Anthem / Elevance Health Mental Health Coverage Guide

Does Anthem Cover Therapy?

Yes, Anthem covers therapy. Operating under parent company Elevance Health (formerly Wellpoint), Anthem is the second-largest health insurer in the United States, serving approximately 47 million members. Anthem operates Blue Cross Blue Shield plans in 14 states and uses Carelon Behavioral Health (formerly Beacon Health Options) to manage mental health services. Under the Mental Health Parity and Addiction Equity Act, Anthem is required to cover mental health services at the same level as medical and surgical benefits.

Anthem plans typically cover a full range of outpatient mental health services, including individual therapy, group therapy, family therapy, psychiatric evaluations, and medication management. Because Anthem operates BCBS plans, members also benefit from the BlueCard program, which allows access to in-network providers across state lines.

If you are exploring therapy for the first time, our therapy for beginners guide can help you understand what the process involves.

Types of Therapy Covered by Anthem

Anthem covers comprehensive mental health services when delivered by a licensed provider:

• Individual therapy — one-on-one sessions billed under CPT codes 90834 (45 minutes) or 90837 (60 minutes)
• Group therapy — sessions with multiple participants led by a licensed therapist (CPT 90853)
• Family therapy — sessions involving family members with a diagnosed patient present (CPT 90847)
• Psychiatric evaluation — initial diagnostic assessment (CPT 90791)
• Medication management — ongoing psychiatric medication monitoring
• Substance use treatment — outpatient and intensive treatment for substance use disorders

Evidence-based approaches covered include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), EMDR, acceptance and commitment therapy (ACT), and exposure and response prevention (ERP).

Anthem provides coverage for a wide range of conditions including anxiety, depression, PTSD, OCD, bipolar disorder, eating disorders, ADHD, trauma, panic disorder, and addiction.

In-Network vs. Out-of-Network Coverage

Your out-of-pocket costs with Anthem depend on whether you see an in-network or out-of-network provider.

In-Network Therapists

Anthem's behavioral health network, managed through Carelon, includes a wide range of providers:

• Lower copays — typically $20 to $50 per session
• Negotiated rates — Carelon has pre-arranged fees with in-network providers
• No balance billing — in-network providers accept Anthem's approved amount as full payment
• Direct claims filing — your therapist handles billing with Anthem
• BlueCard access — as a BCBS affiliate, you can see in-network BCBS providers across state lines

Out-of-Network Therapists

Many Anthem PPO plans include out-of-network benefits:

• Higher deductible — separate out-of-network deductible, typically higher than in-network
• Higher coinsurance — expect to pay 30% to 50% of Anthem's allowed amount
• Balance billing — out-of-network providers can charge above Anthem's allowed rate
• Superbill reimbursement — you pay the full fee and submit a superbill to Anthem for partial reimbursement

Anthem HMO and EPO plans typically do not cover out-of-network services except in emergencies.

For a complete overview of therapy payment options, see our guide to paying for therapy.

How to Find In-Network Therapists

Anthem offers multiple ways to find covered behavioral health providers:

1. Anthem provider directory — Visit Anthem's Find Care tool and search for behavioral health providers by location and specialty. Enter your member ID for plan-specific results.

2. Sydney Health app — Anthem's mobile app provides personalized provider search, benefits verification, and claims management.

3. Anthem member portal — Log into Anthem.com for detailed provider search and benefits information.

4. Call member services — Contact Anthem at 1-800-331-1476 or the number on your insurance card for help finding in-network therapists.

5. BlueCard program — If you are traveling or live near a state border, use the BCBS national provider finder at bcbs.com to locate in-network providers from other BCBS companies.

6. Carelon Behavioral Health — Since Carelon manages Anthem's behavioral health network, you may also search through Carelon's resources for behavioral health providers.

When choosing a therapist, our guide on how to interview a therapist covers key questions to ask.

Common Copays and Deductibles

Anthem therapy costs vary by plan. Here are typical ranges:

Your specific costs depend on your plan type (HMO, PPO, EPO, POS, or HDHP), your employer's plan design, and your deductible status. Log into the Anthem member portal or Sydney Health app to check your current deductible progress.

Many Anthem employer-sponsored plans include an Employee Assistance Program (EAP) through Carelon, offering free therapy sessions (typically 3 to 6). These sessions are available at no cost and do not require a deductible. Ask your HR department about EAP availability.

Mental Health Parity Information

Federal parity law requires Anthem to provide equitable mental health coverage:

• Equal cost-sharing — copays, deductibles, and coinsurance for therapy must be comparable to those for medical visits
• No discriminatory session limits — Anthem cannot impose therapy visit caps that are stricter than limits on medical treatment
• Network adequacy — Anthem must maintain sufficient behavioral health providers through Carelon to serve its membership
• Consistent utilization management — any review processes or authorization requirements for mental health must be applied consistently with medical care

Most Anthem commercial plans do not impose annual limits on outpatient therapy visits. Anthem is also subject to state-level parity laws in the 14 states where it operates BCBS plans, which may provide additional protections.

