(Please note: Rehabs.com strives to provide you with the most updated information on each carriers' addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. Rehabs.com is not affiliated or endorsed by the Blue Cross and Blue Shield Association or any of its licensees.)
Do Blue Cross and Blue Shield Companies Cover Detox Services?
Some Blue Cross and Blue Shield companies have contracted with providers across the country. Many government employees have insurance under its Federal Employee Program®, which covers inpatient professional visits and can include detox. During the detox phase, your body adjusts to the lack of alcohol or other substances to which it had become dependent on. Withdrawal symptoms vary depending on the substance, how long the person has been using, the average dose used, the individual's physiology, etc. For instance, the acute stimulant withdrawal syndrome is often less acutely severe than alcohol, benzodiazepine, and opioid withdrawal syndromes, which have the potential to be very distressing and even dangerous. Depending on the substance(s) being used, symptoms of withdrawal may include nausea, vomiting, muscle and bone aches, depression, anxiety, tremors, paranoia, irritability, and cravings. Some of the more severe withdrawal symptoms include grand mal seizures, hallucinations, delusions, and dysregulation of blood pressure, pulse, and body temperature. Seizures and delirium are associated with severe alcohol or sedative withdrawal.1
"During the detox phase, your body adjusts to the lack of alcohol or other substances to which it had become dependent on."
Does it Cover Rehab?
Some Blue Cross and Blue Shield companies may offer plans that cover rehab, but it all depends on your policy. The Federal Employee Program® covers group and individual therapy sessions that you attend during outpatient rehab, but you're responsible for the copay or coinsurance.
You may be required to obtain pre-certification before seeking residential treatment. Again, the amount you will have to pay for addiction treatment can vary vastly so it's important to check the details of your individual plan.
Addiction Treatment Length that Blue Cross and Blue Shield’s Plans May Cover
Not everyone recovers from addiction at the same pace, which is why Blue Cross and Blue Shield companies may offer plans that might consider other factors when it comes to private addiction treatment.
Instead of giving you a set length of time, such as five days, the company will cover a portion of your stay based on your deductible and amount of coverage. If you have additional coverage through your employer or choose a more affordable treatment facility, you might qualify for a longer stay. The treatment center and your insurance provider will keep your information discreet regardless of the duration of your stay.
Specialty Alcohol and Drug Treatment
The Mental Health Parity and Addiction Equity Act requires that health insurance companies and group health plans to provide equal coverage for mental health services, such as substance abuse treatment, as they do medical coverage.2 This act was created to expand mental health and substance abuse coverage for people across the country. As a result, many Blue Cross and Blue Shield companies may provide you with affordable coverage, and that is reflected in the pricing. For example, an unlimited stay at an approved inpatient treatment center may cost $250 out of pocket.
For an out-of-network treatment center, you might pay $350 plus a set fee based on your plan allowance. By letting you choose any treatment center, you get the chance to choose from some exclusive centers. Some luxury treatment centers have a wide array of amenities, including:
- Elegant dining rooms.
- Spa treatments.
- Holistic treatments.
- State-of-the-art fitness centers.
- Designer linens.
Insurance for Inpatient Addiction Treatment vs. Outpatient
Addiction isn't something that you can cure overnight, but with the proper help from professionals in a recovery center, you can start working on taking back your life. Whether your provider covers outpatient or inpatient programs, you'll want to decide which is the best option for you. When you want a fresh start that gets you away from former friends and loved ones who use drugs and alcohol, you can stay at a residential center. These inpatient programs provide you with around-the-clock addiction treatment, support, and monitoring. Many people benefit from the structure of inpatient programs. If you have a mild addiction, a strong support system, and reliable transportation, an outpatient rehab may be appropriate for you. You can schedule your treatment sessions around work, school, or other personal obligations, while still returning home in the evening. Outpatient programs can range in terms of time intensiveness; standard outpatient may require a couple hours of treatment per week while an intensive outpatient program (IOP) or partial hospitalization program (PHP) may include several hours per day of treatment.
How to Cover What Insurance Won't
Not everyone has access to great insurance through a respected provider, but those people still deserve treatment from a great rehabilitation center. If you're one of the millions of uninsured Americans, now is the time to work out a payment plan with the facility. For example, if you are willing to pay a small amount every month and make installments until you've paid off the total cost of the stay, some centers might agree to start treatment immediately. Many programs also offer sliding scale options, in which the treatment cost is adjusted according to your salary and what you can realistically pay. Other options include grants and scholarships.
Verifying Coverage and Finding the Best Treatment
"Let us help you find out what rehab facilities accept your Blue Cross Blue Shield insurance."
According to the Substance Abuse and Mental Health Services Administration, nearly 22 million Americans needed treatment for a substance addiction in 2015, but only about 2.3 million people received treatment. This means that not even 11% of people who needed rehab received it.3 This figure shows that there are millions of people in the same situation as you. There are many barriers to addiction treatment, including cost, but you don't have to let the price keep you from ending the cycle of abuse and living a happier and healthier life. You can find out what rehab facilities accept your Blue Cross Blue Shield insurance by contacting your plan administrator, or you can work with the treatment center directly to answer all your payment questions.
Questions for Your Insurance Company
If you’re struggling with substance abuse and are looking for professional treatment, the more you know about your insurance plan and what it covers, the better. You can use this information to guide your search for the rehab that is appropriate for you.
Some questions you may want to consider asking your insurance company include:
- What kind of program does my plan cover?
- How long of a stay is covered?
- What facilities are in-network vs. out-of-network?
- Are there any limitations on types of therapy/treatment?
- Does the plan cover medications that may be used during detox and treatment?
Before You Call
It can be beneficial to have relevant information available for when you call a helpline or treatment center. An admissions consultant will likely ask you different questions surrounding you or your loved one’s substance abuse. If possible, you should have your insurance card in front of you so the admissions consultant can verify your benefits, using your policy number. Helpful information may include the specific substance or substances abused, length of abuse, average dose used, and method of administration, such as injecting. Also provide the admissions consultant with information regarding co-occurring mental disorders, such as depression, anxiety, schizophrenia, or a personality disorder, as there are many treatment centers that specialize in treating a dual diagnosis. It’s also important to voice any medical concerns, such as pregnancy.
1.Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol, TIP 45.
2.Substance Abuse and Mental Health Services Administration. (2017). Implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA).
3. Substance Abuse and Mental Health Services Administration. (2015). America's Need for and Receipt of Substance Use Treatment in 2015.