Formerly Beacon Health Options · Treated in Encino, Los Angeles
Plans administered by Carelon cover detox and residential treatment. Carelon itself is not your insurer. It manages substance use benefits on behalf of other companies' plans, and it is not the Carelon company that reviews physical therapy. New Spirit Recovery treats members whose behavioral health runs through Carelon at its residential facility in Encino, Los Angeles, using their out-of-network benefit.
Out of network on every plan · benefits read from your policy on the first call · adults 18+
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Check your Carelon Behavioral Health benefits
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Two companies, one name
Carelon Behavioral Health reviews and authorizes mental health and substance use treatment. Carelon Medical Benefits Management, formerly AIM, reviews physical, occupational and speech therapy. They share a parent company and nothing else that matters to a rehab claim. Calling the wrong one costs days.
| Company | What it reviews | Governs a rehab claim |
|---|---|---|
| Carelon Behavioral HealthThis one | Mental health and substance use treatment, from withdrawal management through outpatient care. | Yes. Precertification, medical necessity, continued-stay review. |
| Carelon Medical Benefits Management | Outpatient physical, occupational and speech therapy. Formerly AIM Specialty Health. | No. A different benefit entirely, despite the shared name. |
Carelon is an administrator, not an insurer.
Nobody buys a Carelon policy. An employer, a union welfare fund or a state programme buys health coverage, and then contracts Carelon to run the behavioral health part of it. So two people who both say they “have Carelon” can hold completely different benefits, because the plan behind Carelon is what sets the deductible, the coinsurance and whether an out-of-network benefit exists at all.
Carelon Behavioral Health was named Beacon Health Options until March 2023. A Carelon Behavioral Health drug rehab authorization can therefore appear under either name, since plan documents printed before then carry the Beacon name for the same benefit and the same review process.
New Spirit Recovery establishes which plan sits behind a member’s Carelon coverage before quoting anything, because the administrator’s name reveals nothing about the deductible or the out-of-network percentage underneath it.
Levels of care
Carelon authorizes withdrawal management and residential treatment where the clinical record establishes medical necessity, and steps the authorization down as the picture improves. New Spirit Recovery delivers those two levels on site in Los Angeles and refers the outpatient levels to providers near the member's home.
| Level of care | How Carelon treats it | At New Spirit Recovery |
|---|---|---|
| Withdrawal managementOn site | Precertified and reviewed against withdrawal risk and medical stability. | Delivered on site under 24-hour nursing. Typically 7 to 10 days, extending to 21 where the clinical picture requires it. |
| Residential treatmentOn site | Precertified, then renewed through continued-stay review rather than granted as a block. | Delivered on site in Los Angeles, typically as part of a 35-day programme. |
| Partial hospitalization | A separate authorization, usually measured in programme hours per week. | Referred to an external provider. |
| Intensive outpatient | Authorized by session count rather than by day. | Referred to an external provider. |
| Medication-assisted treatment | Reviewed alongside the level of care it supports. | Provided during treatment under medical direction, then coordinated at discharge. |
Carelon's role and the Beacon renaming are stated by Carelon Behavioral Health. Facility figures come from New Spirit Recovery programme records. Administrator practice and facility practice are stated separately and never combined.
The question behind the search
No. A plan with an out-of-network behavioral health benefit pays toward a facility holding no Carelon contract, at the out-of-network rate rather than a negotiated one. What decides it is your plan document, not the facility's contract status.
Most pages answering this question belong to facilities that are in network, so the answer they give is “choose us”. That is useful only if their bed, their programme and their location suit you. A member whose preferred facility is not on the list needs the other answer.
New Spirit Recovery holds no network contract with Carelon or with any other insurer. Members use the out-of-network benefit their plan carries. The admissions team reads that benefit from the policy on the first call and states what it pays before anyone commits or travels.
Two numbers decide the outcome: the percentage the plan pays out of network for behavioral health, and the out-of-pocket maximum that caps the year. Both come from the plan behind Carelon, not from Carelon itself. That out-of-network percentage is what makes a rehab center in Los Angeles reachable for a member whose local network holds no residential bed they want.
Ask for behavioral health, not general medical, or you reach an administrator that cannot authorize a residential stay. New Spirit Recovery's admissions line is (855) 932-2725. More on how coverage works and how admission works.
Ten minutes and a member ID is all it takes. Someone answers at any hour, including this one.
Questions Carelon members ask
