Blue Cross Blue Shield Drug And Alcohol Rehab Coverage
The majority of Blue Cross Blue Shield plans cover a stay at an addiction treatment facility but the amount of coverage varies as does the length of stay and actual type of treatment center. Understanding exactly which addiction treatment services are covered by your Blue Cross Blue Shield plan can be helpful in making sure people are fully prepared for rehab.
Examples of potentially covered services include medically-supervised detoxification, outpatient services, including intensive outpatient programs (IOPs) or partial hospitalization programs (PHPs); inpatient residential treatment, and medication-assisted therapies (MAT) to treat opioid use disorders.
Choosing the right combination of treatments gives a person the greatest opportunity for sobriety and a stable recovery.
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What Is Blue Cross Blue Shield?
One in three Americans receives health insurance coverage from a Blue Cross Blue Shield company. This coverage extends across all 50 states and provides health insurance to over 106 million people.
Blue Cross Blue Shield is passionate about providing dynamic options for health care insurance. This statement from their website makes their mission clear:
“Throughout our history, Blue Cross Blue Shield has risen to the challenges that come with change, continually innovating and evolving in our longstanding commitment to quality, affordable healthcare for all Americans.”
Blue Cross Blue Shield insurance is provided by 36 independent and locally-operated companies located across the United States, the District of Columbia, and Puerto Rico. BCBS also offers insurance through their BCBS Federal Employee Program.
The Blue Cross Blue Shield companies by state and territory include:
- Alabama: Blue Cross and Blue Shield of Alabama
- Alaska: Premera Blue Cross and Blue Shield of Alaska
- Arizona: Blue Cross Blue Shield of Arizona
- Arkansas: Arkansas Blue Cross and Blue Shield
- California: Anthem Blue Cross, Blue Shield of California
- Colorado: Anthem Blue Cross and Blue Shield Colorado
- Connecticut: Anthem Blue Cross and Blue Shield Connecticut
- Delaware: Highmark Blue Cross Blue Shield Delaware
- District of Columbia: CareFirst BlueCross BlueShield
- Florida: Florida Blue
- Georgia: Blue Cross Blue Shield of Georgia
- Hawaii: Blue Cross and Blue Shield of Hawaii
- Idaho: Blue Cross of Idaho, Regence BlueShield of Idaho
- Illinois: Blue Cross and Blue Shield of Illinois
- Indiana: Anthem Blue Cross and Blue Shield Indiana
- Iowa: Wellmark Blue Cross and Blue Shield
- Kansas: Blue Cross and Blue Shield of Kansas
- Kentucky: Anthem Blue Cross and Blue Shield Kentucky
- Louisiana: Blue Cross and Blue Shield of Louisiana
- Maine: Anthem Blue Cross and Blue Shield Maine
- Maryland: CareFirst BlueCross BlueShield
- Massachusetts: Blue Cross and Blue Shield of Massachusetts
- Michigan: Blue Cross Blue Shield of Michigan
- Minnesota: Blue Cross and Blue Shield of Minnesota
- Mississippi: Blue Cross & Blue Shield of Mississippi
- Missouri: Anthem Blue Cross and Blue Shield Missouri, Blue Cross and Blue Shield of Kansas City
- Montana: Blue Cross and Blue Shield of Montana
- Nebraska: Blue Cross and Blue Shield of Nebraska
- Nevada: Anthem Blue Cross and Blue Shield Nevada
- New Hampshire: Anthem Blue Cross and Blue Shield New Hampshire
- New Jersey: Horizon Blue Cross and Blue Shield of New Jersey
- New Mexico: Blue Cross and Blue Shield of New Mexico
- New York: Empire Blue Cross Blue Shield, BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, Excellus BlueCross BlueShield
- North Carolina: Blue Cross and Blue Shield of North Carolina
- North Dakota: Blue Cross Blue Shield of North Dakota
- Ohio: Anthem Blue Cross and Blue Shield Ohio
- Oklahoma: Blue Cross and Blue Shield of Oklahoma
- Oregon: Regence BlueCross BlueShield
- Pennsylvania: Capital BlueCross, Highmark Blue Shield, Highmark Blue Cross Blue Shield, Independence Blue Cross
- Puerto Rico: BlueCross BlueShield of Puerto Rico
- Rhode Island: Blue Cross & Blue Shield of Rhode Island
- South Carolina: Blue Cross and Blue Shield of South Carolina
- South Dakota: Wellmark Blue Cross and Blue Shield
- Tennessee: BlueCross BlueShield of Tennessee
- Texas: Blue Cross and Blue Shield of Texas
- Utah: Regence BlueCross BlueShield
- Vermont: Blue Cross and Blue Shield of Vermont
- Virginia: Anthem Blue Cross and Blue Shield Virginia, CareFirst BlueCross BlueShield
- Washington: Premera Blue Cross, Regence BlueShield
- West Virginia: Highmark Blue Cross Blue Shield West Virginia
- Wisconsin: Anthem Blue Cross and Blue Shield Wisconsin
- Wyoming: Blue Cross Blue Shield of Wyoming
The law requires that insurance benefits for the treatment of mental health and substance use disorders be equal to those made available for medical and surgical procedures. This is mandated by the Mental Health Parity and Addiction Equity Act.
