Modified: 15th Oct 2019

Maryland Blue Cross Blue Shield 

Signs You May Need Rehab

Seeking treatment for substance addiction is an important step. Feeling overwhelmed by drug and alcohol addiction can contribute to denial you exhibit around friends and family members. 

One of the most important signs that you may need drug and alcohol rehabilitation is the denial that you have a substance addiction. The way you deny your addiction is by hiding it from friends and family members, denying that you over-consume drugs and alcohol, and denying that drugs and alcohol have caused significant impairment in your thinking, actions, and social relationships. 

Prolonged substance use might lead to significant clinical impairment and may affect your ability to make sound judgments. Impairment is also a sign that you may need drug and alcohol rehabilitation. 

If you have received a diagnosis of a co-occurring mental illness condition with a diagnosed substance use disorder, then this is further a sign that you may need drug rehab. Patients presenting with a mental illness condition may be comorbid with a substance use disorder that fits one or more criterion of the Diagnostic and Statistical Manual of Mental Disorders (2013). 

It is essential to speak with a drug and alcohol rehabilitation specialist. You may contact your primary care physician for a physician referral, which is also another sign that you may need drug rehab. 

The following are additional signs that you may need drug rehab: 

  • Over-consumption leading to tolerance
  • Daily seeking 
  • Withdrawal symptoms 
  • Impairment leading to loss of job, friends, and close relationships

If you cannot navigate family and close relationships, this may be a sign that you struggle with triggers and daily stressors. Without treatment, your substance use might lead to significant problems later. 

Contact Maryland BlueCross BlueShield to determine your drug rehab needs. Health plan coverage depends on your addiction treatment. 

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

Do Blue Cross Blue Shield of Maryland Plans, Cover Drug & Alcohol Rehab?

Maryland Blue Cross Blue Shield health plans provide pre-authorized drug and alcohol coverage. Healthcare services, including prescription drugs for drug rehab, require authorization through a primary care physician. 

It is the health plan member’s responsibility to obtain authorization before services. Patients may be responsible for out of network expenses for services utilized without securing prior approval. 

Doctors may request coverage exceptions for non-formulary drugs. Urgent requests receive consideration within 24 hours. Non-urgent applications receive consideration within two business days. To obtain limitations, plan providers and members must contact member services by logging in to “My Account.”

Maryland BlueCross BlueShield coverage and benefits vary by plan and market. Maryland BCBS covers medically necessary health services. Physician referrals for drug and alcohol rehab are considered medically necessary. Maryland BCBS may cover all drug rehab in-network costs. Maryland BCBS will bill you for non-participating providers. Patients will be responsible for the deductible, co-insurance, co-payments, and other healthcare costs that are not authorized.

Physician referrals will provide you with your first appointment to speak with a therapist at the drug rehab center. Once you make the appointment, you will receive an assessment of your substance addiction and the type of treatment you may need. Treatment might include medical detox or inpatient treatment. The therapist will also evaluate any underlying mental illness condition. 

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

The History of Blue Cross Blue Shield of Maryland

Maryland Blue Cross Blue Shield provide high-quality healthcare coverage for its members. 

Maryland BCBS began as Group Hospitalization in 1934. It was sanctioned to use the Blue Cross Servicemark in 1942. Maryland Hospital Services, Inc. enrolled one million members in 1957. In 1972, Maryland Blue Cross introduced a healthcare program for pre-paid group members as an alternative to traditional healthcare. 

Today, Maryland BCBS has provided $40 million to nonprofit organizations, has granted access to underserved communities, and has invested in public care access programs. 

Maryland BCBS service areas include Maryland, District of Columbia, Alexandria, Fairfax, Arlington County, and Prince William Counties in Virginia.

It’s signature program is the Patient-Centered Medical Home Program, which is a model that coordinates care to manage overall healthcare costs for members with a chronic disease. The plan was launched in 2011. 

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield. 

Why Do We Need Rehab Coverage?

