Health Care Service Corporation (HCSC) Insurance Coverage for Rehab

Health Care Service Corporation (HCSC) is an insurance company that insures about 18.6 million Americans through Blue Cross and Blue Shield (BCBS), Medicare and Medicaid plans. Of these millions, many use their insurance to access drug and alcohol addiction treatment.

An independent licensee of the Blue Cross and Blue Shield Association, HCSC provides plans for people in Illinois, Montana, New Mexico, Oklahoma and Texas.

Understanding insurance coverage can be a tricky process, particularly for addiction treatment. That’s why we’ve put together everything you and your family members need to know about HCSC and addiction rehab coverage. Scroll on to learn more.

Answer: Yes, HCSC does cover substance abuse treatment, which is required by the Affordable Care Act (ACA) for all marketplace plans.

Because addiction rehab is considered one of 10 essential health benefits under the ACA, all health insurance providers must offer some coverage for treatment services.

HCSC addiction treatment coverage is contingent on several factors, so you may only receive partial coverage or need to pay a copay.

Answer: HCSC provides coverage for a vast array of substance use disorder (SUD) treatment types. Coverage levels will differ between treatment options.

When you enroll in an addiction treatment program, you may receive a combination of treatment services or seek a particular type of treatment based on your needs.

Keep reading to learn about the coverage you may receive as well as short descriptions of the most common addiction rehab services.

Medical Detox

Medical detoxification is covered by many HCSC health insurance plans, but you may be responsible for a copay or coinsurance depending on your plan.

Medical detox is a service often offered at the beginning of treatment to prepare an individual for their treatment program. This service helps rid the body of addictive substances, manage withdrawal symptoms, monitor vitals, and administer medications as needed.

Because detoxing at home can be incredibly dangerous, it is recommended to receive medical detox in a licensed facility to prevent emergency medical situations.

Medication-Assisted Treatment

HCSC health insurance plans may cover medication-assisted treatment, also known as MAT. Like detox services, you may be required to pay a copay per visit or coinsurance for the total treatment program price.

MAT is a service that relies on FDA-approved medications to treat substance abuse. These medications work by reducing withdrawal symptoms and cravings as well as reducing the risk of relapse.

Over time, you will be slowly tapered off the medication, but many people continue MAT for an extended period of time.

Inpatient Rehab

Inpatient rehab is covered by many HCSC plans. Depending on your plan, you may pay coinsurance or a flat fee per day.

Inpatient treatment, sometimes called residential treatment, is a widely known treatment service that involves round-the-clock care in a designated treatment facility where individuals live for the duration of their treatment. It is considered to be the most intensive treatment option, as it is very structured.

You can expect to take part in several treatment services during an inpatient program. You will likely have a set schedule for each day to ensure you receive comprehensive treatment.

Dual Diagnosis Treatment

HCSC plans will also cover dual diagnosis treatment at least partially. Much like the services above, you will most likely have to pay a copay or coinsurance depending on your plan.

Dual diagnosis treatment offers behavioral health services and mental health treatment alongside the physical health aspect of addiction. Many people with addictions also have mental illnesses, known as co-occurring disorders, which can be the catalyst for addiction.

In a dual diagnosis program, your care team will treat your mental health conditions alongside your addiction to offer a broad-spectrum treatment approach. This often involves therapy and counseling.

Outpatient Treatment Programs

Outpatient treatment programs are covered by many HCSC health insurance plans. Most plans will require a copay for each office visit or coinsurance for the overall cost.

Offering a slightly lower level of care than inpatient treatment, outpatient rehab is a well-structured treatment approach, but it doesn’t require participants to live in a rehab facility. Instead, individuals travel to a care center several days a week for several hours.

Outpatient treatment also comes in different varieties such as partial hospitalization programs (PHP) or intensive outpatient programs (IOP).

Counseling & Behavioral Therapy

HCSC plans often cover counseling and behavioral therapy with a copay for each session, though this will differ between plans.

