Carelon Residential Behavioral Health

Carelon Behavioral Health, formerly known as Beacon Health recognizes the significance of behavioral health care and offers a wide array of treatment options. The Affordable Care Act also mandates that all health insurance providers, including Carelon, cover mental health treatments.² However, the specifics of coverage can differ based on your policy. To ensure you clearly understand what your Carelon plan covers, it’s important to review your policy details or consult with Carelon for accurate information on the treatments included.

• Residential Treatment: Intensive care in a residential setting for continuous support.
• Outpatient Care: Regular treatment sessions with mental health professionals without needing an overnight stay.
• Intensive Outpatient Programs (IOP): Targeted programs for serious behavioral health issues, short of full hospitalization.
• Partial Hospitalization Programs (PHP): Daytime therapeutic programs offering comprehensive therapy multiple times weekly.
• Group Therapy: Group sessions led by therapists for communal support and shared learning.
• Individual Therapy: Customized, one-on-one sessions to address specific behavioral health challenges.
• Family Therapy: Involving family members to reinforce support systems.
• Behavioral Health Treatment: Techniques such as CBT and DBT to manage various mental health conditions.
• Substance Use Disorder Treatment: Combined treatment for simultaneous mental health and substance use disorders.
• Telehealth Services: Virtual sessions, increasingly covered and utilized, particularly since the pandemic.

For precise information on your coverage, directly contact Carelon or consult with our admissions team, who can assist in verifying your benefits.

Carelon provides coverage for residential mental health treatment. However, the specifics depend on your plan. Consider the following steps:

• Policy Details: Check your coverage documents to understand what’s included, especially for residential care.
• Pre-authorization: Confirm if your plan requires pre-authorization to ensure your stay is medically necessary.
• Provider Network: Consider using a Carelon-approved facility to maximize your coverage benefits.
• Out-of-Pocket Costs: Be aware of deductibles and copayments you may be responsible for.
• Admissions Team Help: We’ll handle the benefit verification process on your behalf.

The Affordable Care Act mandates parity in coverage for mental health, but it’s important to review the details of your policy with our admissions team.²

The length of stay in residential treatment covered by Carelon depends on various elements, including:

• The details of your specific Carelon plan.
• Medical necessity as determined by a healthcare provider in conjunction with Carelon.
• Your progress and any reassessments during treatment.
• Limits set by your plan on the number of covered days or types of treatment programs.

For the most accurate details about your coverage, contact us, and we will help you review and understand your policy documentation.

Entry into a residential mental health facility with Carelon can depend on a few factors, such as:

• Verifying your insurance benefits for residential care.
• The requirement for pre-authorization or a healthcare provider’s referral, if stipulated by your plan.
• Availability at the residential mental health center.
• Any waiting periods under your insurance policy.

Contact us to confirm your benefits and see what needs to be done regarding getting a pre-auth for treatment. Cornerstone’s skilled admissions team has helped hundreds of individuals like yourself meet the necessary requirements to enter into treatment.