Does BlueCross BlueShield Cover Addiction Rehab?

Typically, yes. But coverage varies from state to state and plan to plan. It all depends on your policy coverage.

It can be overwhelming to go through your BCBS policy to find out if they will cover the cost of substance abuse treatment for you or a loved one. Please call us, so we can check your eligibility.

BlueCross BlueShield Insurance for Drug and Alcohol Treatment

BCBS insurance companies are nationwide and insure close to 105 million individuals and families that’s almost one in every three people that they cover! While each policy varies, providing a range of benefits that can cover drug and alcohol addiction treatment, the assorted options can include anywhere depending on the state you live in and what plan you have purchased.

does insurance cover rehab

Universal BCBS coverage includes some of the costs associated with the following levels of care:

  • Inpatient Hospitalization
  • Residential Detox or Non-Medical Detox
  • Residential Level Treatment
  • Partial Hospitalization Treatment
  • Intensive Outpatient or Outpatient Treatment

Helping You Navigate Your BlueCross BlueShield Drug Rehab Policy

A high number of rehabilitation facilities across the country accept BlueCross BlueShield (BCBS) insurance for all types of substance abuse treatment services.

While we help people nationwide with many different types of BlueCross BlueShield plans, here are a few providers we mainly have a lot of history with:

  • Premera Blue Cross of Washington
  • Empire BCBS of New York
  • Horizon BCBS of New Jersey
  • Massachusetts BCBS
  • Illinois BCBS

BlueCross BlueShield is accepted in all 50 states and covers more than 100 million Americans. As a network, BCBS is made up of more than 35 independent and locally operated agencies, all of which help policyholders navigate state laws regarding health care. More than 96 percent of hospitals and 92 percent of health care providers work directly with a BCBS agency.

If BlueCross BlueShield covers you, then you should have several options for a successful and healthy recovery from addiction.

Addiction Prevention Tools and Resources with a BlueCross BlueShield Policy

BlueCross BlueShield also has several different resources that can help you identify or find help for substance abuse problems. The company, most recently, has created a prescription pain medication safety program that can help individuals who may be at risk of drug addictions, by reducing them. The platform specifically was designed for painkillers containing narcotic opioids like Vicodin and Percocet.

The application provides members and families with 24/7 support. BlueCross BlueShield sponsors the mobile platform called OneHealth. In it contains the education and tools needed to help recover from substance abuse.

Policy Coverage for Substance Abuse with BlueCross BlueShield Insurance

Depending on your location, BlueCross BlueShield offers different plans. Current plans are the bronze, silver, gold, or platinum level. The Bronze Plan is the lowest in coverage, along with the lowest monthly premium and highest deductibles. The higher-level plans, such as the Platinum or Gold, have a higher cost and provide more comprehensive coverage with lower deductibles.

If the policy is a Federal Employee Program policy (commonly known as BCBS Federal policy), it usually consists of two plan options, either the first option or the standard option. The basic Federal employee plan option requires individuals to use providers within a preferred network. At the same time, the standard plan allows its members to choose between preferred and non-preferred providers (also known as PPO).

Policyholders might be responsible for the difference in cost between the plan allowance and the actual billed amount by the provider if an out-of-network or non-preferred provider was used.

How BCBS Policies Work for Addiction Treatment Centers

BlueCross BlueShield is accepted, at least on some level, by most addiction treatment centers, although the coverage varies significantly from state to state. It is not uncommon for someone with a policy in one state to have all of their claims approved and in the neighboring state have all of their claims denied.

In some cases, we have seen extreme stipulations on a policy, such as only hospital treatment or no substance abuse or mental health benefits at all.

Due to the complexity of BlueCross BlueShield insurance coverage from state to state, Addiction Treatment Services helps you find the highest possible level of care at the least amount of expense.

Furthermore, contacting BCBS directly may not yield the best options for you, as we base most of our referrals on the past experiences of actual clients who have gotten their alcohol and drug rehab treatment programs covered by insurance.

Does it need to be a In-Network BlueCross BlueShield Rehab?

BlueCross BlueShield plans will typically fall under one of two categories: an HMO (Health Maintenance Organization) plan or a PPO (Preferred Provider Organization) plan.

HMOs usually only cover services provided by HMO-contracted facilities. PPO plans have more options regarding the number of providers from with thy have access to.

With a PPO plan, covered individuals can be treated by an out-of-network facility. However, the expenses for the member will be considerably higher.

Each plan is different, so be sure to speak with your insurance provider about specific details about a plan’s coverage. The financial responsibility of going to a substance abuse treatment center most commonly is what determines which one the individual chooses to go to.

About BlueCross BlueShield Coverage for Detox

In many instances, those who are seeking treatment for an addiction problem must first go through a medical detox process. This isn’t the case for everyone, but for those who are suffering from certain types of addiction, such as benzodiazepine dependence or alcoholism, a detox may be in order.

Detoxing from excessive use of benzos, alcohol, or opiates can be very difficult and even dangerous if individuals do not go through a medical detox process. So, in cases like these where detox is necessary, it’s essential to have information about BlueCross BlueShield’s policy on drug and alcohol detox.

Your BCBS insurance may cover inpatient detox or outpatient detox. But, like with many policies, just a portion of the detox process will be covered. Again, coverage mainly depends on the type of plan you have and the kind of facility you are considering. If you have an HMO plan, you may only be covered if you attend an HMO-contracted detox center. A PPO plan may enable you to choose from a wider variety of detox facilities.

BCBS offers a little more flexibility on detox and treatment options than some other insurance companies. Individuals who are looking for medical detox centers that are covered by BlueCross BlueShield can likely find a facility with little difficulty. But, the best way to know for sure which detox facilities are included in your options, it may be best to call the insurance company to get more details about coverage. You can also contact us here at Addiction Treatment Services.

