Does BCBS of North Carolina Insurance Cover Drug Rehab?

Blue Cross of North Carolina is a not for profit organization with 4.3 million members. They’re affiliated with the Blue Cross Blue Shield Association. The company has been serving North Carolina residents since 1933 and now offers a wide variety of plans — some let you get care where you live locally, while other plans can cover you if you choose to travel or live abroad.

The company focuses on improving the health and wellbeing of every community they operate in. They also have 10 locations in North Carolina where you can get free in person one on one help from an insurance specialist. The locations also offer preventive care, fitness classes, and more.

Does Blue Cross of North Carolina Cover Drug Rehab?

Most Blue Cross of NC plans cover medically needed substance use treatment. The 2010 Affordable Care Act requires most plans to cover 10 essential health benefits which include mental healthcare and addiction treatment. However there are exceptions to the law, so it’s always important to verify your coverage details before starting treatment.

Some of the Blue Cross of NC plans will only cover treatment centers that are in the plan’s network, while other plans offer more flexibility. You can work with the insurance company to find in network providers or you can talk to treatment centers directly to verify your insurance.

What Types of Plans Does Blue Cross NC Offer?

Blue Cross of NC offers individual and family plans through the Insurance Marketplace and employers who provide them to employees. There are a wide variety of options: for example the Blue Advantage plans allow you to access the Blue Cross Blue Shield network across the country, while the Blue Value plans are less expensive and has a smaller but still robust provider network.

They also offer Medicare plans. If you have Original Medicare, Blue Cross of NC can offer you a Medicare Part D prescription drug plan and/or a Medicare supplement plan. They also offer Medicare Advantage plans which fully replace Original Medicare and offer additional benefits, such as vision and dental care, gym memberships, and more. However Advantage plans have a smaller provider network and some of the plans do not cover out of network providers.

Their North Carolina Medicaid plan is called Healthy Blue. This plan serves lower income families and adults who qualify for Medicaid. Some additional services that their Healthy Blue customers have access to include help with transportation to appointments, help quitting smoking, and access to the Chess Health app that provides peer support and daily motivation.

Does Blue Cross of NC Cover Other Mental Healthcare?

In compliance with the Affordable Care Act, most Blue Cross of NC plans offer mental health care as well as addiction treatment, but the types of services available vary according to plan. So, you should always verify your specific coverage by checking with your insurance agent.

Mental health treatment options available in Blue Cross of NC plans may include crisis care, counseling and psychotherapy, and medication management. Both in person and virtual sessions that are conducted over the phone or internet are available. Evening and weekend appointments are available.

Co occurring disorders, also known as a dual diagnosis, where a mental health disorder and addiction are both present at the same time are common. It is important in such cases that both conditions are treated simultaneously with a coordinated care plan. If you have co occurring disorders, make sure that both your healthcare provider and your insurance company are aware of this, so that you can receive the integrated services that will assure your long term success.

Blue Cross of NC also offers a self guided care option using their digital platform, which connects you with support resources like mental health tips, meditations, and informational podcasts.

What Inpatient Addiction Treatment Does Blue Cross of NC Cover?

Blue Cross of NC covers inpatient addiction treatment when it is medically necessary. To help ensure coverage, you’ll want to work with your doctor to create a treatment plan that will show what’s medically necessary for your situation.

Inpatient treatment usually takes place in a hospital or clinic and residential care happens in a facility that has a more home like atmosphere. Both options provide 24 hour monitored care and a structured environment. Care is provided by credentialed clinical staff and clients live at the facility 24/7. With inpatient care, you are removed from the stresses and temptations of everyday life so you can focus on your treatment. If you have a severe addiction, a dual diagnosis, or another health issue that requires close support, inpatient or residential rehab is a good choice.

Medical detox is often available before you start inpatient or residential treatment. You will have 24/7 support during the detox process, and FDA approved medications may used to reduce physical withdrawal symptoms so that you can detox safely and as comfortably as possible.

What Outpatient Rehab Does Blue Cross of NC Cover?

Addiction treatment in an outpatient setting is covered by most Blue Cross of NC plans. Your behavioral health substance use treatment coverage may include one or more of the options listed below. Check with your insurance company for details about your plan’s specific addiction treatment coverage.

Outpatient treatment is delivered at a facility that does not offer overnight care, so you’d receive treatment during the day and return home at night. There can be more flexibility to schedule outpatient rehab around your work or school obligations. But because you are not removed from the outside environment, you will still face stressors and temptations. That’s why it’s a good idea to start outpatient treatment after completing an inpatient or residential program.

Outpatient treatment options include partial hospitalization programs (PHPs) that provide at least 20 hours of treatment per week for 3-4 weeks. Intensive outpatient programs (IOPs) typically provide 9-20 hours of programming per week and last for 4-8 weeks. Regular outpatient programs (OPs) often meet once or twice a week and involve one to 1.5 hours each session. Some programs may meet for 3-4 hours a day. The length of outpatient programs varies, but 30 days is typical.

With outpatient treatment, aftercare services may be offered. These often include the option of additional counseling sessions, 12 step peer recovery meetings, and alumni meetings that include socialization opportunities.

Does Blue Cross of NC Cover Methadone & Suboxone (MAT)?

MAT, or medication assisted treatment, can be used for medical detox or as an ongoing treatment for alcohol or opioid addiction. MAT medications work best when used as part of a comprehensive treatment plan that includes counseling.

Methadone and Suboxone, which is a combination of buprenorphine and naloxone, are both FDA approved medications used in the treatment of opioid addiction. If you have a diagnosis of opioid use disorder (OUD) your primary care physician would likely refer you to an opioid treatment program that provides SAMHSA certified opioid treatment. In that case, Blue Cross of NC would usually provide healthcare coverage for the treatment. But again, plans vary, so you would want to verify the specifics of your coverage by contacting the insurance company.

If you have moderate to severe alcohol use disorder (AUD), you would be a candidate for MAT alcohol treatment. Naltrexone can be used as a MAT medication for alcohol use disorder, but it is not prescribed until after alcohol detoxification has been completed.

Naltrexone blocks the euphoric effects of opioids or alcohol and decreases the desire to use these drugs. However it does not reduce the withdrawal symptoms associated with alcohol detox as it does with opioid detox. Treatment with naltrexone for AUD is often covered by insurance, so your Blue Cross of NC plan may provide coverage. Verify this with your insurer.

Blue Cross of North Carolina Addiction Treatment Coverage