Modified: 7th Oct 2019

Signs You May Need Rehab

Overconsumption of drugs and alcohol, prolonged use of drugs and alcohol, and clinical impairment due to drugs and alcohol are signs that you may need rehabilitation and addiction treatment. Individuals who seek and obtain alcohol daily may be too impaired to make rational decisions. Substance addiction rehabilitation will help you to address your decision-making with drugs and alcohol, take actions that are more productive for your life, and improve your social relationships with family members and close friends. 

Because mental illness is no longer considered a pre-existing condition under the provisions of the ACA, if you are diagnosed with a substance use disorder co-occurring with a mental illness condition, and you fit one or more criterion under the Diagnostic and Statistical Manual of Mental Disorders (2013), then this is also a sign that you may need rehab. Insurance companies must provide comparable coverage for substance use disorders and mental illness conditions as they do for medical and surgical procedures. 

A drug and alcohol rehabilitation program can assess whether you may need rehab. You will need to contact your primary care physician and obtain a physician referral. If you need a physician referral, then this is also a sign that you need rehab. 

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

  • Substance addiction 
  • Daily triggers with drugs and alcohol
  • Craving drugs and alcohol
  • Impaired relationships

Without addiction treatment, it will be challenging to improve your life and your relationships.

Contact Missouri 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 Missouri BlueCross BlueShield.

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

Missouri Blue Cross Blue Shield health plans provide drug and alcohol rehabilitation coverage. Individual and family health plans require plan members to obtain authorization before meeting with a drug rehab center or therapist. Coverage must be pre-authorized through a primary care physician. Pre-authorization includes prescription medication, detox, and inpatient residential treatment. Patients will be responsible for out of network costs that are not pre-certified. 

Missouri BlueCross BlueShield coverage is based on medically necessary health services. A physician referral determines if drug and alcohol rehab is medically required. Patients are responsible for copays, deductibles, and co-insurance. 

The physician referral provides you with the first appointment with the therapist, where you will discuss your substance addiction. The therapist will assess your behavioral patterns, how long you have been consuming drugs and alcohol, and if there are any signs of prolonged use and tolerance. The therapist will assess any underlying mental illness conditions. 

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

The History of Blue Cross Blue Shield of Missouri

Missouri Blue Cross Blue Shield provide healthcare coverage for individuals, families, Medicare and Medicaid recipients, and plan members traveling out of state. Coverage for medical travel must be approved through the insurer. Missouri BCBS may offer catastrophic plans depending on the age of the individual and the addiction treatment plan. Missouri BCBS services the Kansas City region. BCBS, Missouri, is NCQA-accredited. 

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

Why Do We Need Rehab Coverage?

Drug and alcohol rehabilitation coverage are necessary today for individuals affected by deaths involving the opioid crisis, synthetic marijuana, and overconsumption of alcohol. Patients continually report their struggles with abstaining from drugs and alcohol. Without addiction treatment, patients will be unable to avoid consistently. 

Because the 2008 Mental Health Parity and Addiction Equity Act requires healthcare providers to provide comparable coverage for substance use disorder and mental illness conditions, patients can receive rehab coverage for their alcohol use disorders and their major depressive disorder due to withdrawal symptoms. 

The National Institute on Drug Abuse (NIDA) reports that in 2017, there were 952 overdose deaths involving opioids in Missouri, at a rate of 16.5 deaths per 100,000 persons. Missouri healthcare providers wrote 71.8 opioid prescriptions for every 100 persons in 2017 (NIDA, 2019). The U.S. rate for opioid prescriptions is 58.7 prescriptions (NIDA, 2019). 

Missouri BlueCross BlueShield provides in-network drug and alcohol rehabilitation providers for addiction treatment. 

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

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

Missouri BlueCross BlueShield offers drug and alcohol rehabilitation coverage through in-network providers that require pre-authorization. A physician referral for medically necessary treatment such as detox will ensure that you receive rehab coverage without having to incur an additional cost burden beyond the minimum copayment, deductible, and co-insurance. You will have to pay out of pocket expenses if you visit a non-network provider or visit a rehab provider, whether in-network or non-network, without prior authorization. 

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

What is Detox?

Patients who have severe substance addiction must enter detox. Medical detox is a medically necessary addiction treatment option for patients who daily seek and obtain drugs and alcohol, for patients who present with prolonged use of drugs and alcohol, and for patients with an underlying mental illness condition that may contribute to their substance use of drugs and alcohol.

During detox, the body undergoes a process of withdrawing chemicals and toxins, which may contribute to nutritional deficiencies as well as medical problems leading to seizures. Detox patients receive prescription medication to alleviate symptoms.

Patients are expected to complete detox, which may take anywhere from seven days to weeks, depending on your substance addiction and addiction treatment plan. A detox may fall under emergency services or urgent care services if you are rushed to a hospital. A detox may also be court-ordered, in which case you must complete it.

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

What are the Differences Between Inpatient and Outpatient Treatment?

Inpatient treatment, commonly referred to as inpatient residential treatment, requires patients to live at the drug and alcohol rehabilitation center. Patients undergo a second assessment after detox to determine an appropriate addiction treatment plan. Patients are required to participate in structured activities, receive therapy and counseling, and complete their treatment, including taking prescription medication. Inpatient treatment is the next level from detox. 

Outpatient treatment may be optional for patients without severe substance addiction. Outpatient treatment requires daily attendance with a counselor or therapist. Patients participate in activities and group therapy. They may return home each night. Patients can work and attend school.

Aftercare support follows outpatient treatment. 

Missouri BlueCross BlueShield offers the following treatment options:

Inpatient Treatment

  • Shared room and board
  • Detox with prescription medication
  • Counseling and group therapy

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

Outpatient Treatment

  • Daily participation
  • Work, attend school
  • Group therapy
  • Aftercare support

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

Get the Help You Deserve Today

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

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Other 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 Medicare & Medicaid Services. (n.d.). The mental health parity and addiction equity act (MHPAEA). The Center for Consumer Information & Insurance Oversight. Retrieved from https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

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