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Welcome to the helpline at RehabNet.com, we are open around the clock, ensuring you can discuss treatment options for yourself or someone close to you at any time. This line is managed by Legacy Healing Center, an esteemed addiction recovery institution with facilities in Florida, New Jersey, Ohio, and California.
Upon reaching out to our helpline, you’ll engage with a dedicated treatment specialist ready to guide you through the various mental health and addiction recovery services available at any Legacy Healing facility.
Neither you nor the individual in need are bound to enroll in any program with Legacy Healing Center when utilizing our assistance line.
In instances where our facilities might not align with your specific requirements, our team can suggest alternative detox or rehabilitation centers, including the possibility of connecting with the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline for a more tailored recommendation. It’s important to note that we do not gain financially or in any other form from referrals to different treatment centers.
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Published: November 28, 2023
A subsidiary of Blue Cross Blue Shield, CareFirst BlueCross BlueShield began in 1934 and offers extra support resources for behavioral health and addiction.
CareFirst covers members in Maryland, Washington, D.C., and Virginia, including members of Congress. If you live in the Mid-Atlantic region, you may have a CareFirst insurance plan through your employer or the Healthcare Insurance Marketplace.
To find out more about your insurance benefits through CareFirst for substance use disorder treatment, read on.
Answer: Yes, most CareFirst plans offer coverage for drug rehab, even those purchased privately.
While insurance companies are not required to follow the Affordable Care Act (ACA) guidelines for plans sold outside the Healthcare Insurance Marketplace, CareFirst maintains that all plans are ACA-compliant.
You may have out-of-pocket costs, like copays and coinsurance. You may also have deductibles to meet before health services are covered with your CareFirst insurance plan.
Answer: CareFirst covers all types of addiction treatment, as they are compliant with the ACA’s 10 essential benefits. Coverage for behavioral health and substance use disorder treatment is included in all plans.
Here are the types of addiction rehab programs and services you can access with CareFirst health plans, depending on your individual policy.
Talk to your primary care provider about whether you need to go through a medical detoxification and if it should be done as an inpatient or outpatient treatment.
Then, check your CareFirst policy for what percentage of treatment services your health plan covers. Your metal type (Bronze, Gold, Silver, Platinum) will determine your coinsurance percentage, copays, and deductibles.
Bronze and Silver plans in Washington, D.C., use a straight coinsurance formula for outpatient surgery and inpatient services.
For medication-assisted treatment (MAT), know that CareFirst offers a range of options based on your plan. Inpatient treatment may be billed under those services.
MAT is a common form of opioid and alcohol treatment that combines medications to treat withdrawal symptoms and counseling and behavioral therapy to address the addiction
Prescription coverage under CareFirst can be any of the following:
If you need prescription drugs on a continuing basis, you’ll need to know what tier level each falls under. If you want non-generic, understand that your out-of-pocket costs will be higher if there’s a generic option available.
Because CareFirst is ACA-compliant, inpatient rehab must match other inpatient services. In D.C., Bronze and Silver plans have a straight coinsurance percentage, while all other plans and locations vary copays, deductibles, and coinsurance.
Inpatient services at a hospital also mean that you’ll have a bill for the hospital, the doctor, and lab services. These services are usually billed separately. LabCorp is the only in-network treatment provider for CareFirst HMO labs.
If you’ve been told by your healthcare provider that you have a mental health disorder and a substance use disorder, then you’ve received a dual diagnosis.
CareFirst has a specific section in each explanation of benefits (EOB) that covers what your financial responsibility is for mental health and SUD treatment office visits under your treatment plan.
These co-occurring disorders can be treated in a few different ways, so it’s essential to determine how your insurance covers your treatment plan.
Outpatient treatment with CareFirst is not addressed explicitly in the EOBs. Still, it may fall under the outpatient surgery section (as an ACA coverage match) and office visits for SUD and mental health treatment.
Check your individual plan through CareFirst’s member login or by calling the number on your insurance card to go over your treatment options.
As part of the 10 essential benefits under the ACA, behavioral health treatment coverage is included in every CareFirst insurance plan. Your plan’s metal type will affect your out-of-pocket costs, as will any employer assistance program (EAP) sessions.
Because treatment for drug and alcohol addiction continues after rehab, so should insurance coverage. Mental health and substance use disorder office visits have a clearly defined row in CareFirst’s EOB.
Your plan may have a copay or coinsurance charge. Or, you may have to meet your deductible before insurance will pay for those treatment options.
Many things factor into whether a recovery center or outpatient care will be covered by your CareFirst plan.
These factors can affect whether services are covered and what your out-of-pocket expenses are:
Answer: On every plan except HMOs, CareFirst covers treatment by out-of-network providers. However, you will pay more for treatment out of pocket.
If you require care at an urgent care center, convenient care, or emergency department while traveling, that is more likely to be covered by CareFirst.
CareFirst healthcare plans are available in multiple forms and vary by state. All subsidies with CareFirst are independently licensed by the Blue Cross and Blue Shield Association.
Metal levels are:
Plan types are:
Maryland plans for 2024 include:
Washington, D.C. plans for 2024 include:
Virginia plans for 2024 include:
Members of Congress and their staff can choose from national and regional plans. National plans provide coverage for over 90% of American doctors and hospitals. Regional plans offer care in the local coverage areas.
Regional plan options for 2023 include:
National plan options for 2023 include:
CareFirst covers all types of addiction treatment, including treatment for:
To locate rehab centers that are in-network for your CareFirst health insurance plan, you have a few options.
You can find rehab facilities that accept CareFirst by:
CareFirst also has a PDF of opioid treatment resources available through its website.
This list of resources includes:
Figuring out the ins and outs of your insurance provider is a lot to handle. And when you’re trying to break the cycle of drug addiction or alcohol dependency, you have enough obstacles.
Let RehabNet.com tackle this one. Visit our website or call our helpline anytime, day or night. We can provide information on accredited treatment centers near you.
CareFirst. “Blue Plans Overview.”
CareFirst. “CareFirst Congressional Health Insurance Plans.”
CareFirst. “Find a Doctor or Health Care Facility.”
CareFirst. “How To Save on Health Insurance Costs.”
CareFirst. “Individual & Family Health Insurance Plans in Maryland.”
CareFirst. “Individual & Family Health Insurance Plans in Virginia.”
CareFirst. “Individual & Family Health Insurance Plans in Washington, D.C.”
CareFirst. “In-Network vs Out-of-Network Providers.”
CareFirst. “Maryland Consumer Health Benefits 2024.”
CareFirst. “Medicaid Plans.”
CareFirst. “Medicare Plans.”
CareFirst. “Metal Levels.”
CareFirst. “National Plans.”
CareFirst. “Non-Quantitative Treatment Limits (NQTL) Disclosure Form.”
CareFirst. “Opioid Treatment Resource Guide In Maryland, Washington D.C. and Northern Virginia.”
CareFirst. “Our History.”
CareFirst. “Plan Types.”
CareFirst. “Regional Plans.”
CareFirst. “Understanding Plans.
CareFirst. “Virginia Consumer Health Benefits 2024.”
CareFirst. “Washington, D.C. Consumer Health Benefits 2024.”
CareFirst. “What Benefits Are Covered?”
CareFirst. “What Impacts the Cost of Health Insurance?”
CareFirst. “When You Need Care.”
National Institute on Drug Abuse. “Commonly Used Drugs Charts.”
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