blue cross blue shield drug rehab

Does Blue Cross Blue Shield Cover Drug Rehab?

There are few things worse than needing help and not knowing if you can afford it. With the average cost of drug rehab running anywhere from a few hundred dollars per week to tens of thousands per month, it’s not surprising that users and their families often hesitate to commit to recovery. Thankfully, many health insurance companies like Blue Cross Blue Shield cover the cost of addiction treatment.

Don’t give up on getting the help you need! Here’s what you need to know about Blue Cross Blue Shield drug rehab.

Blue Cross Blue Shield Basics

Blue Cross Blue Shield (BCBS) owns 36 health insurance companies and covers 105 million people across the United States. The company also serves many employees of the Federal government under its Federal Employee Program®.

BCBS coverage is available in all 50 states. If you have a BCBS insurance policy, you’ll need to review it in detail to determine what is and isn’t covered. Coverage varies depending on both the policy type and your resident state.

Generally, coverage falls under either an individual or family plan, which is then broken down into one of four levels.

Bronze Plan

Bronze Plans have a low monthly payment and a high deductible. They generally cover about 60 percent of medical expenses. This plan is the best option for those who don’t go to the doctor often.

Silver Plan

Silver Plans have a slightly higher monthly payment and a slightly lower deductible than Bronze Plans. This plan will cover about 70 percent of your medical expenses.

Gold Plan

Gold Plans have a high payment and low deductible. If you have a Gold Plan, it will cover about 80 percent of your healthcare costs.

Platinum Plan

This is the most expensive option, but it also offers the best coverage. With this plan, you’ll have the lowest possible deductibles and a medical expense coverage of close to 90 percent. It is important to note, however, that not all states offer the Platinum Plan.

Overview of Blue Cross Blue Shield Drug Rehab Coverage

Almost all BCBS plans cover addiction treatment, at least in part. The coverage you’ll receive will depend on your specific circumstances, your specific policy, and the treatment options you elect to try.

Medical Detox

Detoxing from substances such as alcohol, opiates, or benzodiazepines can lead to dangerous and even life-threatening withdrawal symptoms. This is why medical professionals almost always recommend medical detox as the first step in the addiction treatment process.

Medical detox takes place under the regular supervision of a medical team. Detox is almost always medically necessary, so most Blue Cross Blue Shield policies cover it.

If you have an HMO (Health Maintenance Organization) plan, you’ll need to seek treatment at one of the designated HMO facilities to receive insurance benefits.

If you have a PPO (Preferred Provider Organization) plan, you will most likely have to choose from a long list of approved providers. Alternatively, you could pay extra to undergo detox through an out-of-network provider.

Either way, since the BCBS network is quite large, finding a suitable treatment facility will not be difficult.

Inpatient or Residential Care

The cost of inpatient rehab is usually covered by BCBS policies, although coverage amounts will vary.

With a Bronze Plan, you’ll need to pay a minimum deductible for treatment. Silver and Gold Plans usually require a coinsurance payment in addition to the plan’s stated deductible.

It’s important to note that all three of these plans only cover treatment with in-network providers.

Alternatively, Platinum Plans usually have either a per-day co-pay with a maximum or a coinsurance percentage that you’ll need to pay. If you want to receive treatment from an out-of-network facility, it might be covered. However, you’ll have to pay your deductible and a higher coinsurance percentage.

In almost all cases, pre-certification is required before coverage is granted.

Outpatient Care

Outpatient rehab options vary greatly. These may occur at a physician’s office, hospital, or a treatment facility. In any case, the coverage guidelines are the same as for inpatient care.

Under the Federal Employee Program, coverage depends on whether you’ve elected the Standard or Basic option. Under the Standard option, you’ll typically receive 15 percent of the plan allowance. The Basic option allows for a daily copayment per facility.

Pre-certification may or may not be required. Be sure to check with your insurance company ahead of time so that you don’t end up with unexpected lapses in coverage.

Verifying Your Coverage

The best way to determine what your insurance will cover for addiction treatment is by discussing it with a representative. The more information you can get, the better your chances of making informed decisions about your future.

When you call for more information, be sure to keep a list of questions on hand. Some might include:

  • What kind of treatment options does my insurance plan cover?
  • Is there a limit to how many days of treatment will be covered?
  • Are out-of-network providers covered under my insurance plan?
  • Can you provide me with a list of in-network treatment providers?
  • Are there any exclusions or limits on the type of treatment I’m eligible to receive?
  • Does my plan cover medications that might be part of my detox and treatment?

Make sure you write down the answers you receive so you can refer to your notes later. Also, be sure to get the name and extension of the person you speak with and ask whether or not the call is recorded. This can prove extremely valuable if you run into a coverage issue later on.

Options Outside of Blue Cross Blue Shield Drug Rehab

Even though your insurance probably won’t cover the entire costs of your addiction recovery, you can still seek treatment without breaking the bank.

Some treatment providers will start providing you with services right away and allow you to make small monthly payments. Others might offer treatment on a sliding scale, depending on your income.

Get the Treatment You Need Today

Don’t let financial concerns stop you from getting the treatment you need. Whether you qualify for Blue Cross Blue Shield drug rehab or need to find another option, we can help.

At Addiction Treatment Services, we work with a variety of insurance companies. We will work with you to help you find the best possible treatment for your recovery needs.

Whether you’re ready to move forward or are just exploring your options, contact us today. Our addiction intervention specialists are here to help you get on the right track.

Article Reviewed by Dr. Keerthy Sunder, MD, DFAPA

Dr. Keerthy Sunder, MD, DFAPADr. Keerthy Sunder, MD is an accomplished and internationally recognized expert in the field of addiction. He has earned diplomates from the American Board of Psychiatry and Neurology, the American Board of Addiction Medicine, and the Royal College of Obstetricians and Gynecologists.