Each person’s specific insurance coverage for these services may differ from state-to-state based on the benefits outlined by each of these companies.
Generally, an insurance plan may stipulate that treatment is covered for a set number of days or a set dollar amount of coverage per day. In certain plans, a person may have to meet their deductible before they’re able to use their benefits for substance abuse treatment. The deductible, copay (or coinsurance), and limitations on coverage may change from plan to plan.
In many cases, insurance benefits may not be provided unless the services are determined to be medically necessary. This means that the insurance company needs proof of the addiction and evidence that the rehabilitation program is the best line of treatment. A clinical assessment can make this determination and offer proof that a substance use disorder has been diagnosed.
Choosing a treatment program and format is not a decision to take lightly. In order to make the best decision, it’s important to fully understand the scope of health insurance coverage offered.
Blue Cross Blue Shield Drug Rehab Coverage
Making the decision to go to treatment for a drug or alcohol addiction is a huge step in the right direction to getting clean and sober. When making this decision you may have come to find out a lot of factors go into what rehab center you can actually go to. It’s important to find the rehab center that best suits your individual needs and budget.
The good news is that if you have a Blue Cross Blue Shield PPO plan, you will generally have access to drug rehab centers with a higher level of care than other places such as state-funded treatment facilities. A stay at a higher end drug and alcohol rehab center can cost anywhere from $500 to $3,000 per day. Without good insurance coverage, it can be very difficult for individuals to go to the treatment center of their choice.
Even with a a Blue Cross Blue Shield Plan there are a lot of details that have to be factored in before checking into a rehab center. Insurance coverage, and where you stand with your plan, is one of the biggest details you’ll need to figure out before you go.
Poring over your insurance can get pretty overwhelming, so it can be helpful to have someone to call to help you examine your plan.
Before heading to a drug rehab center, you’ll want to know the following about your BCBS plan:
- What parts of treatment are covered by your insurance
- Which rehab centers will accept your plan
- What your out-of-pocket expenses will be
Most private insurance plans cover anywhere from 50-90 percent of a 30-day inpatient drug rehab stay. Drug and alcohol addiction is now considered a medical illness, which means it requires adequate treatment. This also means addiction treatment must be regarded the same as any other medical illness or injury.
In other words, if your insurance plan covers it, you can receive treatment for addiction. Knowing the details of your coverage is the next step.
Does Blue Cross Blue Shield Cover The Cost Of Treatment At An Inpatient Rehab Center?
Inpatient drug rehabilitation programs offer short- to long-term care options in a residential setting. Treatment may range from 28 to 30 day programs, upwards to a year or longer. Research shows that the most optimal treatment outcomes are obtained in 90-day programs, at minimum.
Inpatient programs typically offer a more diverse array of treatments, provided in a more individualized way. This person-centric care allows for more comprehensive treatment and better outcomes. Treatments include medically-supervised detoxification and a variety of behavioral therapies.
The residential format of these programs offers extra protection against the triggers and temptations present in an outpatient program. Inpatient programs are highly encouraged for those facing moderate to severe addictions or a serious relapse to drug abuse.
The length of treatment which is covered may vary. Covered services may include inpatient hospital services and residential care.
Does Blue Cross Blue Shield Cover The Cost of Outpatient Substance Abuse Treatment?
One aspect of outpatient care which may benefit some is the ability for the individual to remain at home throughout the duration of treatment, versus living on site at a residential treatment facility. However, this element is also one reason why outpatient treatment is not always the best option for rehabilitation for certain individuals.
Without the protection and consistency that a residential format establishes, an individual may continue to be exposed to harmful triggers within their life. For some, these influences draw them back into a life of substance abuse, and away from the recovery principles of treatment.
Because of this, outpatient programs are often better options for those with mild concerns of substance abuse, not moderate to severe addictions. Another good use of these services is as a step-down program from inpatient drug rehab.
For those who choose this route, examples of covered outpatient services may include intensive outpatient programs, partial hospitalization programs, and office-based opioid treatment.
Does Blue Cross Blue Shield Cover the Cost of Suboxone?
One of the most widely-used medications in medication-assisted treatment (MAT) for opioid use disorders (including addiction to heroin and prescription painkillers) is buprenorphine.
Buprenorphine-based medications, including Suboxone, are used to help a person quit or reduce abuse of opioid drugs. As part of MAT, these medications are used in conjunction with behavioral therapies to help patients achieve the most optimal recovery outcomes.
