Signs You May Need Rehab

The severity of substance addiction is an essential consideration for determining if a person may need rehab. Individuals who do not drink alcohol to excess or consume drugs beyond recreation typically do not need substance addiction treatment. However, individuals who consume drugs and alcohol and have subsequently built a tolerance leading to indifference about substance use and abuse may need rehab.

Prolonged use of drugs and alcohol impair judgment. Individuals struggling with substance addiction are typically in denial. They hide their substance addictions from family members and close friends. They daily seek drugs and alcohol. They spend all their days trying and obtaining drugs and alcohol. Daily use is a sign that you may need rehab.

If you have a dual diagnosis, then this is further a sign that you may need rehab. A dual diagnosis is defined as an individual with a primary disorder or condition that co-occurs with another disease or disease. For example, if you have an alcohol use disorder, you may also present with a mental illness condition such as a depressive disorder or an anxiety disorder. Individuals are dual diagnosed through a licensed clinician.

The following are additional signs that you may need rehab:

  • Cravings after attempts to withdraw from drugs and alcohol
  • Indifference about substance addiction and need for addiction treatment
  • Court-ordered substance addiction treatment
  • Denial

Tolerance of substance addiction may require detox and long-term inpatient residential treatment.

Contact Virginia BlueCross BlueShield to determine your drug rehab needs. Health plan coverage depends on your addiction treatment.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

Do Blue Cross Blue Shield of Virginia Plans Cover Drug & Alcohol Rehab?

Virginia Blue Cross Blue Shield provide drug and alcohol rehab coverage under the ACA (2010) provisions. Addiction treatment must be medically necessary through prior authorization from a physician referral. Virginia BCBS provides catastrophic coverage for patients with a chronic condition. Virginia BCBS also accepts Medicaid coverage for patients with chronic conditions.

Virginia BCBS covers pre-existing conditions under the ACA provisions. Mental illness is no longer considered a pre-existing condition. Medical and surgical procedures qualify for healthcare coverage. The Mental Health Parity provisions require insurance companies to provide comparable coverage for substance use disorder and mental illness condition similarly to medical and surgical procedures. Although drug and alcohol rehab coverage is available for patients, they must obtain authorization to visit in-network providers.

Patients are responsible for shared balance billing for outstanding claims, per-visit copays, deductibles based on individual and family health plans, and co-insurance for part of the costs of addiction treatment. These out of pocket costs must be met before Virginia BCBS covers the remaining addiction treatment costs.

The first therapist appointment will establish your addiction treatment plan and the length of your stay in detox, inpatient treatment, and outpatient treatment. You will also learn about any out of pocket costs that Virginia BCBS may not cover. What you and the therapist learn in the initial appointment is tentative. Further assessment will be needed to determine an appropriate substance addiction treatment plan.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

The History of Blue Cross Blue Shield of Virginia

Virginia Blue Cross Blue Shield is a private, non-profit healthcare organization that provides quality of care for its health plan members. Virginia has an NCQA accreditation. Virginia BCBS provides rehab coverage for individuals and families and accepts Medicare and Medicaid. Drug and alcohol rehab coverage may be available for federal employees, depending on the addiction treatment plan and individual health plan.

Virginia BlueCross BlueShield is licensed under two healthcare systems:

  • Anthem Blue Cross Blue Shield Virginia
  • CareFirst BlueCross BlueShield

Virginia BlueCross BlueShield serves the Virginia region.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

Why Do We Need Rehab Coverage?

Rehab coverage is still a necessity for people who struggle with substance addiction. Provisions of the ACA and the Mental Health Parity Act of 2008 supports the need for drug and alcohol rehabilitation coverage. Patients who have a substance-related disorder may present with a co-occurring mental illness condition. Healthcare insurers must provide coverage for substance use disorder, mental illness conditions, medical, and surgical procedures, without discrimination and bias.

Recent opioid deaths, addiction to prescription drugs, and current deaths involving vaping support the need for drug and alcohol rehab coverage. Adolescents and youth who also binge drink have reported additional issues with Ritalin and Adderall.

