Does BCBS of Massachusetts Insurance Cover Drug Rehab?

Blue Cross Blue Shield (BCBS) is a federation of 34 independent, community based health insurance companies. Each of these operates independently including BCBS of Massachusetts. They are licensed to use the BCBS trademark but are allowed to customize the health insurance products and services to meet the community’s specific needs.

BCBS of Massachusetts provides services to Massachusetts residents and must operate under state and federal regulations and market conditions. This can lead to differences in policy options, pricing, and services when you compare them to BCBS insurance plans in other states.

Does Blue Cross Blue Shield of Massachusetts Cover Drug Rehab?

Most health insurance policies offered by Blue Cross Blue Shield of Massachusetts provide some level of coverage for drug rehab. Two federal laws mandate this coverage for most insurance plans.

The first is the 2008 Mental Health Parity and Addiction Equity Act. This federal law prevents group health plans and health insurance providers from offering benefits for substance use disorders that are less favorable than those they offer for medical and surgical benefits.

The second law is the 2010 Affordable Care Act, which mandates that most health insurance providers offer mental and behavioral health services as an essential health benefit. This must cover substance use disorder and mental health treatment.

However, there are exceptions to the laws, so be sure to get the details of your plan before you start rehab. Also take time to work with your doctor to create a treatment plan so that you can prove what’s medically necessary in your case.

What Are the Coverage Options in Massachusetts?

Blue Cross Blue Shield of Massachusetts offers health insurance plans for employers as well as individuals and families. They also provide Medicare plans.

State residents may get individual and family plans through Massachusetts Health Connector, which is a state-based Marketplace that offers assistance with insurance premiums based on your income. You can also get coverage through your employer.

When you buy within the marketplace, you’ll encounter “metal tiers” that help you understand how much coverage is offered through each plan.

Bronze plans have a very low monthly premium but higher out of pocket costs when you seek medical care. Platinum plans have the highest monthly premium but the lowest out of pocket costs. In between, gold and silver plans can offer you a balance of monthly premium and out of pocket expenses.

Medicare Advantage plans from BCBS of Massachusetts are a full replacement for Original Medicare and generally include additional coverage like prescription medications, gym membership, and may also have vision and dental coverage. However, Advantage plans generally require you to stay within their provider network, where Original Medicare allows you to go to any Medicare provider in the country.

How to Verify Coverage With Blue Cross Blue Shield of Massachusetts

There are two ways to verify your coverage and determine how much your BCBS of Massachusetts insurance covers addiction treatment. The first way is to contact your insurance provider.

BCBS of Massachusetts has a toll free member service phone number and TTY for hearing impaired customers. They can answer any of your questions about your insurance policy or coverage. You can also log in to MyBlue on the web or using the app, which allows you to see your coverage details and find in network providers.

Your second choice is to work with a substance use disorder recovery center to verify your insurance coverage and estimate your out of pocket expenses. Some recovery centers offer sliding scale fees, payment plans, or help you find financial aid within the community.

Does BCBS of Massachusetts Cover Other Mental Healthcare?

Most plans from Blue Cross Blue Shield Massachusetts cover mental health care in compliance with the 2010 Affordable Care Act. However, there are exceptions. You should always check your coverage with your insurance provider or have the substance abuse and mental health treatment center verify your coverage.

Substance use disorders and mental health conditions commonly occur together. These are called co occurring disorders and are also referred to as dual diagnosis. Dual diagnosis requires integrated and concurrent care to address any mental health conditions and substance use disorders at the same time.

This sets you up for long term sobriety and sustainable recovery. Without concurrent treatments, your mental health issues can trigger substance use and substance use can trigger mental health symptoms. Addressing only one at a time typically is not effective. Most BCBS of Massachusetts policies offer coverage for dual diagnosis.

What Inpatient Addiction Treatment Does BCBS of Massachusetts Cover?

Blue Cross Blue Shield of Massachusetts covers medically necessary inpatient addiction treatment. This is why it is crucial to have a treatment plan from your physician and have the necessary documentation to submit to your insurance provider. You may also need a referral or preauthorization before you begin rehab.

Common inpatient treatments include medical detox and inpatient or residential care. Medical detoxification is a protocol used to support you as substances leave your system by providing medical care that reduces withdrawal symptoms and monitoring for dangerous side effects that can occur while detoxing from specific drugs. Medical detox uses FDA approved prescription medications to achieve these goals. Detox is the first crucial step in drug and alcohol rehabilitation.

After completing detox you may continue in an inpatient or residential care setting to receive evidence based treatment without any distractions from daily life. Common therapies include Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT).

Evidence based therapy is designed to help you address the triggers of addictive behavior and find healthier coping strategies. In an inpatient or residential setting, you have 24/7 support and monitoring. This provides you with a supportive and highly structured environment so you can focus on your recovery without the stressors associated with daily life. This provides a strong foundation for your recovery.

What Outpatient Rehab Does BCBS of Massachusetts Cover?

BCBS of Massachusetts covers a wide range of outpatient treatment for substance use disorders and mental health conditions. These treatments must also be medically necessary to be covered under your policy benefits. Some of those outpatient treatments include Partial Hospitalization Programs (PHP), Intensive Outpatient Programs (IOP), and general outpatient treatment.

This range of outpatient treatments ensures that you receive the intensity of services you need while still being able to live at home. Outpatient care is best for people who have a stable living environment without the temptations of drugs and alcohol in the home, which might mean that living in a sober living facility.

A PHP is sometimes used as a step down after an inpatient admission. It also can be the first level of care you receive, depending on your comprehensive evaluation that determines your treatment plan. A PHP provides the most intense outpatient treatment you can receive. The intensity is typically similar to that you would receive on an inpatient basis but you are allowed to return home in the evening.

An IOP usually has fewer therapy sessions per week, but continues to provide therapy over several days each week and for several hours each day. A general outpatient treatment program usually provides care one or two days per week. Each level of care provides evidence-based therapies in individual, group, or family therapy settings.

As you’re ready to graduate from the outpatient program your discharge plan will likely include an aftercare program. Aftercare programs can include several levels of care, from community support groups to weekly or biweekly therapy sessions. Some aftercare programs include alumni groups from the treatment center and others may include community vocational or educational support.

Does BCBS of Massachusetts Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) is commonly covered by most Blue Cross Blue Shield of Massachusetts plans. MAT programs use FDA approved prescription medications during alcohol and drug detoxification and for ongoing treatment of opioid and alcohol use disorders. The medications help reduce withdrawal symptoms during detoxification. In long term treatment the medications also reduce your cravings and help prevent relapse and drug overdose.

MAT programs typically include medication management. This means that your prescriptions are carefully monitored and managed to ensure they are effective and you are not experiencing side effects associated with the medication or side effects from drug interactions with other medications.

While in an inpatient or residential treatment setting, your treatment is monitored daily. As you move into an outpatient setting, you may be asked to report for medication management on days that you do not have therapy scheduled. Most treatment centers attempt to schedule your medication management and outpatient therapy on the same days. However, as your recovery progresses, you may only be getting therapy every two or three weeks and will need to report for medication management more frequently until your medication treatment stabilizes.

Blue Cross Blue Shield of Massachusetts Coverage for Addiction Treatment