Carelon Drug and Alcohol Rehab Treatment Coverage

What's on this page?

Serenity at Summit is a leading provider of drug and alcohol addiction rehab and mental health treatment services with facilities in Massachusetts and New Jersey. With a solid commitment to helping individuals overcome the challenges of addiction and improve their mental well-being, our centers offer a serene and supportive environment for your or your loved one’s recovery.

We understand that access to quality treatment is essential, so we accept various health insurance plans to make our services more accessible to those in need. In addition, we may also take your Carelon Behavioral Health policy. We encourage you to call (844) 326-4514 to inquire about your insurance coverage levels and explore the treatment options available to you or your loved ones. Our dedicated team is here to provide the guidance and support necessary to begin the journey towards a brighter, healthier future.

Who is Carelon Behavioral Health?

Carelon Behavioral Health was established by a major healthcare organization in the U.S. Previously known as Beacon Health Options, Carelon is responsible for managing and delivering behavioral health services to health plans, employers, federal, state, and local governments, as well as labor organizations. They currently serve more than 47 million clients, including Fortune 500 companies.¹

The company’s mission is to eliminate the barriers to complete health by connecting the healthcare system with the help of expertise, data, and advanced technology, making healthcare more personalized, accessible, and affordable to everyone. The health solutions offered by Carelon focus on the mind, body, and spirit and aim to address disparities in behavioral health.²

Carelon Behavioral Health is a network of behavioral health specialists providing mental health support and behavioral health services. They work with therapists, counselors, and treatment facilities to offer tailored solutions to their clients. Carelon strongly emphasizes monitoring and improving the quality of behavioral healthcare services, measuring outcomes, and ensuring effective, evidence-based care. The company is also involved in mental health advocacy efforts and provides educational resources to its clients and the public.³

Some of Carelon Brands, Products, and Services

Carelon Behavioral Health provides a broad spectrum of offerings, encompassing pharmacy, behavioral health, complex care delivery, medical benefits management, payment integrity, palliative care, advocacy, research, digital platforms, and operations and technology services. Within this diverse range of brands, products, and services, you can find the following: 

Carelon Brands 

  • CarelonRx: Formerly Ingenio Rx, this pharmacy benefit manager provides prescription drug benefits to health plans and employers and manages a network of over 60,000 pharmacies, dispensing over 1 billion prescriptions annually.4
  • Beacon Health Options: Now called Carelon Behavioral Health, this provider of behavioral health services offers a comprehensive range of treatments such as individual therapy, group therapy, family therapy, and medication management. With its vast network of over 200,000 providers, the company caters to more than 40 million individuals.
  • Carelon Post Acute Solutions: Formerly myNEXUS, this home healthcare provider offers various services, including nursing care, physical therapy, occupational therapy, and speech therapy, serving over 200,000 patients annually through its network of over 10,000 providers.5

Carelon Products and Services

  • Behavioral health services: Carelon offers behavioral health services through its broad network of licensed clinicians.
  • Carelon Well-being: Employee Assistance Programs (EAPs) offer counseling, digital tools, and educational resources to enhance work-life balance and wellness.
  • Medical benefits management services: Carelon provides medical benefits management services, including claims processing, network management, and utilization review, to health plans and employers.6
  • Palliative care services: Carelon offers palliative care services to patients and their families suffering from chronic or life-limiting illnesses, focusing on providing comfort and support.7
  • Advocacy services: Patients and their families can receive advocacy services from Carelon to navigate the healthcare system and access necessary care.8
  • Digital Platforms: Digital tools and data-driven insights for healthcare providers and members, ensuring transparency, connection, and affordability.9

What is Carelon Rehab Coverage?

Carelon focuses primarily on managing and coordinating behavioral health services, encompassing mental health and substance abuse treatment, rather than offering traditional insurance coverage for rehabilitation services. Rehab coverage, however, includes a wide range of services and programs related to the treatment of substance use and mental health conditions, including but not limited to outpatient care, counseling, and medication-assisted treatment (MAT).

Review your policy documents for a more comprehensive understanding of your rehabilitation coverage through Carelon Behavioral Health. Our team is here to assist you in clarifying the extent of your Carelon rehab coverage and ensuring you have access to the necessary resources for your specific treatment needs.

Check Your Insurance Coverage

Does Carelon Cover Rehab?

Carelon provides coverage for drug and alcohol rehab services. Carelon’s comprehensive behavioral health services include support for substance abuse treatment, encompassing detoxification, inpatient care, outpatient rehabilitation, counseling, and more.10 Reviewing your specific plan to understand the extent of your coverage and any associated co-pays or deductibles is essential.

