Signs You May Need Rehab

One of the significant signs that you may need rehab is if your primary care physician provides a physician referral for you to speak with a drug and alcohol specialist or for you to enroll in a drug and alcohol treatment program.

Individuals who may need drug and alcohol rehabilitation tend to be dual-diagnosed with a substance use disorder and a mental illness condition.

Individuals who may need drug and alcohol rehabilitation may have a record of attempting to abstain from drugs and alcohol but without much success.

Individuals who may need drug and alcohol rehabilitation may have built a tolerance for drugs and alcohol, which makes them indifferent to substance addiction treatment. 

Lastly, individuals who may need drug and alcohol rehabilitation are often in denial about their overconsumption. They are typically in denial about their prolonged use of drugs and alcohol. 

Signs that you may need drug rehab to include the following: 

  • The severity of substance addiction 
  • Giving into triggers and daily stressors associated with drugs and alcohol consumption
  • Ignoring the cravings of drugs and alcohol 
  • Indifference to repairing close relationships due to substance addiction

To resolve your substance addiction, you will need to enroll in a medical detox program if this is necessary or in inpatient residential treatment. 

Contact Empire New York 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 New York BlueCross BlueShield.

Do Blue Cross Blue Shield of New York Plans Cover Drug & Alcohol Rehab?

Empire New York Blue Cross Blue Shield provide medically necessary drug and alcohol rehab addiction treatment. Patients must receive pre-approval for healthcare services. Preapproval may be defined as precertification, prior authorization, and preauthorization. Preapproval is the process of confirming that a healthcare service is medically necessary. 

New York BCBS may cover pre-existing conditions depending on your HMO benefit design. Mental illness is no longer a pre-existing condition under the Affordable Care Act of 2010. If you are diagnosed with a substance use disorder with also an underlying mental illness condition, then New York BCBS will likely provide drug and alcohol rehab coverage. Visits to non-network providers and non-authorized services may require out of pocket expenses. 

Drug and alcohol rehab coverage require copays, deductibles, and co-insurance, even for medically necessary treatment.

You will need to visit a drug and alcohol rehabilitation center after you obtain authorization. You will set your initial appointment where the therapist will discuss your substance addiction and any other underlying conditions. At this appointment, you will learn about a tentative addiction treatment plan. 

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

The History of Blue Cross Blue Shield of New York

Empire New York Blue Cross Blue Shield have NCQA accreditation as a private, non-profit organization. The NCQA evaluates the healthcare system and the provision of quality of care. 

Empire New York BCBS provides healthcare plans for individuals, families, federal employees, and Medicare and Medicaid. 

Empire New York BCBS is divided into two healthcare systems that are licensed by the BlueCross BlueShield Association: 

  • Empire HealthChoice HMO
  • Empire HealthChoice Assurance, Inc. 

Empire New York BCBS contracts with Radiant Services, LLC to provide approval for healthcare treatment. Contact Member Services for more information. 

Empire New York BCBS serves the New York region. 

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

Why Do We Need Rehab Coverage?

Rehab coverage is supported by the provisions of the ACA and the Mental Health Parity and Addiction Equity Act of 2008, which the latter governs how healthcare insurers provide coverage for substance use disorders and mental illness conditions. Drug and alcohol rehab coverage is necessary for patients with substance addiction and an underlying mental illness condition that hinders their addiction recovery.

Rehab coverage is also necessary to address and resolve the current opioid, prescription drug, and synthetic marijuana crises flooding regions nationally and affecting adolescents and youth, and adult men and women. 

Rehab coverage is necessary for individuals struggling with prolonged use of drugs and alcohol. Prolonged use without attempts to abstain from drugs and alcohol or with unsuccessful attempts to abstain from drugs and alcohol may lead to issues with tolerance. 

Patients with prolonged, severe addictions typically are entered in medical detoxification because overconsumption of drugs and alcohol have led to health and legal problems. Rehab coverage provides significant benefits to seek treatment and manage addiction recovery.

The opioid prescription crisis is especially poignant. The National Institute on Drug Abuse (NIDA) reports that in 2017, there were 3,224 overdose deaths involving opioids in New York, at a rate of 16.1 deaths per 100,000 persons. New York healthcare providers wrote 37.8 opioid prescriptions for every 100 persons in 2017 (NIDA, 2019). The U.S. rate for opioid prescriptions is 58.7 prescriptions (NIDA, 2019). Heroin-involved deaths in New York rose from 666 deaths to 1,356 deaths (NIDA, 2019). Prescription opioid deaths rose from 859 in 2013 to 1,044 in 2017 (NIDA, 2019). 

New York 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 New York BlueCross BlueShield.

How Does Blue Cross Blue Shield of New York Rehab Coverage Work?

New York BlueCross BlueShield offers consumer protections through their grandfathered health plans. Under the Affordable Care Act of 2010 provisions, patients may receive drug and alcohol rehab coverage as well as coverage for mental illness condition. The ACA provides protections for comparable coverage of substance use disorder with a co-occurring mental illness condition with medical and surgical procedures provided under the New York BCBS health plan. 

Patients must receive preauthorization to visit an in-network drug and alcohol, rehab provider. Physician referrals constitute medically necessary treatment. Any medically essential treatment covered under the New York BCBS will typically include court-ordered detox, medical detox through individual enrollment, and any inpatient residential treatment. Outpatient treatment generally is not covered, and patients may be required to pay out of pocket expenses. Prior authorization is necessary for in-network and non-network providers. Visits may include urgent care services. 

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

What is Detox?

Detox is typically required for patients with severe addictions. It is also necessary for patients who have tried to abstain from drugs and alcohol but have been unsuccessful after repeated attempts. 

Detox is also necessary for patients with an underlying mental illness condition and a primary substance use disorder. Patients who have an alcohol use disorder may present with a major depressive disorder, antisocial personality disorder, adult conduct disorder, and anxiety disorder under criteria of the Diagnostic and Statistical Manual of Mental Disorders (2013).

Detox is medically necessary for severe substance addictions. Patients undergo the withdrawal processes where drugs and alcohol are rid of the physical body. Patients receive prescription drugs for medical problems experienced during the process. Some medical issues that result from detox might include seizures. Medication will help to alleviate withdrawal symptoms. 

A detox may last for days or weeks depending on the severity of the substance addiction. 

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

What are the Differences Between Inpatient and Outpatient Treatment?

Inpatient treatment and outpatient treatment differ by length of stay.

Inpatient residential treatment requires an addiction treatment plan that also requires patients to remain on campus, abstain from drugs and alcohol, and participate in structured activities, including group therapy. Patients must work closely with a drug and alcohol rehabilitation counselor.

Outpatient treatment may be optional for some patients without severe substance addiction. Patients must attend daily therapy and counseling and participate in related center activities.

Detox, inpatient treatment, outpatient treatment, and aftercare support may be required for patients severely addicted to substances after prolonged use.

New York BlueCross BlueShield offers the following treatment options:

Inpatient Treatment

  • Residential stay by the treatment plan
  • Detox by the treatment plan 
  • Individual and group therapy by the treatment plan 

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

Outpatient Treatment

  • Daily attendance
  • Aftercare support

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

Get the Help You Deserve Today

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

Empire New York BCBS Benefits Claims

References

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

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

Resources

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