If you live in California and have a problem with drugs or alcohol, you’re not alone; according to the National Survey on Drug Use and Health (NSDUH), nearly 5 million individuals 12 and over reported using an illicit substance of some kind between 2015 and 2016, the most current data available. To further put this into context, about 12.5 percent of all Californians reported having a substance abuse problem between 2015 and 2016, which is more than the national average of 10.36 percent. To say that the state of California has a problem with substance abuse would be a gross understatement. Fortunately, many of the state’s largest health insurance providers are making it possible for individuals to overcome addiction by offering health insurance plans that include coverage for substance abuse treatments. And Blue Cross Blue Shield (BCBS) of California is no exception.?


As one of the largest health insurance providers in the United States, Blue Cross Blue Shield provides substance abuse and traditional healthcare coverage through more than 36 locally operated and community-based companies. In the state of California, these companies include Anthem Blue Cross Blue Shield California. As with any other primary health insurance provider, coverage can vary depending on the type of policy a member has in place. For example, some treatments may be automatically covered under some policies while others may require a physician referral and prior authorization from Blue Cross Blue Shield or its ancillary companies. Furthermore, copays, deductibles, and out-of-pocket costs associated with some treatments can also vary from policy to policy. That aside, Blue Cross Blue Shield has probably one the largest networks of healthcare professional of any other health insurance provider, with more than 95 percent of hospitals, physicians, and rehab facilities ready to provide the best care possible to all Blue Cross Blue Shield policyholders.


Blue Cross Blue Shield offers a wide range of policies to help meet the needs of their customers, some of which include PPO (preferred provider organization), HMO (health maintenance organization), and HSA (health savings accounts) plans, all of which allow members to receive the care they need to improve and maintain their health. More than that, all of these plans include coverage for substance abuse and mental health treatments. While we are on the topic of health plans, it is essential to note that all Blue Cross Blue Shield plans have a “metal” level, platinum, gold, silver, or bronze. And coverage for most substance abuse treatments will be based on the policy’s “metal” level. For example, a “Gold” 80 HMO Trio plan will provide coverage for the following:

  • Inpatient treatments
  • Outpatient treatments
  • Psychological testing
  • Hospitalization
  • Office visits
  • Detox services
  • Substance abuse counseling
  • Medication management

It is important to note that members will need to be treated at an in-network facility to have these treatments and services covered under their Blue Cross Blue Shield health insurance policy. That said, it would be a good idea to speak with a Blue Cross Blue Shield of California, Anthem Blue Cross, or Blue Shield California representative to find in-network providers in your area.


Some Blue Cross Blue Shield policies will require a copay for office visits as well as outpatient treatments. And the out-of-pocket costs don’t stop there as some policies also have deductible thresholds and coinsurance rates that must be satisfied before Blue Cross Blue Shield will cover any portion of a member’s substance abuse treatments. On that note, all Blue Cross Blue Shield health plans have an annual out-of-pocket maximum, meaning Blue Cross Blue Shield of California and their ancillary companies will cover any remaining treatment costs at 100 percent once a member has reached that specified dollar amount.


Regardless of the type of policy an individual has in place, Blue Cross Blue Shield will cover many of the crucial aspects of their addiction recovery, including


Recognizing that detox is a critical first step in terms of achieving long-term sobriety, Blue Cross Blue Shield of California will cover the cost of detox assistance treatments under most of their policies. However, there is a caveat in that the health insurance provider will only cover a portion of those costs. Further, the percentage that they will cover can vary significantly from policy to policy. For those who are not familiar with detox, it is a process whereby the body naturally rids itself of drugs and other toxins once an individual stops using. However, this natural process also triggers an onslaught of severe withdrawal symptoms. To get through this aspect of addiction recovery, many individuals will need round-the-clock monitoring and access to prescription-based medication. Some of the most commonly prescribed medications include

  • Suboxone
  • Naltrexone
  • Benzodiazepines
  • Methadone


Like detox, inpatient treatment is also critical to addiction recovery, especially for those with a severe addiction to alcohol or opioids, for example. One benefit of an inpatient program is that individual receive both food and housing, which minimizes their chances of being exposed to outside triggers that can lead to relapse. These programs also provide individuals with access to physicians, counselors, and addiction education courses that can be helpful in their journey toward sobriety. Inpatient treatments can last from several weeks to a few months and will require that individuals submit clean urine tests to remain in the program. That said, members should discuss the specifics of their policy with a Blue Cross Blue Shield, Anthem Blue Cross, or Blue Shield California representative to find out if there is a cap on the number of days that will be covered and also whether or not their policy covers drug testing.


Outpatient treatments are also covered under certain Blue Cross Blue Shield of California policies; however, like other substance abuse treatments provided by the health insurance provider, they may require prior approval. Substance abuse treatments in an outpatient program are nearly identical to those offered in an inpatient program, meaning individuals will still have access to addiction recovery resources. However, there is one big difference; they are free to return home after completing their addiction recovery treatments.


If you need help overcoming a drug or alcohol problem, a Blue Cross Blue Shield of California health insurance policy can provide access to substance abuse treatments that can make achieving sobriety that much easier. To learn more about these treatments or to start a Blue Cross Blue Shield policy, you’re encouraged to speak with one of our health insurance experts today.