For example, opioid prescriptions have been a significant problem since 2013. The National Institute on Drug Abuse (NIDA) reports that in 2017, there were 1,241 overdose deaths involving opioids in Virginia, at a rate of 14.8 deaths per 100,000 persons. Virginia healthcare providers wrote 52.9 opioid prescriptions for every 100 persons in 2017 (NIDA, 2019). The U.S. rate for opioid prescriptions is 58.7 prescriptions (NIDA, 2019).

Virginia BlueCross BlueShield provides in-network drug and alcohol rehabilitation providers for addiction treatment.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

How Does Blue Cross Blue Shield of Virginia Rehab Coverage Work?

Virginia BlueCross BlueShield provides rehab coverage for substance addiction and patients who present with a mental illness condition. Patients who seek substance addiction treatment must obtain pre-authorization before visiting with a drug and alcohol rehab specialist.

Under the ACA provisions, mental illness is no longer a pre-existing condition. Patients must obtain permission through their primary care physician. The physician referral will permit patients to visit a drug and alcohol rehab center and set an initial appointment with a therapist.

Virginia BCBS coverage may work for court-ordered medical detox. Rehab coverage also works for inpatient treatment and outpatient treatment. Drug and alcohol rehab coverage include out of pocket expenses for copays, deductibles, and co-insurance. Visits to non-network providers will require payment of out of pocket expenses.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

What is Detox?

Substance addiction treatment plans vary. Medical detox is an addiction treatment process tailored to the individual patient. Some patients with severe substance addiction may need medical detox. Patients who have relapsed due to drug and alcohol substance addiction may further need a detox. Patients who have attempted drug and alcohol abstinence may also need detox because of a record of unsuccessful attempts.

Patients who need detox may also present with a mental illness condition that fits one or more of the criteria under the DSM-5 (2013). A patient with a substance use disorder such as an alcohol use disorder may also present with an anxiety disorder that results from the withdrawal process. Intense cravings are part of the detox process.

Detox includes the withdrawal process where the body withdraws drugs and alcohol. A detox may require prescription medication. Patients under rehab are severely impaired as a result of the process. They become nutritionally deficient. Their body experiences the “shakes” and possible seizures.

A detox may last a minimum of seven days. For severe addictions, patients may undergo medical detox for weeks. Length of stay in rehab is dependent on the individual’s addiction treatment plan.

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

What are the Differences Between Inpatient and Outpatient Treatment?

Virginia BCBS provides rehab coverage for inpatient treatment and outpatient treatment.

Inpatient treatment includes inpatient residential treatment. Length of inpatient residential treatment is predicated on the addiction treatment plan. Inpatient treatment requires patients to live on campus, attend daily and weekly therapy, and participate in group therapy. Patients must abstain from drugs and alcohol while in inpatient treatment. Inpatient treatment may be necessary for patients with severe substance addictions such opioid use disorder, alcohol use disorder, and inhalant use disorder, and other substances under the DSM-5 (2013).

Outpatient treatment is dedicated to patients with less severe substance addiction. Counseling is required as well as daily attendance to the drug and alcohol rehab facility. Patients work with a licensed counselor and participate in structured activities. Aftercare support may be part of the outpatient treatment program.

Virginia BlueCross BlueShield offers the following treatment options:

Inpatient Treatment

  • Substance addiction treatment plan
  • Shared room and board; private room without of pocket expense
  • Detox, including prescription, seven days to weeks
  • Therapy and counseling

Contact Virginia BlueCross BlueShield for more information about coverage and out of pocket expenses.

Outpatient Treatment

  • Outpatient treatment and aftercare plan
  • Home returns
  • Daily attendance
  • Aftercare support, if necessary

For more information on your coverage and plans or access to resources, contact Virginia BlueCross BlueShield.

Get the Help You Deserve Today

If you or a loved one needs drug and alcohol rehabilitation treatment, contact Virginia BlueCross BlueShield discover your healthcare options.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Washington, D.C.: American Psychiatric Publishing.

National Institute on Drug Abuse. (2019, March). New York opioid summary. It is retrieved from https://www.drugabuse.gov/opioid-summaries-by-state/new-york-opioid-summary.