Counseling services are offered in both individual and group settings. Essentially, counseling is an opportunity to discuss your feelings, thoughts, goals, and concerns about addiction and addiction treatment.

On the other hand, behavioral therapy is a specific kind of talk therapy that focuses on behavioral patterns.

Behavioral therapy is often used for people with mental health disorders working to change their thought patterns. You may encounter dialectical behavioral therapy (DBT) or cognitive behavioral therapy (CBT) if you try behavioral therapy.

Continuing Care

Some continuing care services may be covered by HCSC plans. This will depend on your plan. You can expect to pay a copay or coinsurance if coverage is offered.

Continuing care, also known as aftercare, is the care you receive after completing your treatment program. Whether that be inpatient or outpatient, you and your provider will determine what services may be beneficial as you transition back to day-to-day life.

Some services, like therapy or counseling, will be covered as outlined above. On the other hand, some may not have a cost, like 12-step programs, and others may not be covered entirely. Check your summary of benefits or talk with a representative from HCSC to be sure.

Coverage levels vary from person to person because there are several factors that affect Health Care Service Corporation coverage for addiction treatment. All of these variables will be taken into account and can increase or decrease your coverage.

Factors that may affect coverage include:

• Your plan: The plan you choose will determine which services are covered and at what level. Some plans may require higher deductibles, copays, or coinsurance.
• Your location: Where you live will affect what insurance plans you have access to, the cost of treatment, and the kinds of treatment available.
• The type of treatment you need: Some treatment services are covered more than others, so your coverage will likely depend on what kind of treatment you’re seeking.

Even if you cannot receive coverage for the type of treatment you need, you may be able to access other payment options like payment plans, sliding scale pricing, or scholarships.

Answer: Sometimes HCSC covers out-of-network rehab programs. This will depend on your specific plan. In most cases however, the out-of-pocket cost of an out-of-network treatment provider will be higher than that of an in-network provider.

In most cases, it is best to choose a participating treatment facility to make sure you’re receiving SUD treatment at the lowest cost possible. If you are set on an out-of-network rehab center, make sure you review the out-of-network coverage level (if any) included in your HCSC plan.

Health Care Service Corporation offers various health insurance plans for Medicaid and Medicare members.

Some plans you may be able to choose from include:

• Blue Precision HMO Bronze HMO plans
• Blue Choice Preferred Bronze PPO plans

The plans you have access to will depend on where you are located as well as other eligibility factors.

You may be able to choose between a few plan options. Make sure you review the details of each plan to determine which one is best for you based on deductibles, premiums, and other factors.

The type of addiction you have will not affect your coverage with Health Care Service Corporation. Substance addictions of any kind will be covered by HCSC as long as the treatment you receive is covered by your plan.

Common addictions you may receive treatment coverage for include:

• Cocaine
• Meth
• Heroin
• Alcohol
• Prescription drugs
• Benzodiazepines
• Opioids

Other substance addictions like nicotine or marijuana may also be covered, so check that your plan covers the type of treatment you need.

Finding a treatment center is half of the journey. It can be an overwhelming process to find a rehab facility, but luckily there are many great resources. Here are some ways to start looking for the optimal rehab center for you or a loved one:

1. Ask your doctor for referrals. They should be able to help you find a few providers that accept your HCSC health insurance plan.
2. Call HCSC to verify that a provider you’re interested in takes your insurance plan, or call the provider.
3. Use the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment locator. Here, you can find treatment facilities in your area.
4. Check out our list of treatment centers in each state for information on hiqh-quality rehab centers near you. The lists also contain insurance information.

HCSC is a very popular healthcare provider in the U.S. that many people use to access addiction treatment. The coverage you receive through HCSC can depend on several factors, but will ultimately save you money on treatment.

Looking for additional guidance on HCSC and SUD treatment coverage for yourself or your loved one? Give our helpline a call today.