BlueCross BlueShield Covers Inpatient Treatment

Again, a BlueCross BlueShield policy varies for each state. Coverage is dependent on state laws and regulations.

Again, a BlueCross BlueShield policy for inpatient drug treatment varies for each state. Coverage is dependent on state laws and regulations.

It also depends on the state and facility where the member receives care and treatment services. For example, coverage for an individual who gets treatment at a hospital may differ from coverage for a member who receives treatment at a residential (inpatient) addiction treatment center. Also, service provided by a physician’s office will cover different amounts than a service provided at a hospital or treatment facility.

Additionally, BlueCross BlueShield plans might call for a pre-certification for those who are planning to attend an inpatient hospital or facility for substance abuse treatment and services.

If your insurance policy covers your addiction treatment, it will do so regardless of the type of substance abuse problem. That means the policy should be able to help, whether you’ve been suffering from a dependence on opioid painkillers or an addiction to alcohol.

Costs and Services BCBS Covers at Inpatient Rehab Level of Care

Inpatient programs offer the highest level of treatment care, with medically supervised detoxification and around-the-clock care and support. Here are some definitions of standard terms regarding health plan coverage:

Premium – This is a monthly payment made to a health insurance company by the policyholder to maintain coverage. Many times, individuals are fortunate enough to have employer-provided insurance, meaning that the company picks up all or part of the monthly premium cost.

Coinsurance – Coinsurance, like a copayment, is a form of cost-sharing for services involving healthcare and prescription medications. It is never a flat fee and is always a percentage of the cost for a health service or Rx paid by a member once they have reached their deductible.

Deductible – This is the amount you will need to pay before your health insurance starts to cover a more substantial portion of your bills. As an example, if your deductible is $1,000, you must pay $1,000 for your care out-of-pocket before the insurance kicks in and pays a higher percentage of the costs- the deductible resets yearly.

Out-of-pocket Maximum – This is the most amount of money you may have to pay in one year out of your pocket for healthcare services you receive before your coinsurance covers 100 percent of the bill.

Here is a rough cost estimate for Inpatient Rehab with commonly used plans with BlueCross BlueShield:

Bronze Plan – Carry the minimum deductible amount for in-network providers. Out-of-network Providers are usually NOT covered.

Silver Plan – Generally, a coinsurance percentage in addition to the deductible for in-network. Usually, out-of-network is NOT covered.

Gold Plan – These plans require a coinsurance percentage (usually this is a smaller amount than that of the lower level plans), as well as a deductible. Out-of-Network providers are not covered.

Platinum Plans – Any in-network provider services will have one or the other- a copay per day (with a maximum daily amount) or coinsurance percentage. Sometimes out-of-network services are covered. If out-of-network is included, it will come with a higher coinsurance percentage as well as the deductible.

BCBS Coverage for Mental Health Treatment

For those who are living with mental illnesses, BlueCross BlueShield can help to cover the costs of care. Behavioral and mental health disorders often co-occur with addiction problems; this is known as dual diagnosis. In these cases, addiction and mental health care are both necessary to help individuals who are suffering from these issues. Finding care for co-occurring disorders can sometimes be challenging. But, it’s best to know which options are available and how your BCBS insurance policy can help you to find the resources you need.

Insurance plans should provide the same coverage for mental health concerns and challenges as they do for matters related to physical health. In other words, an insurance plan offers a certain amount of coverage for treatment for a physical injury or concern must also provide that level of care for treatment for a mental health issue.

Common mental and behavioral health disorders may include:

  • Depression
  • Anxiety
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder

Those who suffer from these disorders, in addition to substance use disorders, can find treatment options that will cater to their individual needs. BCBS can help to provide coverage for this treatment. Again, however, it’s essential to speak with our professional team to discuss the mental health coverage of your policy.

Helping You Understand Your BlueCross BlueShield Benefits

Here are some other benefits to being a BCBS policyholder and enlisting the help of Addiction Treatment Services:

  • We will thoroughly review your BlueCross BlueShield health insurance plan.
  • We will help determine if you are covered for substance abuse treatment.
  • We will help determine what kind of treatment and how much is covered.
  • BlueCross BlueShield health insurance is accepted by almost every treatment center in the U.S., so we’ll identify which ones will work best with your policy.

We know the specifics of your insurance coverage are confusing and not always easy to understand. Addiction Treatment Services will clarify your insurance coverage with BlueCross BlueShield for you and make sure you have a better understanding of what your insurance will cover and what may or may not come out of pocket.

does insurance cover drug rehab

Understanding your treatment center options is vital for both your sobriety and long-term health goals. Addiction Treatment Services does a thorough job of explaining what your insurance covers and which treatment centers are available in light of your policy.

A side note: BlueCross BlueShield plans often require some kind of pre-certification for any inpatient hospital or facility treatment for substance abuse. Pre-certification, also known as prior-authorization, is the process of getting a pre-approval from BlueCross BlueShield before receiving any services. This is to let the provider know in advance what your health plan will cover services.

The Addiction Treatment Services Promise

We won’t recommend a drug and alcohol rehab facility unless it meets or exceeds our standards of what comprises an effective, comprehensive, and client-centered program. At Addiction Treatment Services, we’ve been in your shoes and understand what you’re going through. Sometimes what you think you need for your recovery isn’t necessarily what’s going to work best.

Questions About Insurance?

Navigating your insurance plan to determine what type of substance abuse coverage you qualify for can be overwhelming. Our insurance specialists are available 24 hours a day to assist you.


State Resources

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