Capital Blue Cross Health Insurance Coverage for Addiction Treatment

Capital Blue Cross is a health insurer in central and eastern Pennsylvania that is a licensee of the Blue Cross Blue Shield Association. They focus on simplifying and personalizing healthcare using patient centered models.

Capital Blue Cross offers a wide variety of plans. For example they may cover health benefits for you and your family if you’re insured through an employer. Other ways they cover people include CHIP plans, student health plans and Medicare Advantage plans. It’s also possible to get an individual or family plan from them on the state Insurance Marketplace.

Does Capital Blue Cross Insurance Cover Addiction Treatment?

Addiction treatment is part of behavioral health, and you can get behavioral health treatment from most Capital Blue Cross plans. The company subcontracts its addiction and mental health services through Carelon Behavioral Health.

You can still search for behavioral health services on the Capital Blue Cross webpage, but you might notice that a lot of contact information about addiction services will be from Carelon.

Every insurance plan is different and there may be requirements before you start treatment so be sure to get the details of your plan before you commit to a program.

What Types of Plans Do They Have?

Capital Blue Cross offers a variety of plans. They have individual and family plans they offer through the Insurance Marketplace and through employers to their employees. Capital Blue Cross also offers Medicare plans, CHIP coverage, and student health plans.

In individual and family plans you will find three different formats of insurance. They are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) along with Exclusive Provider Organizations (EPOs).

PPO plans have a higher monthly premium but give you the most freedom. If you get a PPO plan, you may be able to go outside of their network and still get covered. Keep in mind if you go out of network, your coverage won’t be as much and you might have to pay a higher deductible.

In an EPO, you’re only covered if you get care from providers in their network. This type of plan usually doesn’t need referrals to see a specialist. Finally, an HMO is the least expensive each month but has more requirements. You have a primary care doctor that provides referrals to specialists and you’ll also need to choose providers from the plan’s network.

Capital Blue Cross also provides Medicare plan options for those who qualify. If you have Original Medicare you can get Medicare Supplement plans to help you cover costs like coinsurance and deductibles. You can also replace Original Medicare with a Medicare Advantage plan. This gives you the same benefits as Original Medicare but often has extra coverage such as vision and dental care. However you generally have to stay within the provider network and you may have to get preauthorizations for care.

Does Capital Blue Cross Have Any Special Features?

The Capital Blue Cross Connect program is a feature clients enjoy. That program has wellness centers you can visit and you can get health coaching and fitness training there. They also teach you skills like how to make healthy meals.

Blue365 gives discounts on fitness gear and gym memberships along with other lifestyle choices that help support your overall health. You register with your member ID card to create an account and get access to everything you need to enjoy these extra benefits.

The Healthy Blue Awards is another wellness program that helps support you based on what motivates you to make a change. There are several different packages including programs that are incentivized and non incentivized. Some tools are available year round while others are available for a predetermined time.

When your care is complex you also have access to case management and a health savings account that can help you save for qualified medical expenses using tax free money. Depending on your plan you may require a referral or prior authorization before being able to get care. Capital Blue Cross also provides online resources to help you determine what’s needed based on your insurance plan and coverage.

What Inpatient Addiction Treatment Does Capital Blue Cross Cover?

Health insurance policies focus on providing medically necessary care including behavioral health services to treat substance use disorders and mental health conditions. It is crucial to have a treatment plan from your doctor that provides the necessary information on what treatment you need based on your diagnosis and symptoms.

When necessary your addiction treatment may start with medical detoxification before moving into an inpatient or residential care program. Medical detoxification is managed by a healthcare professional who can manage and monitor your withdrawal symptoms. This process may also include FDA cleared prescription drugs that reduce withdrawal symptoms and help you stay safe and as comfortable as possible during detox.

Once the addictive substance is out of your system you may move into full time evidence based therapy and counseling in an inpatient or residential setting. This helps to identify what triggers your addictive behavior and helps you to develop healthy coping strategies that reduce your need for drugs or alcohol.

