Find Alcohol & Drug Rehabs that Accept Carelon Behavioral Health Insurance

Carelon’s focus is on evidence-based, clinically appropriate treatment. It uses its national provider network to deliver:

• Streamlined access to licensed rehab facilities
• Lower out-of-pocket expenses when using in-network providers
• Quality oversight of behavioral health programs
• Coordination of mental health and addiction services

This framework allows members to access a complete continuum of care, from initial assessment through long-term aftercare.

Coverage varies by plan, but Carelon-managed benefits often include the following treatment services when medically necessary:

1. Comprehensive Assessments & Diagnoses

Coverage typically includes:

• Substance use screenings
• Psychiatric evaluations
• ASAM level-of-care assessments
• Medical necessity reviews
• Treatment planning

These assessments are often required before accessing higher levels of care.

2. Medically Supervised Detoxification

Detox is covered for individuals facing dangerous or medically complicated withdrawal from:

• Alcohol
• Opioids
• Benzodiazepines
• Stimulants
• Polysubstance dependence

Carelon may cover both inpatient and outpatient detox services, depending on clinical need.

3. Inpatient & Residential Rehab Programs

These programs provide intensive, 24-hour addiction care and may include:

• Medical monitoring
• Individual behavioral therapy
• Trauma-informed therapy
• Group counseling
• Family therapy
• Medication management
• Relapse-prevention planning

Residential treatment is usually authorized when outpatient services are not sufficient.

4. Partial Hospitalization Programs (PHP)

PHP is often approved as a step-down level of care or an alternative to inpatient treatment.

These programs may include:

• Daily treatment sessions
• Psychiatric suppor
• Medication management
• Structured therapy environments

Carelon generally requires documentation demonstrating clinical need for PHP.

5. Intensive Outpatient Programs (IOP)

IOPs offer structured treatment while allowing individuals to continue living at home.

Services may include:

• Group therapy
• Individual sessions
• Coping-skill development
• Relapse-prevention training
• Case management

IOP is commonly used for individuals transitioning down from higher levels of care.

6. Traditional Outpatient Therapy

Outpatient benefits may include:

• Weekly counseling
• Psychiatric follow-ups
• Medication maintenance
• Relapse-prevention planning
• Dual-diagnosis support

This is the lowest level of care and is usually covered with minimal restrictions.

7. Medication-Assisted Treatment (MAT)

Carelon Behavioral Health may cover:

• Suboxone / buprenorphine
• Methadone (through licensed opioid treatment programs)
• Naltrexone / Vivitrol
• Alcohol anti-craving medications

MAT coverage varies by state and insurance plan.

8. Dual-Diagnosis Integrated Treatment

Many Carelon-approved rehabs treat both SUD and mental health conditions such as:

• PTSD
• Anxiety disorders
• Depression
• Bipolar disorder
• Personality disorders
• Trauma-related conditions

Dual-diagnosis treatment is often required for individuals with complex behavioral health needs.

Substance Use Disorders

Programs accepting Carelon typically treat:

• Alcohol addiction
• Opioid use disorder
• Cocaine and methamphetamine addiction
• Benzodiazepine dependence
• Prescription drug misuse
• Marijuana dependence
• Polysubstance abuse

Mental Health Disorders (Co-Occurring)

Carelon facilities may also treat:

• Major depression
• Generalized anxiety disorder
• PTSD and trauma
• Bipolar disorder
• OCD
• ADHD
• Mood or personality disorders

Specialized Population Needs

Many Carelon facilities also accommodate:

• Teens and young adults
• Veterans
• Individuals with chronic mental illness
• Pregnant women (detox & MAT availability varies)

Better Addiction Care helps identify facilities that match each client’s specific needs.

Coverage depends on several criteria:

1. Medical Necessity

Carelon uses clinical guidelines such as ASAM criteria to determine:

• Appropriate level of care
• Required treatment duration
• Step-down or step-up needs

2. In-Network Provider Requirements

Members receive the best coverage when using:

• Carelon-contracted rehab centers
• Facilities participating in the plan’s behavioral health network
• Out-of-network coverage varies by plan.

3. Prior Authorization

Higher levels of care often require Carelon approval, including:

• Detox
• Inpatient rehab
• Residential treatment
• PHP
• Some IOP programs

Outpatient services may not require authorization.

4. Plan Type

Coverage differs depending on whether your plan is:

• Medicaid (Carelon manages many state Medicaid BH programs)
• Medicare Advantage
• Commercial PPO/HMO
• Employer-sponsored plan

We help clients navigate these differences.

Your out-of-pocket costs under Carelon depend on:

• In-network vs. out-of-network status
• Plan type (HMO, PPO, Medicaid, commercial)
• Deductibles, copays, and coinsurance
• Authorization requirements
• Treatment intensity and duration

In-network rehabs almost always provide lower costs compared to out-of-network facilities.

Step 1 — Review your insurance card

It may list:

• “Carelon Behavioral Health”
• “Managed by Carelon”
• “Behavioral Health: Carelon/Beacon”

Step 2 — Call your insurance plan

Ask:

• “Is Carelon managing my behavioral health benefits?”
• “Which addiction treatment services are covered?”
• “Which rehab centers are in-network?”
• “Do I need prior authorization?"

Step 3 — Confirm with the treatment center

Ask whether they:

• Accept Carelon
• Are in-network with your plan
• Handle insurance verification directly

Step 4 — Contact Better Addiction Care

We help you:

• Find rehabs that accept Carelon
• Verify your benefits
• Understand your expected costs
• Navigate pre-authorizations
• Secure placement quickly

Better Addiction Care does not manage Carelon benefits; instead, we:

• Connect clients with Carelon-approved treatment centers
• Identify detox, rehab, PHP, IOP, and MAT programs that accept this coverage
• Provide guidance on benefit verification
• Coordinate with admissions teams
• Help patients understand their treatment options

We streamline the process so you can focus on recovery.