Suboxone is a combination medication which contains naloxone in addition to buprenorphine. Naloxone is added to help prevent drug misuse and diversion.
The availability of this prescription may vary per state. Before an individual can receive this drug a prior authorization (PA) may be necessary. This means that the prescribing doctor must obtain permission from BCBS before they can prescribe the drug.
To receive this approval, a doctor will likely have to furnish documents or information which provides evidence of the addiction and the need for this medication as treatment.
Each BCBS company may produce its own drug formulary or custom drug list. This information will likely detail if a PA is necessary. It will also note other guidelines specific to the prescription of each drug, such as quantity limits.
Before enrolling in a treatment program, we suggest contacting the insurance provider directly to establish if the anticipated medications will be covered. We can also assist you in obtaining this information.
Does Blue Cross Blue Shield Cover the Cost of Methadone Maintenance?
Methadone is used within MAT to help people reduce or quit heroin and/or prescription opioid painkillers. Methadone is only available through Substance Abuse and Mental Health Services Administration-certified opioid treatment programs (OTPs). This means that a person cannot go to a pharmacy and pick up a prescription of methadone.
As a part of MAT, methadone maintenance treatments should be accompanied by counseling and social support programs. Methadone treatment should last, at minimum, 12 months. Certain individuals may require this treatment for several years.
Because of this longer duration of care, it’s important to know if BCBS covers methadone. Like Suboxone, methadone coverage will be dependent on the specific company providing the BCBS services. We can contact the insurance company to determine if methadone maintenance is included within a certain benefits package.
Understanding Your Specific BCBS Plan
Each plan is specific to the individual. If you need medical treatment for addiction, and your plan provides coverage, then you should be able to get it. You’ll want to work with drug rehabs that accept both your provider (Blue Cross Blue Shield) and individual plan (I.E Gold, Silver, etc).
Once your treatment needs have been identified, you can begin looking at drug rehab centers for treatment.
Some things you’ll need to consider include:
- What you’ll have to pay depending on the portion covered by your plan
- What types of treatment are offered at each center
- If you’ll need medication assisted therapy (I.E buprenorphine treatment), and what other types of therapy or treatment you’ll need
For instance, some people entering treatment need to undergo detoxification, or a process that allows the body to rid itself of harsh chemicals gained from drug abuse. For those who need it, this process is necessary and should be medically supervised. The best rehab centers will provide excellent care during detoxification. Post BCBS plans will cover a drug and alcohol detoxification.
For those who need detoxification, medication assisted therapy can help ease some of the more extreme withdrawal symptoms. Not all plans will cover medication assisted therapy, so if you need it, you’ll want to know where you stand with your plan.
After you have figured out exactly what your treatment needs will be—such as mental health treatment, counseling, detox, medication assisted therapy, etc.—you’ll know what coverage you’ll need to examine under your Blue Cross Blue Shield plan.
Using Your Blue Cross Blue Shield Coverage To Go To Rehab
This may seem like an overload of information, and perhaps may be a bit overwhelming. Our treatment specialists can answer questions about your insurance, find a drug rehab that will accept it, and help you build a customized plan that meets your individual needs.
With your permission, our treatment specialists can contact Blue Cross Blue Shield, get your plan information, and review it with you. They can help you understand the details of your plan, estimate your overall costs, and direct you to resources that can help you figure out either a payment plan or any assistance, such as scholarships or aid.
Choosing the right drug rehab center is also a big step. It’s important to find both a rehab center that works with your BCBS plan, and one that will offer all the treatment methods necessary to help you properly heal from addiction. We can compile a list of all the drug rehabs that accept your plan, and help you choose one based on location, treatment offered, price, and a number of other factors.
According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning.
-The National Institute On Drug Abuse (NIDA)
Finding A Rehab Center That Accepts Blue Cross Blue Shield
The highest measures of success are found in programs which offer individualized, research-based treatments. This comprehensive care blends medications and behavioral therapies to address the addiction on both a physical and psychological level.
Becoming familiar with coverage details can help a person best utilize these potentially life-changing treatments. Should a person find that their BCBS benefits don’t fully cover their treatment needs, additional payment options may exist.
A variety of treatment facilities offer sliding fee scales which reduce payments based on a person’s financial standing. Others partner with financial institutions to offer financing which may cover the remaining balance. Aside from these options, consider looking into scholarships and grants, personal loans, or assistance from close family and friends.
Reach out to OpioidTreatment.net to learn more about how BCBS can help pay the cost of your treatment.
- National Institute On Drug Abuse—How Effective Is Drug Addiction Treatment?
- BlueCross BlueShield — Advancing Smarter Healthcare, BCBS Companies and Licensees, Blue Facts
- Blue Shield of California — Blue Shield of California Endorsement
- Substance Abuse and Mental Health Services Administration — Buprenorphine, Implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA), Methadone