Contact your insurance provider about Carelon alcohol rehab or Carelon drug rehab for detailed information tailored to your needs. You can also contact us for additional information.

Does Carelon Cover Medical Detox Treatment?

Carelon typically covers medical detox treatment as part of its behavioral health services. Medical detoxification is a critical component of substance abuse treatment, as it helps individuals safely withdraw from addictive substances while under medical supervision. The coverage details vary from plan to plan, so review your policy or contact Carelon directly for a comprehensive understanding of your coverage.

You can also check your insurance with us. One of our helpful staff members will get back to you with all the details as soon as possible.

Does Carelon Cover Residential Treatment?

Carelon usually includes coverage for residential treatment, catering to those in need of assistance with substance abuse and mental health issues. Residential programs offer a structured, supportive environment for individuals to access intensive 24/7 therapy and care.  The extent of your residential treatment coverage can differ based on your specific plan and other factors.

We recommend reviewing your policy details or calling (844) 326-4514 for a comprehensive understanding of your coverage. Your path to recovery is our priority, and we’re committed to providing the necessary support.

Does Carelon Cover Mental Health Therapy Treatment?

Carelon Behavioral Health typically provides mental health therapy treatment coverage within its comprehensive suite of behavioral health services. These services encompass various therapeutic approaches such as counseling, cognitive-behavioral therapy (CBT), motivational interviewing, and more designed to address mental health challenges.

Nevertheless, it’s essential to note that the specifics of your coverage vary depending on your individual policy and additional factors. Your mental well-being is of utmost importance, and we’re dedicated to supporting your journey toward improved mental health.

Check Your Insurance by Phone

Call Now: (844) 326-4514

Does Carelon Cover EMDR Therapy?

Carelon Behavioral Health may cover Eye Movement Desensitization and Reprocessing (EMDR) therapy as part of its behavioral health services. EMDR is an evidence-based therapy often used to treat conditions such as post-traumatic stress disorder (PTSD), anxiety, and other mental health challenges. However, the specific coverage for EMDR therapy can vary depending on your plan and other factors.

To understand the extent of your coverage, it’s recommended to review your policy details, reach out to Carelon directly, or contact us.

Other Rehab Treatment Programs Covered by Carelon

Understanding your insurance coverage details for various treatment programs is essential to ensure you or your loved one receives the appropriate level of care. Call (844) 326-4514 for a clear understanding of your specific coverage and the treatment options available. Your well-being is a priority; we support your journey toward better mental health, recovery, and sobriety.

Coverage for Partial Hospitalization Programs

Carelon typically covers Partial Hospitalization Programs (PHPs) – intensive, structured treatment programs ideal for comprehensive care but not round-the-clock inpatient supervision. PHPs offer therapy, medical monitoring, and support, usually for several hours a day, providing flexibility while addressing mental health and substance use issues.

PHPs play a pivotal role in addressing a range of mental health conditions, such as depression, anxiety, and substance use disorders. They often involve individual and group therapy sessions, medication management, and educational components that equip individuals with coping strategies and life skills. This blend of comprehensive care and flexibility can be a crucial factor in promoting recovery, as it enables participants to apply newly acquired skills in real-life situations while receiving vital therapeutic support.

Coverage for Intensive Outpatient Programs

Carelon typically provides coverage for Intensive Outpatient Programs (IOPs), which offer a step-down level of care for individuals in need of ongoing support for mental health and substance abuse treatment. IOPs involve regular therapy sessions, group therapy, and counseling, allowing individuals to maintain their daily routines while receiving crucial treatment.

Coverage for Acute Treatment Programs

Carelon frequently extends its coverage to encompass acute treatment programs designed to address immediate and severe mental health issues. These programs provide a vital lifeline during crises with intensive, short-term care that ensures prompt and appropriate treatment. This level of care is crucial for individuals facing acute mental health challenges, as it helps stabilize their conditions and prevent further deterioration.

Coverage for Inpatient Rehab

Inpatient rehabilitation is a comprehensive treatment program consisting of round-the-clock care for severe mental health or substance abuse issues. This program involves staying in a specialized facility and receiving constant monitoring, therapy, and medical support in a highly structured environment. This level of care is particularly beneficial for those facing significant challenges and need a safe, focused space for recovery.

Carelon usually covers inpatient rehab. By covering inpatient rehab, Carelon ensures that individuals have access to the intensive care, support, and aftercare needed to begin their path to recovery.

Check Your Insurance Coverage

Rehab Center in Massachusetts That Takes Carelon

At Serenity at Summit, we’re fully committed to helping you through every step of your recovery, from the initial detoxification phase to outpatient care. We believe in a holistic approach to achieving lasting sobriety and better mental health. Our state-of-the-art facility provides a peaceful, private environment for rehabilitation from drug abuse, alcoholism, and more, using advanced practices and evidence-based methods.

