blue cross blue shield rehab coverage

How to Apply for Blue Cross Blue Shield Rehab Coverage

If you or someone you love is struggling with addiction, you’re not alone. In fact, nearly 21 million people in the U.S. are living with a substance use disorder. For many of those people, treatment isn’t something they can afford on their own. Fortunately, the cost of addiction treatment is covered, at least in part, by insurance. Large companies like Blue Cross Blue Shield offer rehab coverage to those that need it.

Today, Blue Cross Blue Shield (BCBS) and its community-based companies offer coverage to more than 106 million people. All 50 states, Washington, D.C., and Puerto Rico offer Blue Cross Blue Shield insurance plans.

If you have an insurance plan with this company, read on to learn more about addiction and Blue Cross Blue Shield rehab coverage.

What Is Addiction?

Addiction (also known as substance use disorder, or SUD) is a disease that affects how the brain and body function. The most common symptoms of addiction are a significant loss of control over drug or alcohol use, continued use despite serious consequences, preoccupation with using, failed attempts to quit, tolerance, and withdrawal.

Since addiction affects the brain, it compromises judgment and self-control. People who try to stop using without professional help often relapse; usually more than once. This vicious cycle of quitting and relapsing requires extensive treatment in the form of medical detox, residential care, or outpatient treatment. 

Types of Rehab

There are several options for drug treatment, and you may benefit from more than one. Most people who enter rehab start with detox and end with outpatient services.

Medical Detox

Depending on how severe the addiction is, some people may not physically be able to stop. In some cases, stopping suddenly— or quitting “cold turkey”— can be dangerous. This is especially true for those who struggle with alcohol abuse. At its worst, alcohol withdrawal can cause hallucinations or even seizures.

Medical detox is the best first step for patients entering rehab. During medical detox, doctors and other medical professionals supervise patients and assist in the detox process. Sometimes, they even prescribe non-addictive medication to ease the symptoms of withdrawal.

Residential Treatment

During inpatient treatment, patients live in a specialized facility while receiving treatment and counseling. Residential treatment can last up anywhere from a few weeks to a few months.

Like medical detox, inpatient programs provide around-the-clock treatment, support, and monitoring. The structure of inpatient programs is especially beneficial for patients entering rehab for the first time.

Moreover, most residential facilities offer a variety of therapies, including cognitive behavioral therapy, life skills, couples and/or family therapy, and 12-step meetings.

Addiction and substance abuse often co-occur with other health problems. Effective inpatient treatment will also address things like mental health conditions, nutrition, and exercise.

Outpatient Treatment

Unlike inpatient programs, outpatient programs offer daytime care while also allowing patients to continue living at home with family. These types of programs work exceptionally well for people who have children or need to keep working at their jobs during treatment.

During outpatient treatment, patients come in every morning for activities and checkups before attending therapy sessions and returning home for the evening. Typically, outpatient treatment lasts up to eight hours per day.

For those who need it, most medical rehab facilities also offer intensive outpatient programs (IOPs), which are similar to inpatient programs without the residential aspect of care. Intensive outpatient programs are also less expensive than inpatient programs.

Blue Cross Blue Shield Rehab Coverage

Blue Cross Blue Shield (BCBS) serves members in all 50 states. If you have an insurance plan through BCBS or one of its state-based companies, then your policy will most likely cover drug and alcohol rehab programs.

However, it’s important to note that, depending on a variety of factors, the level of your coverage may vary.

Affordable Care Act Requirements

The Affordable Care Act requires insurance companies to provide coverage for ten essential healthcare services. Those services are:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services

Plus, no matter what insurance company you have a plan with, the ACA caps out-of-pocket costs. That means that there is a limit to how much you are required to pay out of the amount not covered by your insurance policy. 

For example, in 2019, the maximum allowable out-of-pocket exposure is $7,900 for an individual and $15,800 for a family.

Types of Blue Cross Blue Shield Coverage

All insurance companies group their health insurance plans into categories. For BCBS, its policies fall under bronze, silver, gold, or platinum categories. The platinum plans cover the most but also cost the most.  

Generally, the bronze level plans cover about 60 percent of medical expenses after the deductible. Silver plans typically include co-pays for office visits and cover about 70 percent of medical costs after the deductible. 

Gold and Platinum plans cover 80 percent and 90 percent of covered medical expenses after the deductible, respectively. 

What Types of Rehab Does Blue Cross Blue Shield Cover?

BCBS will often cover inpatient drug treatment if a medical assessment deems it necessary. But, again, coverage varies from plan to plan.

A typical inpatient stay lasts between 30 and 60 days. Still, the amount of time will depend on the patient’s condition and insurance plan. Some plans cover an unlimited number of days while others only cover a specific amount.

Most BCBS plans also cover outpatient treatment services like counseling and psychiatric care. Additional drug and alcohol addiction treatment services covered by BCBS may include:

  • drug testing
  • group therapy
  • family therapy
  • individual therapy
  • mental health treatment programs
  • medically supervised detox programs

Overall, the most important thing to remember when looking at Blue Cross Blue Shield rehab coverage is to talk to your insurance provider about your policy. Remember, policies vary from person to person and from state to state. So, be sure to ask about what kind of coverage your particular plan offers. 

Questions to Ask Your Blue Cross Blue Shield Insurance Provider

Before you make any plans to enter rehab, ask your insurance representative for more information about your policy. It’s important to know what kind of coverage you have so that you can understand what to expect when you look at various treatment options.

For example, you could ask any of the following questions:

  • Does my plan cover medical detox?
  • What kinds of outpatient care are covered?
  • Are inpatient programs covered under my plan?
  • Is there a limit on how long I can stay in an inpatient facility?
  • What paperwork do I need to submit before entering treatment?
  • What will I have to pay for any treatment services out-of-pocket?
  • Is a medical assessment necessary for specific treatments to be covered?
  • Does my plan cover the costs of any medications that may be provided during treatment?

Final Thoughts About Blue Cross Blue Shield Rehab Coverage

Blue Cross Blue Shield insurance covers a wide variety of treatment options for drug or alcohol addiction.

Please reach out to us if you have questions about addiction, treatment or scheduling an intervention. We would be happy to answer your questions and advise you and your family on your next steps, including helping you understand your insurance coverage better, specifically Blue Cross Blue Shield drug rehab.


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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.