Excellus Blue Cross Blue Shield New York for Addiction Treatment

Excellus BlueCross BlueShield serves communities across upstate New York. They are an independent licensee of the Blue Cross Blue Shield Association of companies. This Federation allows independent companies to use Blue Cross Blue Shield resources while operating independently to serve the needs of local communities.

One of the key features of Excellus BlueCross BlueShield is its commitment to preventive care. They emphasize regular health screenings, wellness programs, and vaccinations. The company provides resources and support to policyholders to help manage chronic conditions like diabetes and heart disease to help reduce costly hospitalizations.

Does Excellus BCBS Cover Addiction Treatment?

Most Excellus BlueCross BlueShield health insurance policies cover drug rehab and addiction treatment. The 2010 Affordable Care Act requires most insurance plans to cover 10 essential health benefits, which include both mental health and substance use treatment. However, there are exceptions to the law, and every plan is different, so be sure to check your coverage details before you begin rehab.

Your insurance plan will also focus on covering medically necessary care, which will be largely determined by the treatment plan your doctor creates. Work closely with your doctor so you know what kind of treatment to look for when it’s time to start your recovery.

What Type of Plans Does Excellus BCBS Offer

Excellus BlueCross BlueShield offers different types of policies across New York state counties. You may have an individual and family plan through the Marketplace or your employer. Those who qualify may have a Medicaid or Medicare plan. Not every policy is available in every county.

The individual and family plans vary based on how much the monthly premium is and how much they cover. A Bronze plan in the Marketplace will have the lowest premium but only cover about 60% of the cost of care. A Gold plan in the Marketplace is more expensive monthly but also covers about 80% of the cost of care. A silver plan offers a moderate premium and covers 70% of your care.

The Excellus Essential Plan is a free insurance plan available to people with lower or moderate incomes who do not qualify for Medicaid. This helps fill the gap for individuals who make too much to qualify for Medicaid but not enough to afford plans in the Marketplace. Each Essential plan has the same benefits and features, but the one you qualify for depends on your household size and income.

They also offer several free or low cost choices if you qualify for Medicaid or Child Health Plus, which is insurance coverage for eligible children up to age 19 based on your family’s gross income. Excellus offers different Medicaid plans depending on the county you live in.

Excellus also offers Medicare Advantage plans that replace Original Medicare and may include extra benefits such as dental, vision, and hearing coverage. However if you have an Advantage plan, you may need to use an in network provider and some care requires preauthorization.

Finally, Excellus BlueCross BlueShield offers dental plans for individuals and families that help cover preventive care, such as exams, fluoride treatments, and x-rays, as well as routine treatment such as cleanings and root canals.

How to Verify Coverage With Excellus BCBS

Not all policies have the same level of coverage for drug addiction treatment. You must verify your insurance coverage before starting treatment so you are not surprised by unexpected bills and can seek financial aid from appropriate sources to cover treatment your policy benefits do not cover.

Excellus has a member services phone number for individual and group policies and if you are on Medicare. Member Services can answer questions about your policy benefits and guide you to in network drug and alcohol addiction treatment centers.

A second option is to work with the treatment center of your choice. Many times they verify your insurance policy coverage free of charge and offer a quick phone assessment to determine if you are a good fit for their program. They can also estimate your out of pocket expenses based on your insurance policy coverage. Some treatment centers will help guide you in finding financial aid within the community, including scholarships and grants from local businesses, and may offer alternative payment plans or sliding scale fees.

What Inpatient Addiction Treatment Does Excellus BCBS Cover?

Most Excellus plans will cover necessary inpatient addiction care. Excellus will expect the clinician who refers you to residential treatment to show that it’s the level of care needed to address your illness severity. With some Excellus plans the referral might need to come from your primary care provider.

Depending on the substance you have been using you may have to go through medical detox before you can go to residential rehab. Some residential rehabs can do medical detox on site but not all can. While at detox the focus is to medically supervise your withdrawal to keep it safe and as comfortable as possible. It can take between three to ten days to withdraw from a substance for most people.

In residential rehab you can expect the focus of the treatment to change from medical management to building your recovery. Your stay may last weeks to months. Life in residential treatment is highly structured to help bring healthy routines back into your life. You’ll spend your day in individual counseling and groups that teach you how to live in recovery and prevent relapse.

What Outpatient Rehab Does Excellus BCBS Cover?

Most Excellus plans will cover some level of outpatient rehab but every plan is different. It’s important to get your insurance details before you commit to treatment — especially because you may need a referral or preauthorization to get coverage.

After inpatient care Excellus may cover treatment in a partial hospitalization program (PHP). Some people can start treatment at this level if they have a stable supportive living environment. PHP is a lot like residential rehab with the main difference being that you sleep at home and return daily for treatment. Like residential rehab the therapy groups center around teaching you how to prevent relapse and live in recovery.

After PHP or instead of it your provider may refer you to an intensive outpatient program (IOP) if your clinical condition warrants. The difference between IOP and PHP is the length of time you’re there each day. An IOP is usually two to three times a week and it might not last the entire day. This option is best for people who are trying to keep their job while they’re in treatment or who are returning to work after having been in treatment full time.

Excellus includes standard outpatient treatment providers in their network. With standard outpatient treatment you’ll meet with an addiction counselor and/or a medication provider on a regular basis. The usual frequency is once a month but you and your clinicians may agree on a different schedule. Note that certain plans may expect you to get a referral from your primary care provider for visits with a counselor or addiction specialist to be covered.

Does Excellus BCBS Cover Methadone & Suboxone (MAT)?

Addiction treatment that uses medications like methadone or Suboxone is commonly known as medication assisted treatment or MAT. You can use medications to help you treat opioid use disorder and alcohol use disorder. If MAT is a medically necessary part of your treatment plan then Excellus may cover it.

One way to use MAT is as part of a medically supervised withdrawal or detox. Medications can aid withdrawal from alcohol or benzodiazepines or opioids so that you avoid the worst health consequences of detox. Once you’re through detox there are medications that can help manage cravings and avoid relapse that your MAT provider can prescribe.

People who are dependent on opioids have another option with MAT and that’s to go on a maintenance dose. With maintenance MAT you avoid going through a full detox. You may not detox at all depending on whether you’re maintained with Suboxone or methadone. A MAT provider can give you a prescription for Suboxone. With methadone you would need to go to a clinic every day to get your dose.

Does Addiction Treatment Need to Be In Network?

The type of plan you have will dictate if you have to stay within the Excellus provider network to get addiction treatment. If you have an HMO the answer is probably yes. Even with plan types that let you go out of network you’ll want to be sure to read the fine print about what happens if you do. If you go out of network with a plan that allows that coverage your expenses are likely to be much higher.