Moreover, we may be able to accommodate your Carelon Behavioral Health insurance policy. To begin your transformation journey, please visit our nationally recognized treatment center at the address below or call (844) 326-4514.

Rehab Center in NJ That Takes Carelon

Our Union, New Jersey, facility provides many treatment options, including detoxification and outpatient care. We believe in delivering customized services to each patient, keeping the staff-to-client ratios low, and having a team of highly qualified master’s level therapists. Our rehabilitation programs are comprehensive and designed to cater to the unique needs of our patients.

For more information or to inquire about our New Jersey rehabilitation center that accepts insurance, call (844) 326-4514 or visit us:

How Much is Rehab with Carelon Insurance?

Rehabilitation costs vary based on many factors, including your particular policy. Psychotherapy sessions typically range from $100 to $200 per hour for those without insurance.11 In New Jersey, outpatient rehab averages around $1,701, while in Massachusetts, it’s about $1,703.12 Keep in mind that individual circumstances and treatment facility choices, among other factors, can lead to significant variations in actual expenses.

Review your policy documents and contact us. We can assist you with accessing the details of your health insurance coverage and the appropriate steps for treatment.

How To Check Carelon Coverage Levels for Rehab Treatment

At Serenity at Summit, we understand that the intricacies of health insurance can be overwhelming. That’s why our goal is to help you verify your insurance information. Our team is fully committed to protecting your rights and ensuring you receive the best possible care, prepared to guide you through every step of this process.

When you contact us, you can trust that any information you provide to us will be handled with the utmost confidentiality. We will verify your rehab insurance, leaving you free to focus on your journey toward recovery.

How To Get Carelon to Pay for Rehab

Contact us or your provider to verify your insurance coverage to navigate the process of having Carelon cover rehab treatment costs. We will provide you with essential information regarding the specifics of your plan, including any deductibles, co-pays, and rehab centers that take Carelon. Understanding your policy is critical to making informed decisions about your treatment options.

Next, work closely with your chosen treatment center to coordinate the process. They can help you with the necessary paperwork, such as pre-authorization, to ensure that your rehab treatment aligns with your insurance plan’s requirements. Open communication with your insurance provider and the treatment facility is key to a smoother, more efficient coverage process. Following these steps and staying informed can increase your chances of having Carelon pay for your rehab treatment.

Check Your Insurance by Phone

Call Now: (844) 326-4514

How Many Times Will Carelon Pay for Rehab?

The extent and number of times Carelon Behavioral Health will pay for rehab depends on various factors, such as your healthcare plan and the medical necessity determined by healthcare professionals. When making decisions, it’s essential to consider factors like the nature of the mental health or substance abuse condition under treatment and the duration of the treatment.

Typically, insurance plans cover rehab treatment costs if a healthcare professional deems it medically necessary and appropriate. However, there may be limitations or exclusions on the number of days or sessions covered within a specific time frame in line with medical guidelines and industry standards.

Addiction Statistics in Massachusetts

  • There are 17,975 homeless people in Massachusetts, with 1 in 5 living with a serious mental illness.13
  • The estimated prevalence of Opioid Use Disorder (OUD) in Massachusetts among individuals aged 11 or older increased from 2.72% in 2011-2012 to 4.60% in 2015.14
  • As per the 2020 National Drug Threat Assessment, Massachusetts documented the fourth-highest incidence of fentanyl cases in the United States during the year 2019.15
  • In 2022, heroin/fentanyl and alcohol were the most common reasons for substance abuse treatment across all demographics in Massachusetts.16
  • More than 25% of the Massachusetts population has experienced the loss of someone due to opioid overdose.17

Addiction Statistics in New Jersey

  • The primary reason for seeking inpatient care in New Jersey is related to opioid maintenance and detoxification. Patients receive medication such as methadone to manage withdrawal symptoms.18
  • In 2019, a report on substance abuse in New Jersey found that heroin, other opiates, cocaine, and marijuana were the most commonly abused illicit drugs.19
  • About 6.1% of all New Jersey residents reported that they faced some type of substance use disorder (SUD).20
  • From 2016 to 2021, approximately 312,000 people in New Jersey received treatment for substance abuse.21
  • In 2019, treatment admissions in New Jersey were primarily driven by heroin, constituting 42% of admissions, with alcohol closely following at 31%.22