If you believe your mental health benefits are being applied unfairly, request a written explanation from Anthem and file a formal appeal. You can also contact your state insurance commissioner.

Pre-Authorization Requirements

Anthem generally does not require prior authorization for routine outpatient therapy. You can typically schedule appointments with an in-network therapist and begin treatment without pre-approval.

Prior authorization is commonly required for:

• Residential treatment programs
• Partial hospitalization programs (PHP)
• Intensive outpatient programs (IOP)
• Inpatient psychiatric care
• Psychological and neuropsychological testing
• Applied behavioral analysis (ABA)

If your provider recommends a higher level of care, they will typically initiate the authorization process through Carelon Behavioral Health. For standard outpatient individual, group, and family therapy, no prior authorization is needed with most Anthem plans.

Telehealth and Online Therapy Coverage

Anthem covers telehealth therapy sessions for most plan members:

• Same cost-sharing as in-person — most Anthem plans apply the same copay or coinsurance to virtual therapy sessions
• Sydney Health integration — the Sydney Health app can help you find therapists offering virtual appointments and manage your telehealth care
• Broad provider access — many in-network Carelon behavioral health providers offer both in-person and video sessions
• Audio and video options — most plans cover both video and phone therapy sessions
• Licensing requirements — your therapist must be licensed in the state where you are physically located during the session

Anthem has expanded its telehealth infrastructure significantly, making virtual therapy widely available across its plan types. Verify your specific plan's telehealth provisions through the member portal or by calling member services.

Tips for Maximizing Your Anthem Benefits

1. Verify benefits through Sydney Health — Before your first therapy session, use the Sydney Health app or Anthem.com to review your behavioral health benefits, check your deductible status, and confirm copay amounts.

2. Leverage the BlueCard program — As an Anthem BCBS member, you can see in-network BCBS providers across the country. This is particularly valuable if you travel, attend school in another state, or live near a state border.

3. Search both Anthem and BCBS directories — Anthem's own directory and the national BCBS provider finder may show different results. Check both for the most complete picture of available providers.

4. Use EAP first — If your employer offers an EAP through Carelon, use those free sessions before tapping your regular insurance benefits.

5. Submit claims through Sydney Health — For out-of-network care, use the Sydney Health app to submit superbills and photos of receipts. You can also fax claims to 1-888-513-1505 or mail them. Anthem typically processes claims within 30 days.

6. Understand Carelon's role — Carelon Behavioral Health manages your mental health benefits for Anthem. If you have questions about behavioral health coverage specifically, you may be directed to Carelon's team.

7. Use pre-tax dollars — Pay therapy copays and out-of-pocket costs with HSA or FSA funds to reduce your effective cost.

8. Appeal denials — If a claim is denied, request the denial reason in writing and file a formal appeal. Ask your therapist for a letter of medical necessity to support your case.

For more cost-saving strategies, see our complete guide on how to pay for therapy.

FAQ

Does Anthem require a referral for therapy?

Most Anthem PPO and EPO plans allow you to see a therapist without a referral. Anthem HMO plans may require a referral from your primary care physician. Check your plan documents or call the number on your insurance card to confirm.

How many therapy sessions does Anthem cover?

Under the Mental Health Parity Act, Anthem cannot impose annual session limits on mental health treatment that are stricter than limits on comparable medical services. Most Anthem commercial plans cover unlimited outpatient therapy visits per year with standard cost-sharing. Verify with your specific plan.

Does Anthem cover therapy in all 50 states?

Anthem operates BCBS plans in 14 states, but through the BlueCard program, you can access in-network BCBS providers nationwide. If you are an Anthem member traveling or living temporarily in another state, the BlueCard program allows you to see in-network providers from the local BCBS company.

What is Carelon Behavioral Health?

Carelon Behavioral Health (formerly Beacon Health Options) is the behavioral health management division of Elevance Health, Anthem's parent company. Carelon manages Anthem's behavioral health provider network, processes mental health claims, and handles authorizations for higher levels of care. You may interact with Carelon when searching for therapists or managing behavioral health benefits.

Does Anthem cover couples therapy?

Anthem covers family and couples therapy (CPT 90847) when billed under an individual who has a diagnosed mental health condition. The identified patient must have a covered condition like anxiety or depression. Pure relationship counseling without a clinical diagnosis is generally not covered.

Does Anthem cover substance abuse treatment?

Yes, Anthem covers substance use disorder treatment as required by federal parity law. This includes outpatient therapy, intensive outpatient programs, partial hospitalization, residential treatment, and medication-assisted treatment. Prior authorization through Carelon is typically required for anything beyond standard outpatient therapy. See our guide on addiction treatment for more information.