Rehab Helps Thousands of Addicts Quit. It Can Help You, Too.

stethoscope on health insurance documentsHCSC (Health Care Service Corporation), America’s largest customer-owned health insurance company, provides a wide array of coverage packages through Blue Cross and Blue Shield. Because HCSC does not have stockholders, it is able to keep the cost of insurance down for patients.

HCSC takes addiction treatment seriously, however. Substance abuse is considered by insurance companies to be a chronic medical illness, so it is generally covered to some extent under most insurance programs – HCSC included.

Because each HCSC insurance plan is unique, coverage for drug and alcohol detox and rehabilitation varies. Depending on your plan, you may be able to get a large portion of both inpatient and outpatient rehabilitation costs covered by your insurance. Some plans offer full coverage, and most plans offer at least partial coverage for detox and rehab services.1

Does HCSC Cover Detox Services?

Detox services are typically covered under the Substance Abuse Disorder section of the Essential Health Benefits coverage on most HCSC plans.Detox is typically the first step of the treatment process. Detox is the body’s process of ridding itself of toxic substances and can produce many painful withdrawal symptoms that make it difficult for people to avoid relapse. The withdrawal period can last for days and even weeks for some substances.

Under medically assisted detox, your doctor may provide you with medication and other medical supports to help ease your withdrawal symptoms.

Detox services are typically covered under the Substance Abuse Disorder section of the Essential Health Benefits coverage on most HCSC plans. Depending on your individual plan, you may have to meet a deductible or pay a copay before your insurance provides coverage.

Many plans provide coinsurance, meaning that HCSC will cover a specific percentage of the bill – and then you will be responsible for the rest. There may be a limit to the number of times detoxification services are covered, so always double check your benefit coverage, especially if you have received detox treatment in the past.

Does HCSC Cover Rehab?

Woman in group therapyRehabilitation services are also typically covered under the Essential Health Benefits provided by HCSC. Individual coverage will vary depending on the plan, but most plans will provide some coverage for both inpatient and outpatient rehabilitation options. It is common for HCSC to require patients to undergo outpatient treatment, but with medical documentation it is often possible to receive coverage for inpatient treatment as well.

Most people will be covered for their first time undergoing treatment. However, coverage for rehab services may be harder to obtain if you have previously taken part in a treatment program. It is important to carefully review your coverage package with HCSC and talk with your provider about payment before starting treatment.

Addiction Treatment Length HCSC Will Cover

Inpatient treatment programs for addiction can vary in length. The most common rehabilitation services are 30, 60 and 90 days long. Some treatment programs last a year or longer depending on the severity of the addiction.

Insurance coverage will vary depending on your individual plan. The most common length of treatment covered is 30 days. Under some plans you may have limited coverage for longer programs, especially if you have been previously treated for addiction. For more information, check the Summary of Benefits listed for your individual plan.

Specialty Alcohol and Drug Treatment Through HCSC

Some patients choose to cover the additional costs of luxury services that are not covered by HCSC to access a wide range of high-end amenities.HCSC offers little to no coverage for the special amenities offered by luxury or executive rehab programs, as they are not viewed by HCSC as medically necessary for recovery. However, for those who are interested, there may be options to pay more than your insurance would cover to receive the kind of treatment you desire.

Luxury and executive rehab facilities offer special, resort-like amenities to make your recovery process more comfortable. These amenities may include:

  • Private rooms.
  • Gourmet meals.
  • Acupuncture.
  • Massage.
  • Spa treatments.
  • Aromatherapy.

Executive addiction treatment programs offer the additional benefit of providing the structure and resources that let busy professionals keep an active involvement in their place of work during their recovery.

Some patients choose to cover the additional costs of these services that are not covered by HCSC. It is important to discuss these options with your insurance company and implement an appropriate payment plan with the rehab facility prior to starting treatment.

Insurance for Inpatient Addiction Treatment vs. Outpatient

man holding papers while thinking in kitchenGenerally, HCSC provides coverage for both inpatient and outpatient substance abuse treatment programs. Although it is typically more common to receive full coverage for outpatient treatment, it is possible to receive full coverage for inpatient recovery programs in some cases as well.

Each insurance plan will vary in the amount of available coverage as well as the guidelines and stipulations. Out-of-network benefits may be also be limited for substance abuse treatment. To determine your coverage, refer to the Summary of Benefits for your specific plan. It is important to make sure that your provider is covered by HCSC before starting treatment. If you are unsure about your coverage, contact an HCSC representative for clarification.

Whether you choose inpatient or outpatient treatment, both structure types involve a period of physical detox – followed by some combination of individual and group therapy that focuses on developing behavioral changes and relapse prevention techniques that facilitate recovery.

Inpatient treatment requires patients to remain in the facility 24 hours a day for 30 days or more. Inpatient treatment consists of intensive, full-time care in a structured environment with little access to the outside world. This type of treatment structure is usually the best option for those with severe addictions, as it has a lower rate of relapse than outpatient treatment.

Some individuals may prefer the treatment setting offered by an outpatient program, as it allows them to return home at the end of the day and continue with their daily lives. Outpatient treatment is similar in scope to residential treatment and usually involves some combination of therapy, counseling, support groups and doctor visits.

How to Cover What Insurance Won’t

There are many cases when an insurance plan doesn’t provide full coverage for certain detox and recovery programs. You may find your insurance coverage is limited, for example, when it comes to:

  • Out-of-state or out-of-network treatment.
  • Specialty or luxury rehab programs.
  • Relapse treatment following a recovery program.

How are you to cover for treatment in such scenarios?

Fortunately, there are still payment options available to help finance your treatment in these cases. If you are unable to pay your out-of-pocket costs for treatment in full, consider setting up a payment plan or installment option with the rehab facility of your choice. Many treatment programs also provide sliding-scale rates for those who qualify.

Cost of treatment can be prohibitive for many individuals who need help. Because addiction is a chronic and debilitating illness, finances shouldn’t prevent you from seeking treatment. If you need further help, we would be happy to answer your questions and help you sort through your options at 1-888-341-7785.

Verifying Coverage and Finding the Best Treatment

Because HCSC offers such a wide variety of insurance options, it is important to verify your coverage before starting treatment. HCSC offers information and support on their website as well as via live chat and telephone.

You may also speak directly with one of our recovery advisors at 1-888-341-7785, who can help you determine your insurance coverage, treatment budget and payment options. Exploring your treatment options alone may feel like an overwhelming burden. Let us help you sort through the information to get the help you need.

Sources

  1. Medical Policies. HCSC.

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