Sources

  1. “About Us.” Carelon Behavioral Health, www.carelonbehavioralhealth.com/about-us. Accessed 8 Nov. 2023.
  2. “Carelon Health | Whole-Person Care.” www.carelonhealth.com, www.carelonhealth.com.
  3. “1.3 Carelon Beh Care.” www.carelonbehavioralhealth.com, www.carelonbehavioralhealth.com/solutions/carelon-behavioral-care.
  4. “CarelonRx | PBM and Home Delivery Pharmacy (IngenioRx).” www.carelonrx.com, www.carelonrx.com. Accessed 8 Nov. 2023.
  5. “Post Acute Care.” Careloninsights.com, www.careloninsights.com/medical-benefits-management/post-acute-care. Accessed 8 Nov. 2023.
  6. “Medical Benefits Management.” Carelon.com, www.carelon.com/capabilities/medical-benefits-management. Accessed 8 Nov. 2023.
  7. “Palliative Care.” Carelon.com, www.carelon.com/capabilities/palliative-care. Accessed 8 Nov. 2023.
  8. “Advocacy.” Carelon.com, www.carelon.com/capabilities/advocacy. Accessed 8 Nov. 2023.
  9. “Carelon Digital Platforms.” Carelon.com, www.carelondigitalplatforms.com. Accessed 8 Nov. 2023.
  10.  “Behavioral Health.” Carelon, www.carelon.com/capabilities/behavioral-health. Accessed 8 Nov. 2023.
  11. Lauretta, Ashley. “How Much Does Therapy Cost in 2023?” Forbes Health, 14 Apr. 2023, www.forbes.com/health/mind/how-much-does-therapy-cost.
  12. Stilkind, Joseph. “Average Cost of Drug Rehab [2023]: By Type, State and More.” NCDAS, 1 Jan. 2023, drugabusestatistics.org/cost-of-rehab.
  13. “Mental Health in Massachusetts.” National Alliance on Mental Illness (NAMI), Feb. 2021, www.nami.org/NAMI/media/NAMI-Media/StateFactSheets/MassachusettsStateFactSheet.pdf.
  14. Barocas, Joshua A., et al. “Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011–2015: A Capture–Recapture Analysis.” American Journal of Public Health, vol. 108, no. 12, American Public Health Association, Dec. 2018, pp. 1675–81. https://doi.org/10.2105/ajph.2018.304673.
  15. U.S. Department of Justice. “2020 DEA National Drug Threat Assessment.” Drug Enforcement Administration, Mar. 2021, www.dea.gov/sites/default/files/2021-02/DIR-008-21%202020%20National%20Drug%20Threat%20Assessment_WEB.pdf.
  16. Commonwealth of Massachusetts. “Data on Enrollments in Substance Addiction Services.” Mass.gov, www.mass.gov/info-details/data-on-enrollments-in-substance-addiction-services. Accessed 20 Oct. 2023.
  17. Crowe, Jack. “Poll: More Than One in Four Massachusetts Residents Have Lost Friend or Loved One to Opioid Overdose.” National Review, 12 Mar. 2018, www.nationalreview.com/2018/03/opioid-crisis-massachusetts-25-percent-overdose-victim.
  18. “New Jersey Drug and Alcohol Abuse Treatment: Substance Abuse Overview 2021 Statewide.” New Jersey Department of Human Services Division of Mental Health and Addiction Services, July 2022, www.nj.gov/humanservices/dmhas/publications/statistical/Substance%20Abuse%20Overview/2021/statewide.pdf.
  19.  “New Jersey Drug and Alcohol Abuse Treatment: Substance Abuse Overview 2019 Statewide.” New Jersey Department of Human Services Division of Mental Health and Addiction Services, Oct. 2020, www.nj.gov/humanservices/dmhas/publications/statistical/Substance%20Abuse%20Overview/2019/Substance%20Abuse%20Overview%20Statewide%20Report%20-%20%202019.pdf.
  20. “Behavioral Health Barometer: New Jersey, Volume 6.” Substance Abuse and Mental Health Services Administration (SAMHSA), 2020, www.samhsa.gov/data/sites/default/files/reports/rpt32847/NewJersey-BH-Barometer_Volume6.pdf.
  21. “New Jersey Drug and Alcohol Abuse Treatment: Substance Abuse Overview 2021 Statewide.” New Jersey Department of Human Services, July 2022, www.nj.gov/humanservices/dmhas/publications/statistical/Substance%20Abuse%20Overview/2021/statewide.pdf.
  22. “New Jersey Drug and Alcohol Abuse Treatment: Substance Abuse Overview 2019 Statewide.” New Jersey Department of Human Services, Oct. 2020, www.nj.gov/humanservices/dmhas/publications/statistical/Substance%20Abuse%20Overview/2019/Substance%20Abuse%20Overview%20Statewide%20Report%20-%20%202019.pdf.

Related Carelon Pages

Related Rehab Insurance Pages

Tap to GET HELP NOW: (844) 326-4514