The rise of the opioid crisis has made rehab coverage a necessity. Healthcare providers nationally have overwritten opioid prescriptions in contrast to the current U.S. rate. The National Institute on Drug Abuse (NIDA) has provided state-by-state statistics on opioid addiction, overdose deaths involving opioids, and prescriptions that have affected adolescents and youths. 

Rehab coverage is also available for patients who present with a substance use disorder with an underlying mental illness condition. The 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act have both made drug rehab coverage available for substance disorders and mental illness conditions. 

The National Institute on Drug Abuse (NIDA) reports that in 2017, there were 1,985 overdose deaths involving opioids in Maryland, at a rate of 32.2 deaths per 100,000 persons. Maryland healthcare providers wrote 51.7 opioid prescriptions for every 100 persons in 2017 (NIDA, 2019). The U.S. rate for opioid prescriptions is 58.7 prescriptions (NIDA, 2019). 

Maryland BlueCross BlueShield will help you locate an in-network drug rehabilitation provider to ensure rehab coverage. For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

How Does Blue Cross Blue Shield of Maryland Rehab Coverage Work?

Blue Cross Blue Shield Maryland provides rehab coverage subject to prior authorization. Plan members must obtain pre-certification for healthcare services, except in cases of an emergency. Rehab coverage for urgent care services is predicated on approval. Healthcare coverage must be medically necessary. Out of pocket expenses will apply for non-network healthcare services. 

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

What is Detox?

Patients who have presented with over-consumption of drugs and alcohol, leading to prolonged use and further leading to tolerance may need medical detoxification. 

Detox is defined as the withdrawal process where the body undergoes the experiences of ridding itself of toxins and chemicals due to over-consumption of drugs and alcohol. During detox, patients cannot consume drugs and alcohol. Patients are expected to complete the detoxification process. Patients may receive prescription medication for help with withdrawal symptoms. For patients with severe addiction, detox may be considered medically necessary. The initial assessment with the drug rehab therapist will determine the length of medical detox. 

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

What are the Differences Between Inpatient and Outpatient Treatment?

Inpatient residential treatment may be necessary for patients with severe addictions. The inpatient residential treatment process is one step down from detox. Patients enrolled in an inpatient treatment program that offers structured programming, licensed counseling, and individual and group therapy. Patients live on-site and receive medical care when necessary. Patients may be required to obtain authorization for inpatient residential treatment.

Outpatient treatment may be necessary for less severe substance addiction. Outpatient treatment requires daily attendance but home returns. Patients must speak with a licensed counselor and participate in structured programming when needed. Outpatient treatment may serve as aftercare support for specific addiction. 

Maryland BlueCross BlueShield offers the following treatment options:

Inpatient Treatment

  • Residential treatment
  • Detox
  • Counseling

Contact Maryland BlueCross BlueShield for more information about coverage and out of pocket expenses. 

Outpatient Treatment

  • Daily attendance
  • Home returns, work, school
  • Counseling
  • Aftercare support

For more information on your coverage and plans or access to resources, contact Maryland BlueCross BlueShield.

Get the Help You Deserve Today

If you or a loved one needs drug and alcohol rehabilitation treatment, contact Maryland BlueCross BlueShield discover your healthcare options. 

Maryland BlueCross BlueShield Resources 

Maryland BCBS Health Plans

Maryland BCBS Company Overview

Maryland BCBS Mental Health Parity Notice

Maryland BCBS Our History

Maryland BCBS Transparency in Coverage

Healthcare and Government Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Washington, D.C.: American Psychiatric Publishing.

Beronio, K., Po, R., Skopec, L., & Glied, S. (2013, February 20). Affordable care act expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans. Retrieved from https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans

Centers for Disease Control and Prevention. (n.d.). Fact sheets—excessive alcohol use and risks to men’s health. It is retrieved from https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm.

National Institute on Drug Abuse. (2019, March). Maryland opioid summary. It is retrieved from https://www.drugabuse.gov/opioid-summaries-by-state/maryland-opioid-summary.