Find Rehabs That Accept Florida Blue GuideWell Insurance

Florida Blue Guidewell is an insurance provider serving the US and Puerto Rico. They’re a subsidiary of GuideWell and are headquartered in Jacksonville, Florida. They’re also an independent licensee of the Blue Cross and Blue Shield Association.

They serve all of Florida and have been providing health insurance to Floridians for 75 years. Florida Blue Guidewell also specializes in addressing social needs in its communities such as food security and transportation for its members in addition to attending to their insurance and healthcare needs. They place special emphasis on the needs of Florida’s Hispanic and Puerto Rican populations.

Does Florida Blue GuideWell Cover Addiction Treatment?

Most Florida Blue plans cover mental health and substance abuse treatment in Florida as required by the 2010 Affordable Care Act (ACA) and 2008 Mental Health Parity Act. The ACA requires that most plans cover specific essential benefits, which include mental health and substance use treatment. The Parity Act requires mental and behavioral health care coverage to be as accessible as other health insurance treatment options.

That said, there are some exceptions to the law, and the details and requirements for addiction and mental health coverage vary from plan to plan. That’s why it’s important to work with your doctor to create a treatment plan that will define what’s medically necessary for you and to verify your insurance coverage before you commit to a rehab program.

What are Florida Blue Plans?

Florida Blue /GuideWell offers several different types of insurance plans that serve individuals and families, employers, and Medicare recipients.

Individual and family plans are available on the state Marketplace. You may also have a Florida Blue plan through your employer. There are two primary types of insurance coverage. Preferred provider organization (PPO) plans let you choose your own doctors and rehab treatment facilities and you won’t need a referral. The tradeoff is that PPOs generally include higher out of pocket costs.

Health maintenance organization (HMO) plans have lower monthly plan fees than PPOs but they include higher deductibles. HMOs use a network of healthcare providers that are preapproved by the insurance company. A referral from your primary doctor is required if you want to see a specialist. Your care is generally not covered if you visit an out of network provider.

Florida Blue offers Medicare Part D and Medicare Supplement plans which help you build your Original Medicare coverage. They also have Medicare Advantage plans known as Medicare Part C. Medicare Advantage plans offer the same services as Medicare but often include extra benefits, such as prescription drug coverage and vision care and perhaps even dental coverage. Florida residents who have both Medicare and Medicaid can access extra benefits from a Florida Blue Dual Eligible Special Needs Plan (DSNP).

Medicare coverage for drug rehab may include inpatient or outpatient care along with medication assisted treatment (MAT) if appropriate. Coverage is often based on medical necessity and you must have a diagnosis of substance use disorder from a physician. Copays and deductibles may apply.

What Inpatient Rehab Treatment Does Florida Blue Guidewell Cover?

Your insurance will focus on covering evidence based and medically necessary care. For inpatient treatment, your insurance may cover medical detox and inpatient or residential rehab.

Medical Detox is the process of allowing substances to leave your system but having medical support in the process. Detox can be a tough process, and many times the fear of it holds people back from getting the treatment they need. Medical detox allows you to have 24/7 support during the process along with medical care to treat withdrawal symptoms. This type of program lasts a few days and can allow you to start fresh safely and as comfortably as possible.

Inpatient treatment takes place in a hospital setting, and residential care takes place in a homelike setting outside of a hospital, but offers many of the services available from inpatient, hospital care, including 24 hour care provided by professional staff. Residential care often involves treatment for 28 to 30 days or 60 to 90 days. Afterward, you may transition to an outpatient treatment program.

What Types of Outpatient Addiction Treatment Does Florida Blue Guidewell Cover?

Outpatient care allows you to attend treatment during the day and return home at night. You may live in a sober living house or at your regular residence. There are several different levels of outpatient care.

Partial hospitalization or day programs often run between four and eight hours a day for three or four days a week. Most partial hospitalization programs run between 30 and 90 days. This is the most intensive level of outpatient treatment and provides the most support.

Intensive outpatient rehab programstypically offer between nine and 20 hours of treatment per week. Clients generally receive treatment on at least three and as many as five days per week. The recommended minimum duration for intensive outpatient treatment is 90 days.

General outpatient addiction treatment programs are the lowest intensity of outpatient care. Clients typically visit a clinic or rehab facility one or more times per week, and participate in group counseling and educational sessions, with individual sessions added as needed.

Does Florida Blue Cover Methadone & Suboxone (MAT)?

Yes, most Florida Blue plans cover methadone and Suboxone as part of a medication assisted treatment (MAT) program if it’s appropriate for your situation. MAT can be medically necessary for you during medical detoxification and for ongoing treatment of opioid and alcohol addiction.

MAT offers a physical and psychological approach to treating addiction particularly opioid use disorder and alcohol use disorder. The treatment combines FDA approved medications alongside behavioral therapy and counseling to provide comprehensive treatment for this complex condition.

Medications used in MAT for an opioid or alcohol use disorder may include methadone and buprenorphine along with naltrexone, Vivitrol, and Suboxone.

The medication is used to stabilize your brain chemistry. This helps reduce withdrawal symptoms during detox and reduce cravings for ongoing treatment.

Methadone and buprenorphine work to reduce cravings and withdrawal symptoms. Naltrexone or naloxone is an opioid antagonist that blocks the effects of opioids. It’s used to reduce the risk of relapse. Suboxone is a combination of buprenorphine and naloxone that works together to reduce your cravings, block withdrawal symptoms, and discourage opioid misuse.

Prescription drugs commonly used in alcohol use disorder include disulfiram and Naltrexone. Disulfam causes unpleasant effects if you drink alcohol and Naltrexone helps reduce cravings.

MAT is part of a holistic recovery treatment plan that is customized for your unique needs. The combination of medication and evidence based therapy can help you in your recovery journey from drug and alcohol addiction.

Does Florida Blue Cover Other Mental Healthcare?

The 2010 Affordable Care Act mandates most health insurance providers offer coverage for Essential Health Services, including treatment for mental health conditions. Most plans from Florida Blue Guidewell offer treatment coverage for mental health conditions. That includes when you have a mental health diagnosis alongside substance use which is known as co occurring disorders or having a dual diagnosis.

Most Florida Blue plans cover the integrated treatment necessary to address both mental health and addiction in dual diagnosis and improve your chance of a long term and sustainable recovery.

However as mentioned insurance plans and policies vary. You must verify your plan’s benefits and requirements. This ensures that the program you’re interested in is covered by your Florida Blue Guidewell policy. You can verify coverage by speaking with your insurance providers member services or working with your treatment center. They can verify your insurance coverage and determine if a referral and/or prior authorization is required before treatment can begin.

Florida Blue Guidewell Coverage for Drug & Alcohol Treatment