Modified: 7th Oct 2019

We are in the midst of an opioid epidemic. Drug-related deaths are rising throughout the country, and it will take all of us to battle this monster in our midst. Insurance companies can affect significant change in this area by offering comprehensive rehab coverage so more addicts can get the help they need before their addiction kills them. Highmark Blue Cross Blue Shield of West Virginia is proud to offer its members help with many drug-related services.

Who is Highmark Blue Cross Blue Shield of West Virginia?

Highmark can trace its roots to the 1930s when the Blue Cross Blue Shield companies were established to help residents pay for health care costs. Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield consolidated in 1996, forming Highmark, one of the largest health insurers in the United States. In 1999, Highmark formed a partnership with Mountain Cross BCBS and became the primary licensee of the BCBS trademarks in West Virginia. In 2011, Mountain State BCBS changed its name to Highmark Blue Cross Blue Shield West Virginia.

From the 1930s to the 1990s, the parent companies of Highmark operated as independent organizations. They created a children’s health care program that would later become a model for the national CHIP program. They also had a plan for seniors before Medicare was formed. Regardless of the number of mergers and partnerships formed, Highmark continues to be highly innovative and provides solutions to all patients irrespective of age or health. They provide service to half a million people in 13 counties.

Does Highmark Blue Cross Blue Shield West Virginia Cover the Costs of Drug Rehab?

All of the plans that Highmark BCBS offers in West Virginia cover at least some of the costs associated with rehab. The amount that the plan pays and the amount you pay varies depending on the individual program you have. Out of pocket maximums are applied, so you can be assured that once you hit a certain amount, you will not pay any more out of pocket. There are various deductibles that you may have to meet, and some plans require a copay or coinsurance amount. If you are concerned about paying for rehab, speak to your Highmark agent so they can help you figure out exactly how much you will owe.

Why is Rehab so Important?

Although drug-related deaths are rising all over America, West Virginia has been hit particularly hard. It is now the state with the highest age-adjusted rate of opioid overdose deaths. In only seven years, from 2010 to 2017, the drug-related deaths in West Virginia doubled. Fentanyl and heroin are the biggest culprits.

If a pregnant mother is addicted to opioids, it can affect her baby. There has been a nationwide rise in babies that are born addicted to these substances and require an enormous amount of medical care to stay alive and healthy. From 2011 to 2014, the rate of babies born with these issues doubled in West Virginia. Both mothers and babies are in desperate need for more affordable rehab services.

Addicts, especially single mothers, often think they cannot afford rehab. Highmark covers these services and will continue to do what they can to fight the rising tide of drug-related deaths in America.

How Does Highmark Blue Cross Blue Shield West Virginia Work?

Highmark does require authorization for some services. Inpatient rehab is one of these services. The healthcare provider who has diagnosed you with addiction and prescribed treatment is responsible for obtaining the authorization necessary before you are admitted to rehab. If you have any questions about the authorization progress, you can call the number on the back of your card or visit Highmark’s website. The website includes a complete list of all services that require prior authorization.

What is Detox?

Detox is the first step on the journey to sobriety, but it is not the treatment itself. Detox is the period following the cessation of the drug you have been abusing. When you have no longer been using the drug, your body enters into a period of detox, meaning it is ridding itself from the drug. Abrupt withdrawal of some substances can be life-threatening, which is why healthcare providers recommend medical detox.

Medical detox is a detox that happens while you are medically supervised. It is generally performed in a hospital. Some rehab centers are also equipped to handle a medical detox. Medications are available to help you through the worst parts of detox. As the drug leaves your body, you will experience symptoms such as nausea, shaking, anxiety, and depression. Once detox is complete, you can then start treatment.

11 Criteria That Determine if You Need Rehab

If you’re questioning whether or not you need treatment for alcohol or drug use, the answer is probably yes. The hardest step for most addicts is coming to terms with the fact that they can’t beat the addiction on their own. You may be telling yourself that it isn’t that bad, or that you can quit if you wanted to. There are eleven criteria to meet to determine if you truly have an addiction. These are:

  • Intense cravings of the substance
  • Genuine desire to quit but every attempt is unsuccessful
  • Lack of control, such as anger management problems
  • Spending a lot of time trying to acquire the substance or the money needed to acquire it
  • Not maintaining your responsibilities, whether this is work, school, or family
  • Loss of interest in activities you previously enjoyed
  • Putting yourself in worsening situations, such as trying to steal money to buy drugs
  • Usage is negatively impacting your relationships
  • Using the substances dangerously, such as driving while under the influence or overdosing
  • Withdrawal from your everyday life
  • Tolerance to the drug, meaning you need more and more of it to feel good

Addictions range from mild to severe. Severity is determined by how many of these criteria you meet. For instance, if you meet three of the requirements, you have a mild addiction. If you meet all 11 of these, you need immediate intervention.

Do You Need Inpatient or Outpatient Treatment?

There are pros and cons to both inpatient and outpatient treatment. Outpatient treatment allows you to stay home and continue to go to work and school. You can continue to be with your family and friends while you work on quitting. If you have a mild addiction, as determined by the previously mentioned criteria, outpatient treatment may be useful.

However, there are times when inpatient treatment is going to be the most effective. These circumstances include:

  • Your addiction is severe
  • You have tried outpatient therapy several times without success
  • Your home, work, or school is a trigger for your addiction
  • You do not have a supportive home environment, such as you have a spouse who drinks in front of you
  • Your addiction is to alcohol, which is easily accessible everywhere
  • You need extra mental, emotional or spiritual help to beat your addiction

There is no shame in needing inpatient treatment instead of outpatient treatment. The chances that you will achieve a successful stay of sobriety is much higher when you receive inpatient treatment.

Get Help Today

Highmark has been serving customers for generations. We wouldn’t have survived this long without exceptional customer service. Give us a call today so we can help you understand your options regarding rehab coverage.