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Blue Cross Blue Shield Insurance Coverage for Rehab

Cropped image of patient giving id card to doctor to fill Blue Cross Blue Shield insurance claim form in clinic

Published: August 2, 2023

Blue Cross Blue Shield insurance is an insurance provider company that began as two separate companies 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 has incentivized treatment 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.

If you want to know more about what treatment plans BCBS covers for mental health conditions, drug abuse, and alcohol abuse as part of substance abuse treatment, keep reading.

Does Blue Cross Blue Shield Insurance Cover Drug Rehab?

Blue Cross Blue Shield insurance does cover drug rehab. However, there may be limits on the cost percentage they will cover. You should review your policy to find out what coverage you’re eligible for.

If you’re not a member, you can contact a Blue Cross Blue Shield insurance provider for your state or visit their website to find out what insurance benefits they offer you and your family members.

What Types of Addiction Treatment Does BCBS Cover?

Most Blue Cross Blue Shield insurance plans cover treatment options for drug addiction, especially those offered through the Healthcare Marketplace following the Affordable Care Act (ACA) of 2008.

However, the amount of coverage available to you will depend on your state, plan type and level, and whether your policy is through the Marketplace, your company, or self-pay.

You’ll need to reach out to your BCBS insurance company to determine your specific coverage.

Medical Detox

Medical detox is usually an inpatient treatment, so you would want to refer to your Explanation of Benefits (EOB) for that type of coverage.

Medication-Assisted Treatment

Anthem Blue Cross and Blue Shield, one of the many companies under the umbrella of BCBS, has recognized the importance of medication-assisted treatment for those with a history of drug abuse or alcohol abuse.

The company has 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 will vary, so you’ll need to verify your specific level of coverage with your BCBS company.

Inpatient Rehab

Coverage for inpatient rehab is required under the Marketplace essential benefits, so any BCBS plan purchased through that will have some level of rehab treatment coverage.

Plans outside of the Marketplace should include some rehab coverage, but it will be affected by your state, age, and other factor

Dual Diagnosis Treatment

A dual diagnosis, or co-occurring disorders, is common with substance use disorders, and levels of care for this diagnosis will differ based on your health insurance plan and if you enroll through an employer or the Marketplace.

Outpatient Treatment Programs

Your insurance plan may cover intensive outpatient programs, partial hospitalization, and treatment at addiction centers and rehab facilities 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 & Behavioral Therapy

Both counseling and behavioral therapy provide treatment for mental health conditions that may or may not be associated with a SUD. Many companies offer a few sessions of counseling as part of an employee benefits package.

The insurance plans that BCBS offers through the Marketplace must offer some coverage of these services for SUD and should be on par with levels of care for other medical services.

Other BCBS plans will vary in coverage depending on factors like your state and plan level.

Continuing Care

Once you are finished with drug or alcohol rehab, you’ll need to maintain care as a recovering addict.

You may end up transferring to a different treatment facility or long-term residential treatment, like a sober living apartment.

Whether these options are covered under your policy should be explained in the terms, usually under the EOB.

Factors That Affect BCBS Coverage for Drug Rehab

Since the Affordable Care Act was passed in 2008, insurance companies must include 10 essential health benefits in all insurance plans offered through the Health Insurance Marketplace.

Coverage cannot be withheld because of pre-existing conditions or have spending limitations 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 non-smoker
  • Age
  • Individual vs. family
  • Location

While an insurance plan may cover a service, keep in mind that you will need to pay 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 something that was not pre-approved and can set limits on how much they will pay for certain levels of care, depending on your policy.

For example, if your policy is grandfathered in prior to 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.

Does BCBS Cover Out-of-Network Rehab Programs?

Out-of-network coverage is only available through a Blue Cross Blue Shield PPO plan.

If you have an HMO or EPO plan, any out-of-network care that you receive will most likely not be covered under your policy.

Check with your state or company’s BCBS provider to verify your coverage options.

Types of Blue Cross Blue Shield Healthcare Plans

Blue Cross Blue Shield offers several health care plan options.

You can choose from:

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

Within each of these plan types, Blue Cross Blue Shield also has what’s known as metal levels.

These levels determine how much of the total cost of your bill is covered by your insurance company, which providers you can see, and what types of treatment require pre-approval.

Your premium costs will also be affected by these metal levels. While the highest level will cost you more, it will also reduce 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%

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

Types of Addiction Covered by Blue Cross Blue Shield Insurance

The types of addiction covered by Blue Cross Blue Shield insurance will 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.

Substance use disorders can include being addicted to:

  • Marijuana
  • Hallucinogens like LSD and PCP
  • Stimulants like cocaine
  • Opioids like heroin
  • Alcohol
  • Inhalants
  • Sedatives

Where to Find Rehab Centers That Accept BCBS Near You

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 will need your insurance card with your member ID number to help you with health services your plan covers that are in your area and in-network.

You can also browse our list of treatment centers by state.

Find Drug & Alcohol Rehab Programs Covered by Blue Cross Blue Shield

It’s crucial to know what your health insurance plan covers if you or a loved one is seeking help at a treatment facility for drug and alcohol rehab.

You can reach out through our helpline if you need to locate the right programs in your area

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