Carelon for Addiction Treatment at 12 South Recovery

12 South Recovery, we believe that financial struggles shouldn’t prevent anyone from accessing the addiction treatment they desperately need. We accept Carelon insurance, a specialized behavioral health insurance provider that offers substantial coverage for substance abuse treatment. Our experienced admissions team works to verify your benefits, navigate the authorization process, and maximize your coverage for our evidence-based programs. Many Carelon plans cover multiple levels of care, from medically supervised detox through residential treatment to outpatient services, giving our clients the comprehensive support needed throughout their recovery journey. We’re committed to transparency about costs and coverage, ensuring you understand exactly what your Carelon plan covers before beginning treatment at our facility, so you can focus entirely on what matters most: your healing and recovery.

Carelon Behavioral Health is a third-party administrator (TPA) that manages behavioral health benefits for various insurance plans, including those available to ILWU members. They coordinate mental health and substance use treatment services within a network of approved providers. They are one of the largest behavioral health insurance providers in the US, specializing in mental health and substance abuse disorder coverage.

Unlike general health insurers that treat addiction as a secondary concern, Carelon focuses specifically on behavioral health needs. They manage benefits for over 40 million Americans through employer-sponsored plans, Medicaid, Medicare, and federal programs. With 40+ years of experience, Carelon prioritizes individualized treatments, living situations, and physical wellness because they believe that no treatment is a one-size-fits-all.

Yes, Carelon covers addiction treatment, but coverage varies by plan. Most Carelon plans include substance use disorder treatment as an essential health benefit. They typically cover evidence-based treatments for alcohol, opioid, stimulant, and other substance abuse disorders. Many of their plans have actually expanded coverage for addiction services in recent years, recognizing the growing need for accessible treatment.

Carelon typically covers a comprehensive range of addiction services:

• Medical detoxification: Supervised withdrawal management with medication to ease symptoms
• Inpatient/residential treatment: 24-hour structured treatment in a live-in setting
• Partial hospitalization (PHP): Intensive daytime treatment while living at home
• Intensive outpatient programs (IOP): Several hours of treatment multiple days per week
• Standard outpatient care: Individual therapy, group counseling, and medication management
• Medication-assisted treatment (MAT): FDA-approved medications like Suboxone, methadone, or naltrexone
• Dual diagnosis treatment: Integrated care for co-occurring mental health and substance use disorders

The requirements for coverage vary depending on the specific plan that you have. In general, Carelon requires that addiction treatment is medically necessary and provided by a licensed healthcare provider. They may also require pre-authorization for certain services, such as inpatient rehab. It’s essential to review your specific plan’s details to understand what is and isn’t covered.

The amount that Carelon will cover for addiction treatment depends on your specific plan’s coverage and benefits. In general, Carelon will cover a percentage of the cost of addiction treatment, and you’ll be responsible for the remaining cost. The percentage of coverage will vary depending on your plan’s specific details.

Getting help for addiction can feel overwhelming but with Carelon Behavioral Health, the process is designed to support you every step of the way.

The first step is to reach out to a treatment center or healthcare provider, like 12 South Recovery. From there, the team will help assess your situation and determine if treatment is medically necessary which is a key requirement for insurance coverage through Carelon.

If treatment is recommended, the provider will handle the next step: submitting a pre-authorization request to Carelon Behavioral Health. This simply means that Carelon reviews the clinical information and confirms that the treatment is appropriate based on your health needs and insurance plan.

Once that pre-authorization is approved, you’re cleared to begin treatment. Whether it’s detox, residential care, outpatient therapy, or dual diagnosis treatment, everything is coordinated to minimize delays and reduce stress so you can focus on healing.

At 12 South Recovery, we make this process as easy and stress-free as possible. From verifying your benefits to advocating for your care, we’re here to help you take the first step toward recovery with confidence and support.

12 South Recovery is an Orange County-based addiction treatment center that accepts Carelon. We offer comprehensive addiction treatment services, including detoxification, inpatient rehab, outpatient rehab, medication-assisted treatment, and aftercare. Our licensed healthcare providers work with Carelon to ensure that our patients receive the care they need while maximizing their insurance benefits.

Don’t let financial concerns keep you from getting the help you need. At 12 South Recovery, we’re committed to making treatment accessible and affordable. Our experienced admissions team is standing by to verify your Carelon benefits and answer any questions you have about coverage. Call 12 South Recovery Today for more information or to get started with treatment. Your journey to recovery can begin right now!