Blue Shield of California Insurance for Addiction Treatment

Blue Shield of California was established in 1939. They are a tax paying, non-profit organization and a member of the Blue Shield Association. Members of the Association operate independently to provide insurance coverage that meets the needs of their local community.

The company is based in Oakland and insures over 4.8 million residents across the state. Since 2020, the company has provided more than $77 million to the Blue Shield of California Foundation, which focuses on investing in local communities. They fund programs aimed at preventing domestic violence and promoting equitable healthcare solutions.

While their primary focus is on California residents, large employers and groups headquartered in the state with more than half who live outside California—can also purchase policies. Policyholders have access to the extensive Blue Cross Blue Shield provider network, which covers 100% of U.S. ZIP codes. This is a significant perk of being an independent BCBS licensee.

Launched in 2020, their Health Reimagined initiative aims to transform healthcare delivery by linking insured members with vital community services.

Does Blue Shield of California Insurance Cover Drug Rehab?

Most Blue Shield of California policies cover essential health benefits, which include mental health and substance use disorder treatments. However, there are some exceptions. Two federal laws mandate most insurance providers and plans cover essential health benefits.

The 2008 Mental Health Parity and Addiction Equity Act ensures that insurers cover mental health and substance use treatment at the same level as other medical care. The 2010 Affordable Care Act also mandates that most insurance plans cover a list of 10 essential health benefits which include mental health and substance use treatment.

However, every insurance plan is different and will have unique requirements and limits. That’s why it’s so important to review your insurance coverage before you commit to a treatment program. You don’t want there to be any surprises once you start rehab.

What Are Blue Shield of California Plans?

Several types of health insurance plans are available in California through Blue Shield of California. All insurance plans have a defined provider network. Some plans offer coverage outside the network and many do not.

You can get an individual and family plan through the state Insurance Marketplace or through your employer. If your plan is a Preferred Provider Organization (PPO), it will cost more per month but you have more flexibility in getting care from specialists and getting coverage outside the provider network. A Health Maintenance Organization (HMO) has a lower monthly fee but you’ll need to use in network providers. You may also need a referral to see specialists and preauthorization before you start rehab.

Those who qualify for Medicare can also buy plans from Blue Shield of California. If you have Original Medicare, you can get Part D prescription plans or Medicare supplement plans. You can also replace Original Medicare with a Medicare Advantage plan that may provide additional benefits such as vision and dental coverage. However you would need to use the Advantage plan’s provider network.

Lower income individuals and families who qualify for Medicaid in Los Angeles and San Diego counties can get a Medi-Cal plan called Blue Shield Promise. Plan benefits include help scheduling rides to your appointments, a 24/7 nurse advice line, and connections to social services, doctors, or specialists in your area.

What Unique Benefits Does Blue Shield of California Offer?

Blue Shield of California has some coverage benefits that make it stand out from other insurers. One unique resource is the mental health hub called Credible Mind. Insurance policyholders can get help and support for mental health and addiction treatment, and access a mental health resource library and on demand mental health support.

Another resource the company offers California residents is the BlueSky Initiative. The program addresses the mental health of middle and high school students by funding school-based programs.

Does Blue Shield of California Cover Other Mental Healthcare?

In compliance with 2010 Affordable Care Act, most insurance plans cover addiction and other mental healthcare. However, there are exceptions, so it’s important to check your specific coverage.

Co-occurring mental health disorders are common with addiction, and it’s essential to seek treatment for both. Your insurance may cover integrated care that will set you up for long-term success in recovering from addiction.

To find out exactly what your Blue Shield of California plan covers, call the member services hotline or verify coverage with your chosen treatment center.

What Inpatient Rehab Does Blue Shield of California Cover?

Insurance coverage focuses on medically necessary care, so it’s important to get a treatment plan from your doctor.

Inpatient care may start with medical detoxification to remove drugs from your body. These medications may include naltrexone for alcohol-use disorder or opioid addiction. Methadone and buprenorphine are also used to treat opioid addiction.

Inpatient care takes place in a clinic or hospital and residential treatment happens in a more home like setting. If you have a dual-diagnosis treatment plan, you will likely require inpatient or residential treatment.

What Outpatient Addiction Treatment Does Blue Shield of California Cover?

Outpatient addiction treatment includes intensive outpatient and partial hospitalization programs. Partial hospitalization care combines inpatient and outpatient treatment plans and is sometimes known as day treatment. This involves going to a treatment center for treatment during the day and returning home in the evenings.

A typical intensive outpatient program involves between 10 and 20 hours of treatment per week and around 90 days total of treatment. These programs include addiction education, recovery support, and individual or group counseling, among other treatment modules.

Does Blue Shield of California Cover Methadone & Suboxone (MAT)?

As a part of medically necessary treatment, your plan may cover methadone and suboxone as part of MAT. Methadone is a common medication-assisted treatment (MAT) that helps patients reduce or quit the use of opiates such as heroin. Methadone is FDA-approved to treat opioid addiction, and suboxone is also used to treat dependence on opioid drugs.

It combines buprenorphine and naloxone for treatment. By binding to the same receptors as opiates, these medications blunt intoxication and prevent cravings, which allows the patient to eventually return to a life of normalcy.

Can I Travel Out of State For Treatment With Blue Shield of California?

In most cases, Blue Shield of California has a medical network focused on specific regions. In general, you most likely won’t need to go out of state for care. However, there are a few exceptions. If your plan’s network is broader than your immediate area and includes areas in other states, you might end up going out of state.

If your plan has out-of-network coverage, you may choose to use it to see an out-of-state treatment provider. However, out-of-network coverage typically involves a lot more out-of-pocket expense than in-network coverage.

How to Verify Coverage With Blue Shield of California

You can check your insurance coverage in two ways. First, you can call the company’s member services hotline with your insurance policy information. They can check your coverage limits and give you a list of in network drug and alcohol addiction specialists in the area.

Most addiction treatment facilities verify your insurance coverage and will give you more information to help begin your recovery journey. For example, they typically offer a phone assessment to determine if you’re a good fit for the facility. Their financial counselors can help estimate your out of pocket costs based on your insurance coverage limits and they can help find financial aid to cover some of the cost of drug rehabilitation.