BlueCross BlueShield Insurance for Addiction Treatment

Last updated on July 14th, 2020

Does Blue Cross Blue Shield Cover Rehab?

Yes, almost all of the Blue Cross Blue Shield insurance plans include treatment for substance abuse and mental health issues, but the amount of coverage for rehab 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 Blue Cross Blue Shield addiction treatment can vary vastly so it’s important to check the details of your individual plan.


Does Blue Cross Blue Shield Cover Mental Health?

Yes, almost all of Blue Cross Blue Shield plans include coverage for mental health conditions, but the amount of coverage for treatment depends on your policy.


Do Blue Cross Blue Shield Companies Cover Detox Services?

Some Blue Cross 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. Some insurance plans cover Blue Cross Blue Shield alcohol rehab or drug rehab.

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


BlueCross BlueShield Insurance

The Blue Cross Blue Shield Association is made up of 36 health insurance companies that are independently owned and operated. Blue Cross Blue Shield (BCBS) provides coverage for more than half of all federal employees who are enrolled in network, and they are covered under the Federal Employee Program.

BCBS has individual and family plans that include the bronze, silver, gold, and platinum plans (categories are dependent on your state). Bronze plans have the lowest cost, and the price of plans goes up from there.

  • Bronze plans cover close to 60% of medical costs and have low monthly payments and high deductibles.
  • Silver plans cover close to 70% of medical costs, with a somewhat higher monthly payment and lower deductible.
  • Gold plans cover close to 80% of medical costs and have higher monthly payments and low deductibles.
  • Platinum plans (which aren’t offered in all states) cover close to 90% of medical costs and have the highest monthly payment with the lowest deductible.

All Blue Cross Blue Shield insurance plans include mental health benefits, and most plans cover at least some portion of addiction treatment. Specifics regarding your coverage are based on your policy. As with most medical issues, only a portion of detox or substance abuse treatment are covered by insurance.


Addiction Treatment Length that Blue Cross Blue Shield’s Plans May Cover

Not everyone recovers from addiction at the same pace, which is why Blue Cross 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 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

doctor consulting with patientAddiction 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, 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 of 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

According to the Substance Abuse and Mental Health Services Administration, nearly 22 million Americans needed treatment for 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.

Rehabs.com, an American Addiction Centers resource, has a relationship with Blue Cross Blue Shield and may be able to help you get into one of our treatment programs. Reach out to one of our admissions navigators at +1 (888) 341-7785 , or check out our online insurance verification form to find out if you are covered.

(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 Blue Shield Association or any of its licensees.)


Sources

1.Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
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.

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