Health insurance

Blue Cross Coverage and Rehab: What Does It Cover?

In the US, over 100 people die every day due to addiction problems. This is a growing concern, and it’s been challenging for the authorities to address. As much as fighting addiction is a collective responsibility, there are also individual roles for those affected directly or indirectly.

Among the individual roles is deciding on getting into a rehab, which can be costly for some people. Luckily, with Blue Cross coverage, it’s possible to reduce your out-of-pocket costs for addiction treatments.

But what exactly does the policy cover? In this post, we’ll help you understand the details of the coverage. Read on!

What Is Blue Cross Coverage?

The Blue Cross coverage is a health insurance policy provided by the Blue Cross Blue Shield Association (BCBS), which owns about 36 health insurance companies in the country. Combined, the companies cover over 106 million people.

The coverage plans they offer to customers vary by state, and they fall into three or four categories: bronze plans, silver plans, gold plans, and platinum plans. Some states don’t offer the platinum plan.

The bronze-level plan has the lowest costs while the platinum plan attracts the highest costs. BCBS recommends the bronze plan for people who don’t go the doctor often.

Government employees can also get this policy through the Federal Employee Program.

Does It Cover Rehab?

The details of your coverage depend on the plan you chose, your state, and the BCBS insurance company that provides it.

Generally, Blue Cross coverage may cover part of the cost of drug and alcohol addiction treatment. Most of the plans cover the cost of a medical detox if it’s necessary. Your policy can cover about 60 and 90 percent of the cost.

However, before BCBS offers coverage for the rehab treatment, you’ll have to undergo a pre-certification process. Of course, you can skip the process, but you’ll have to pay a $500 fee.

The Federal Employee Program covers individual and group therapy sessions for outpatient rehab. However, you’re responsible for copay or coinsurance.

Also, keep in mind that the treatment center and specific professionals you choose depend on your plan.

For example, if you have a Health Maintenance Organization (HMO) plan, you’ll use HMO-contracted facilities. For those with a Preferred Provider Organization (PPO), you have access to a wide range of providers, or you can pick an out-of-network provider at a higher rate.

In general, each plan will have different deductibles, limits, co-pays, and daily and per-stay maximums.

Levels of Coverage

BCBS companies provide two types of coverage: HMOs and PPOs.

As noted before, HMOs only allow members to use in-network providers. These providers have contracts with BCBS to provide services at discounted rates. As such, BCBS will only cover your rehab treatments if you use in-network providers.

The HMO network works within a specific geographical area. If you need special services, you’ll need a referral from a primary care provider.

On the other hand, PPO plans are more flexible as members can use  “out of network” providers. However, the coverage for these services will be typically lower. You’ll, therefore, need to spend more.

Also, in PPO, you’ll not need a referral from a primary care provider to see a specialist.

These coverage options are available in addition to the tiered plans (bronze, silver, gold, and platinum) offered by BCBS. If your employer provides the insurance, you should find out if rehab is covered.

You’ll need to pay the deductible, which is the set amount you’ll need to reach before your coverage kicks in at the agreed percentage. For example, if you have a deductible of $500 and your insurer pays 80 percent of the cost, you’ll first need to pay the $500 amount. Then, the insurer will pay the 80 percent after which you’ll pay the remaining 20 percent.

Specialty Alcohol and Drug Treatment

Accord to the Mental Health Parity and Addiction Equity Act, all health insurance companies must provide equal coverage for mental health services, including substance abuse treatment.

As such, BCBS provides adequate coverage for addicts with mental problems and those that need specialty services like relapse prevention and education programs. So, if you need special services, you may need to talk your insurer to determine the ideal plan for you.

However, BCBS requires members to get verification from their providers before such services are covered.

Blue Cross Blue Shield Benefits

If you’re a BCBS policyholder, it’s essential to understand the benefits your plan offers. This is particularly important if you want coverage for your rehab treatment.

Your treatment facility can review your Blue Cross coverage to uncover some of the details you might not know. If you have an existing plan, they’ll determine if you’re covered for substance and drug abuse treatment.

The facility will also determine the kinds of treatments you need and the percentage that your plan covers. Or, if you’re a current member, you can use your Member ID Card on BCBS website to learn more about the specific benefits offered by your company.

For example, Anthem Blue Cross and Blue Shield in New Hampshire covers in-home alcohol treatment program for drug addiction

Final Thoughts

Fighting your addiction is an essential step to leading a healthy life. In most cases, you’ll need professional help to overcome your addiction problems as well as prevent relapse.

At Addiction Treatment Services, we offer several treatment options, including outpatient treatment, inpatient treatment, and detoxification. We accept Blue Cross coverage if your plan covers rehab treatment.

If you don’t understand the details of your plan, we’re here to help. Our team will help you identify drugs and rehab programs that your policy accepts. If you have any questions your BCBS insurance plan, be sure to contact us. Or, call us at (855) 242-8532 to start your recovery journey.


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.