Rehab Centers That Accept Blue Cross Blue Shield Insurance

Blue Cross Blue Shield (BCBS) is an insurance company that began as two separate entities in the early 1900s. Blue Cross started in Texas, and Blue Shield in the Northwest. The two merged in the 1940s, and the Blue Cross Blue Shield Association was established in 1982.

BCBS companies partner with other organizations to address some of the challenges with drug and alcohol addiction treatment services. For example, it incentivized rehab providers to use a holistic approach to treating addiction by encouraging them to combine medication-assisted treatment (MAT) with treatment for mental health conditions.

Blue Cross Blue Shield companies also aim to reduce the number of opioid prescriptions issued and relapse occurrences among people recovering from drug addiction. Learning more about BCBS coverage for mental health conditions, drug abuse and alcohol abuse can help you determine whether your policy will cover some of the costs of your treatment.

BlueCross BlueShield insurance covers drug rehab, but the amount of coverage depends on your specific plan. Review your BCBS policy to find out what’s covered in your plan and what percentage of your costs the company is willing to pay. If you’re not a member, contact a Blue Cross Blue Shield insurance provider for your state or visit their website to find out what insurance benefits they offer.

Most Blue Cross Blue Shield insurance plans cover treatment options for drug addiction, especially those offered through the Healthcare Marketplace, due to the Affordable Care Act (ACA) of 2008. However, the amount of coverage available to you depends on your state, plan type and level and whether your policy is through the Marketplace, your company or self-pay. Reach out to your BCBS insurance provider to determine your specific coverage.

Medical detox is usually an inpatient treatment, so you’ll need to refer to your BCBS Explanation of Benefits (EOB) to find out if it’s covered.

Anthem Blue Cross and Blue Shield, one of the many companies under the BCBS umbrella, recognizes the importance of medication-assisted treatment for those with a history of drug or alcohol abuse. It partnered with Project ECHO to connect doctors with patients and help those willing to receive a combination of MAT and mental health services. Coverage under individual BCBS policies varies, so you’ll need to verify your coverage with your provider.

Coverage for inpatient rehab is required under the Marketplace essential benefits, so any BCBS plan purchased through it will include some level of treatment coverage. Plans outside the Marketplace should include some rehab coverage, but it depends on your state, age and other factors.

If you have a substance use disorder (SUD) and a mental health condition, it’s called a dual diagnosis, or co-occurring disorder. Co-occurring disorders are common with substance use disorders, as some people try to self-medicate for mental health conditions, such as anxiety and depression, through substances. The coverage levels for this diagnosis will differ based on your BCBS health insurance plan and whether you enroll through an employer or the Marketplace.

Your BlueCross BlueShield plan may cover intensive outpatient programs, partial hospitalization and standard outpatient treatment that you or your loved ones undergo while still living at home. Visit the BCBS website or call the phone number on the back of your insurance card to ask about your health insurance plan specifics.

Counseling and behavioral therapy provide treatment for mental health conditions that may or may not be associated with an SUD. Many companies offer a few counseling sessions as part of an employee benefits package. The insurance plans BCBS offers through the Marketplace must offer some coverage for SUD treatment and should be on par with levels of care for other medical services. Other BCBS plans will vary in coverage depending on factors such as your state and plan level.

Once you complete drug or alcohol rehab, you’ll need continuing care to sustain long-term recovery. You may end up stepping down to a lower level of care, such as outpatient treatment or staying in a sober living apartment.

Sober living provides a drug-free environment to keep you stable until you’re ready to return home. You can find out whether your BCBS policy covers these options by reviewing the terms in the Explanation of Benefits (EOB) section of your policy.

Since the Affordable Care Act was passed in 2008, insurance companies have been required to include 10 essential health benefits in all plans offered through the Health Insurance Marketplace. Coverage can’t be withheld because of preexisting conditions, and spending limits can’t be set for the 10 benefits outlined by the ACA. Outside of those benefits, parts of the ACA are optional and determined by individual states.

Insurance companies may adjust pricing based on the following:

• Plan type
• Smoker vs nonsmoker
• Age
• Individual vs family
• Location

While an insurance plan may cover a service, you’ll still be responsible for paying the premiums, co-pays and out-of-pocket expenses. If you’re purchasing through an employer or the Healthcare Marketplace, some or all of the premium costs may be waived.

Insurance companies can refuse to pay for services that weren’t preapproved and can set limits on how much they’ll pay for certain levels of care, depending on your policy. For example, if your policy was grandfathered in before the ACA, it may not be required to cover the 10 essential health benefits.

Insurance companies can also set limits on how much of a drug you can have filled under your policy. If the doctor prescribes more than insurance covers, you’re responsible for paying the difference for the additional pills. The laws affecting insurance companies and medical care determine what BCBS coverage offers in each state.

Out-of-network coverage is only available through BlueCross BlueShield PPO plans. If you have an HMO or EPO plan, any out-of-network care you receive is unlikely to be covered under your policy. Check with your BCBS provider to verify your coverage options.

Blue Cross Blue Shield offers several health care plan options, including:

• Health Maintenance Organization Plan (HMO)
• Exclusive Provider Organization (EPO)
• Preferred Provider Organization (PPO)

Within each of these plan types, BCBS also has what’s known as metal levels. These levels determine how much of your bill is covered by your insurance company, which providers you can see and what types of treatment require preapproval.

Premium costs are also affected by metal levels. While the highest level costs more, it also reduces the amount of all out-of-pocket expenses and deductibles.

The metal levels for Blue Cross Blue Shield insurance are:

• Bronze – 60%
• Silver – 70%
• Gold – 80%
• Platinum – 90%

Your coverage can be for individuals or families, small businesses (1-50 employees) or larger businesses (over 50 employees).

The types of addiction covered by BCBS insurance depend on your specific policy. Under the ACA, behavioral health treatment, mental and behavioral health inpatient services and substance use disorder treatment are all considered essential health benefits. This means that any plan purchased through the Healthcare Marketplace must offer coverage for these treatments.

Covered substance use disorders may include:

• Marijuana
• Hallucinogens, such as LSD and PCP
• Stimulants, including cocaine
• Opioids, such as heroin
• Alcohol
• Inhalants
• Sedatives

The best way to find drug and alcohol rehab treatment centers that accept Blue Cross Blue Shield insurance is by going to the BCBS website and searching for in-network providers. You’ll need your insurance card with your member ID number to help you identify which health services your plan covers in your area and in-network. You can also browse our list of treatment centers by state.

If you or a loved one is considering drug and alcohol rehab, it’s crucial to know what your health insurance plan covers. RehabNet can help you locate programs covered by BCBS in your area.