For patients who are ready to change their lives through professional addiction treatment, one of the main concerns may be paying for treatment. Many insurance companies, such as Blue Cross Blue Shield, provide at least some level of coverage for drug rehab.
Blue Cross Blue Shield is one of the largest and oldest health insurance companies in the United States. The company provides coverage to more than 100 million people across the nation. Blue Cross Blue Shield covers individuals across all 50 states through independently operated companies and subsidiaries. Many hospitals, healthcare providers and drug and alcohol rehab facilities work directly with Blue Cross Blue Shield.
Behavioral health services, which include mental health concerns and substance abuse, are covered by Blue Cross Blue Shield. While exact coverage varies, these services are required by the Affordable Care Act to be covered at the same rates as other medical and surgical procedures.
Blue Cross Blue Shield Levels Of Coverage
Two levels of coverage are provided by Blue Cross Blue Shield: HMOs and PPOs.
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Health Maintenance Organizations
A health maintenance organization requires members to stay in-network when receiving care for services to be covered. Patients will also likely need a referral from their primary care physician for specialty services like drug or alcohol rehab.
Preferred Provider Organizations
Preferred provider organizations offer more flexibility, allowing members to seek care outside of the network as well. However, services obtained out-of-network are covered at a lower percentage. Patients can seek treatment services through providers who aren’t in-network, but they’ll pay more out of pocket.
Blue Cross Blue Shield Plan Tiers
Blue Cross Blue Shield plans come in different tiers, and while these tiers vary from state to state, there are generally four options: bronze, silver, gold and platinum. Deductibles, co-pays, premiums and coverage amounts vary, which means that coverage for drug and alcohol rehab varies based on what plan a patient has.
- Bronze – While monthly premiums are low, deductibles for these plans are high. Coverage provided is usually about 60 percent.
- Silver – Monthly premiums and deductibles for these plans fall in between those for bronze plans and gold plans, and coverage provided is around 70 percent.
- Gold – A gold plan usually offers about 80 percent coverage, and while monthly premiums are quite high, the deductibles are low.
- Platinum – Platinum plans aren’t available in all areas, but they come with the highest monthly premiums, have low deductibles, and may offer 90 percent coverage or more.
Some of the biggest variables between Blue Cross Blue Shield policies can include:
- Outpatient services
- Hospital benefits
- Physician benefits
- Partial hospitalization
- Number of days or visits covered
Does Blue Cross Blue Shield Cover Drug And Alcohol Detox?
Professional services help patients manage withdrawal symptoms that come with drug or alcohol detox. These symptoms are uncomfortable and have the potential to be dangerous. Medical detox allows patients to get the substance out of their system while under the close supervision of medical professionals.
Although exact coverage for drug and alcohol detox varies, most Blue Cross Blue Shield plans provide coverage for detox if it’s considered medically necessary.
Does Blue Cross Blue Shield Cover Inpatient Rehab?
Once again, exact coverage will vary based upon the individual plan, since Blue Cross Blue Shield plans vary greatly. However, Blue Cross Blue Shield generally only covers inpatient rehab when there’s medical evidence to show a patient requires this type of treatment. Most Blue Cross Blue Shield plans will cover inpatient rehab, but they usually require prior authorization.
Depending on the plan, Blue Cross Blue Shield may pay for an unlimited stay as long as patients pay their copay. However, most plans will only pay for a limited number of days in inpatient rehab.
Does Blue Cross Blue Shield Cover Outpatient Rehab?
Outpatient rehab or intensive outpatient rehab is also covered by most Blue Cross Blue Shield plans. Blue Cross Blue Shield plans may also cover psychiatric care, counseling, group therapy and other treatments. However, the exact coverage and the number of visits covered for outpatient treatment will vary based upon the specific plan.
Does Blue Cross Blue Shield Cover Medication-Assisted Treatment?
Medications are often used in medication-assisted treatment for opioid use disorders to help improve long-term recovery outcomes. Suboxone (buprenorphine and naloxone), methadone and Revia (naltrexone) are often used in conjunction with behavioral therapies to help patients as they stop taking opioids. If patients are prescribed any of these medications as a part of a medication-assisted treatment plan, in most cases prior authorization is required for it to be covered. A patient’s doctor will likely need to provide information or documents showing evidence for the necessity of this medication for treatment.
Methadone is only available through opioid treatment programs certified by the Substance Abuse and Mental Health Services Administration. This means patients cannot simply go into a pharmacy and pick up this prescription. Methadone treatment as generally lasts at least 12 months and may last longer, but long-term treatment with methadone may not be covered by Blue Cross Blue Shield.
Does Blue Cross Blue Shield Cover Sober Living Houses?
Sober living houses, sometimes called halfway houses, offer a form of transitional housing for patients who have completed addiction treatment but who many not yet be ready to dive back into their daily life. Residents have the chance to live in a safe, sober environment as they get their footing in a new life of sobriety.
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Although sober living houses offer a safe environment where patients can recover from addiction, they are not treatment facilities. For this reason, sober living houses may not be covered by Blue Cross Blue Shield.
In-Network And Out-Of-Network Coverage
HMOs will require patients to find treatment within the network for drug and alcohol rehab to be covered, while PPOs give patients greater flexibility and will allow patients to seek treatment outside of the network if they desire. Keep in mind, going out of network can increase the amount patients must pay out of pocket for drug or alcohol rehab services.
If someone is interested in a treatment center that doesn’t appear to be in their network, they shouldn’t give up on getting the addiction treatment they need. Sometimes a verification of insurance benefits performed by one addiction treatment center may yield different results than a verification of benefits done by another treatment center.
A few important things to remember:
- While Blue Cross Blue Shield policies vary, patients usually will have a copay for in-network rehab.
- If patients go out of the network for drug or alcohol rehab, then they’ll also have a deductible to pay.
How To Find Drug And Alcohol Rehab Centers That Accept Blue Cross Blue Shield
- Call Vertava Health for an immediate verification of benefits. Vertava Health can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.
- Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.
- Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.
Get Your Verification Of Benefits Today
Although Blue Cross Blue Shield may not cover all of a patient’s treatment, most plans will cover some of the treatment and help patients on their journey to sobriety. Vertava Health accepts many forms of insurance and can help patients find out what their plan covers.
Call Vertava Health today for a free, confidential verification of benefits.