Inpatient treatment is ideal when you require 24/7 supervision and monitoring and a highly structured and intensive treatment program. During inpatient and residential care you live at the treatment facility. In some instances, you may be allowed a day pass on the weekend when therapy and counseling are not as intensive and you’re preparing for discharge.

What Outpatient Rehab Does Capital Blue Cross Cover?

Your comprehensive assessment will determine the level of care for your initial treatment. This can include an inpatient program or one of several outpatient programs. Outpatient treatment may include a partial hospitalization program (PHP) or intensive outpatient program (IOP) or even general outpatient treatment. A PHP provides the same level of intense therapy and counseling as you would receive as an inpatient or in residential care with the benefit of living at home or in sober living.

An IOP typically includes therapy several days per week for a few hours each day. While this program is less intensive it is just as structured as a partial hospitalization program. You will continue to meet with your therapists and counselors as well as participate in group support meetings. Some treatment centers offer IOPs during the morning hours or evening hours to help accommodate your family and work or school obligations.

A general outpatient treatment program usually provides therapy or counseling once or twice weekly. This can also include group support meetings and family therapy. Once you have completed your outpatient programming, you may have access to an aftercare program. The resources available in aftercare depend on the treatment center you’re working with.

Some treatment centers have alumni programs where you can connect and receive support from people who have graduated from the treatment center. Your aftercare program may include therapy sessions and community group support sessions along with routine drug or alcohol testing and life skills training. This may include sober living arrangements and educational or vocational support.

Does Capital Blue Cross Cover Methadone & Suboxone (MAT)

Methadone and Suboxone are integral parts of a medication assisted treatment (MAT) program. These programs use the FDA cleared medication to reduce your experience with withdrawal symptoms and lower the risk of severe complications that may occur during withdrawal from certain drugs.

MAT is also used in ongoing treatment for opioid and alcohol use to reduce cravings and help prevent overdose deaths. Medications that are commonly used include methadone, buprenorphine, naltrexone, and suboxone. Methadone and buprenorphine are opioid agonists. They bind on the same receptors as opioids but do not produce the euphoric effects.

This helps prevent withdrawal symptoms and reduce cravings. Naltrexone also blocks the effects of opioids at the receptor level and can help prevent relapse when you have already detoxed from opioids. Buprenorphine and methadone are used exclusively for opioid use disorders while naltrexone may be used for both opioids and alcohol. Suboxone is a combination drug of buprenorphine and naltrexone.

Does Capital Blue Cross Cover Other Mental Healthcare?

The 2010 Affordable Care Act and 2008 Mental Health Parity and Addiction Equity Act are federal laws that help provide access to mental health and substance use disorder treatment through coverage by insurance providers. However not all plans are subject to these laws so it’s crucial to check your benefit and limitation levels with your insurance provider.

Mental health conditions may include depression, anxiety disorder, eating disorders, bipolar disorders, and borderline personality. Your insurance coverage may cover therapy and crisis support when you need immediate help or pose a risk to your safety or the safety of others. This type of support is critical to stabilize the situation and connect you with the appropriate care long term.

Co occurring mental health conditions are common with substance use disorders. When your insurance provider covers treatment for substance use disorders and mental health conditions, they will typically cover integrated care for dual diagnosis. This is the medical term used to describe having both a mental health condition and a substance use disorder simultaneously.

Treatment for dual diagnosis can be more complex and requires integrated care administered concurrently to achieve the best potential for long term success.

Does Addiction Treatment Need to Be In Network?

Some Capital Blue Cross insurance plans cover out of network care and some do not. Before choosing to receive care it’s important to understand if the provider is in network or out of network for your plan and your coverage levels for each. While your insurance plan may offer some coverage for out of network care it likely comes with higher co payments and a higher deductible.

You can maximize your insurance benefits by receiving care with an in network provider. Whatever your choice by reviewing your insurance plan carefully you can make an informed decision about which provider to use.