). Preauthorization.