Blue Cross Blue Shield Health Insurance for Addiction Treatment

In 1929, Blue Cross Blue Shield (BCBS) was founded. Today, they are a Federation of 33 independent health insurance companies. There are 100 million members across the U.S. that have access to quality healthcare through BCBS plans.

The Federation takes corporate responsibilities seriously and works hard to positively impact healthcare in U.S. communities through the growing number of independent companies that access their network of healthcare providers and facilities.

If you live and work internationally, you can also get BCBS coverage. The BCBS Axis program is the industry’s largest database used to power analytics and insights in healthcare, resting on the concept of better healthcare through bigger data, including data that supports behavioral health services.

Does Blue Cross Blue Shield Insurance Cover Addiction Treatment?

Yes, most Blue Cross Blue Shield insurance policies cover drug rehab and addiction treatment.

BCBS may cover several types of behavioral health services. For example, if you need inpatient and outpatient care, medical detox, therapy, counseling, and aftercare programs to support your recovery journey, your plan may help.

Two federal laws regulate the insurance industry. These laws are the 2008 Mental Health Parity and Addiction Equity Act and the Affordable Care Act. However, there are exceptions to these laws, so it is important to check your insurance coverage before starting treatment.

Typically, an addiction treatment center can help verify your insurance coverage, estimate your out of pocket costs, and answer your questions about the therapy options.

Where Does Blue Cross Blue Shield Offer Coverage

Blue Cross Blue Shield offers coverage across the U.S., including all states, Washington DC, and Puerto Rico. The insurance coverage is provided through 33 independent and locally operated companies. Each one serves a specific region and offers tailored plans to meet the needs and regulations of the local communities.

In addition to domestic coverage, BCBS offers international coverage through the Blue Cross Blue Shield Global network. This provides coverage when you live, work, or travel abroad, and it ensures that as a member of Blue Cross Blue Shield, you have access to healthcare services worldwide.

BCBS has insurance plans in all 50 states through various licensee companies. Learn more about Blue Cross Blue Shield insurance in a few of these states:

What Types of Policies Does Blue Cross Blue Shield Provide?

BCBS offers a full range of policies across independent insurance companies. The policies are designed to meet the needs of the local communities. This means you may not find every type of BCBS plan in your geographical area.

You can usually buy individual and family plans through the health insurance marketplace for your state. They include a range of Health Maintenance Organizations and Preferred Provider Organizations. You can also find High Deductible Health Plans that can be paired with Health Savings Accounts.

Long term plans in the Marketplace must meet the Affordable Care Act regulations for essential health benefits, including covering treatment for mental health conditions and substance use disorders.

Employer Sponsored Group Health Plans cater to businesses of all sizes. Often, larger employers can acquire more benefits in their policies and have more flexibility in choosing what to cover. These plans may cover essential health benefits, including behavioral health services and chronic disease management.

Government sponsored health plans include Medicare and Medicaid. Blue Cross Blue Shield offers Medicare Advantage plans, Medicare Supplement Insurance, and Medicare Part D prescription drug plans.

Medicare Part D typically covers medication assisted treatment for Original Medicare. Medicare Supplement Insurance helps cover Original Medicare copays and deductibles for inpatient and outpatient care, including behavioral health services. Medicare Advantage plans replace Original Medicare and often offer additional coverage benefits but you generally have to stay in the plan’s provider network.

Specialty insurance plans offer additional coverage beyond standard insurance policies. This might include dental, vision, critical illness, and short-term health insurance.

BCBS also offers international health insurance policies to cover your medical care while you’re traveling or living abroad.

What Types of Inpatient Addiction Treatment Are Covered By Blue Cross Blue Shield?

Most BCBS plans cover the cost of inpatient or residential treatment. During inpatient treatment you’ll be in a clinic or hospital while residential treatment usually takes place in a more home like facility located outside of a hospital. Medical detox may occur in either setting.

In inpatient programs you’ll get around the clock care and support delivered by professional staff. Inpatient care often lasts for several days or weeks while residential care typically lasts 28 to 30 days with some programs running 60 days or 90 days or more.

Insurance plans emphasize medical need as a condition of coverage so you may need a referral and/or preauthorization before you start treatment. Every plan is different so be sure you understand your coverage and out of pocket costs. Also remember that if you go to a facility in your plan’s network you can get maximum benefits for the lowest cost to you.

What Types of Outpatient Rehab Are Covered By Blue Cross Blue Shield?

There are several different outpatient programs that may meet your needs For example apartial hospitalization or day treatment program offers the most intensive care. You may also encounter intensive outpatient programs and general outpatient care.

If you’re in a partial hospitalization program you’ll attend treatment during the day and then return home or to a sober living environment at night. A typical PHP program runs for 4 to 8 hours a day for three to six days a week and lasts 30 to 90 days. You’ll get treatment similar to a residential program including evidence based care and holistic treatment options.

If you attend an intensive outpatient programs you usually get 9 to 20 hours of treatment per week with the hours spread over 3 to 5 days. The program generally lasts for at least 90 days.

In generaloutpatient programs you would visit a clinic or rehab facility one or more times a week. Group counseling and educational sessions on substance misuse and relapse prevention strategies make up the typical program schedule. Individual sessions are often offered as needed and some general outpatient programs include 12 Step peer group meetings.

Does BCBS Cover Suboxone & Methadone (MAT)?

Medication assisted treatment is a common form of treatment used to address alcohol and opioid use disorders with the use of FDA approved medications and counseling. As standard medications for MAT, Suboxone and methadone are often covered under BCBS plans.

Does Blue Cross Blue Shield Cover Mental Health Benefits?

Depending on your policy, you may have access to a range of behavioral health benefits, including those that address mental health and substance use disorders.

Your coverage details including benefits and co-payments along with deductibles and provider networks will vary based on where you live and the plan you purchase. You are encouraged to review your plan’s benefits or work with your addiction treatment center for precise information about your coverage.

Their insurance policies may include inpatient and outpatient mental health counseling and therapy, medications, telehealth services, and case management.

Does Addiction Treatment Need to Be In Network?

Depending on the type of plan you choose you might need to attend an in network rehab in order for the costs to be covered by your insurance.

They offer both preferred provider plans, also called PPO, and health maintenance organization plans. PPO plans let you get treatment from any provider you wish to use and you don’t need a referral. But these plans generally have higher premiums and greater out of pocket expenses than HMO plans.

HMO plans will have a lower monthly premium, but the cost savings come with some tradeoffs. You’ll need to see a provider that’s within the plan’s network and you generally need a doctor’s referral to see a specialist such as an addiction counselor. HMO plans usually do not cover out of network care unless it’s a life threatening emergency.

How Much Does Addiction Treatment Cost Without Insurance?

If you don’t have private insurance you can still find affordable addiction treatment. Most states and many counties have government funded substance abuse treatment programs and you can find information about them on the state or county website. These rehabs might have longer waiting periods for admission and you won’t find luxury amenities but you can get the treatment you need for free or at a very low cost.

Other ways to afford addiction treatment include using scholarships which are sometimes available from treatment centers or advocacy groups such as LGBTQ+ groups. Ask the rehab you are considering whether they have these options. Also find out whether the rehab offers sliding scale reduced fee options. Finally if need be you might consider using a credit card to pay for your addiction treatment or you could borrow money from family or friends.

The most important part is getting the care you need so take the time to be diligent and creative in searching for funding options.