Explore how CareFirst provides comprehensive addiction treatment coverage, wellness programs, and community support for a healthier you.
CareFirst Insurance
Explore how CareFirst provides comprehensive addiction treatment coverage, wellness programs, and community support for a healthier you.
CareFirst is part of the Blue Cross Blue Shield Federation of 34 independently owned insurance companies. The network operates under the Blue Cross Blue Shield umbrella and customizes product offerings based on the local community. This collaboration with Blue Cross Blue Shield helps reduce costs and improve the quality of care.
CareFirst was established in 1934 as a not for profit organization. They are committed to affordable health care and emphasize preventive and wellness programs. They focus on transforming healthcare through building community partnerships and removing obstacles to healthcare.
They work to advance health equity through policy change, community engagement, and data collection and analysis. They invest in community initiatives addressing opioid addiction, mental health conditions, and health disparities.
Does CareFirst Cover Addiction Treatment?
Most CareFirst BlueCross BlueShield plans offer addiction and mental health treatment coverage including drug rehabilitation. Two Federal laws mandate this coverage for most plans: the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act. However there are exceptions to the laws, so be sure to verify your insurance details before starting rehab.
The amount of coverage you have depends on your specific policy. You could be required to go to a treatment center in the plan’s provider network and your doctor might need to preauthorize care before you begin rehab. Your out of pocket costs will vary as well.
All insurance plans focus on covering medically needed care, so work with your doctor to create a treatment plan that will show what types of addiction treatment are best for your situation.
Where Does CareFirst Operate?
They are the largest nonprofit health insurer serving people in the Mid Atlantic region with over 3.5 million members. The company employs 9,500 individuals in Maryland, Northern Virginia, and Washington DC.
They also have one of the largest enrollments in the Federal Employees Health Benefits Program in the nation and enroll Congressional employees with access to more than 96% of hospitals and 95% of doctors and specialists in the U.S.
CareFirst also provides members with digital tools and resources. This includes mobile health apps, telemedicine services, and online wellness programs. While the insurance plans offer coverage to individuals living in the Mid Atlantic region, it gives them access to over 1.7 million providers throughout the U.S.
Does CareFirst Cover Methadone & Suboxone (MAT)?
Another form of treatment that may be covered by your CareFirst plan is medication assisted treatment (MAT). MAT is the use of medications, combined with behavioral therapies, to treat addiction. Your CareFirst insurance plan may cover Suboxone and methadone MAT. However, you may need preauthorization from CareFirst for the prescriptions. The out of pocket costs (copay and deductibles) vary depending on your plan.
Does CareFirst Cover Other Mental Healthcare?
Those with CareFirst insurance gain access to a preferred network of behavioral and mental healthcare providers and addiction treatment centers. Providers include registered nurses, licensed behavioral health clinicians, and specially trained mental health representatives. You can contact CareFirst directly to be connected to this network of providers and choose a specialist near you.
Most CareFirst plans are required to handle mental health and behavioral conditions in the same manner they treat medical conditions. That means your coverage for mental and behavioral health treatment will generally be the same or better than for physical check ups, surgeries, etc. The percentage of coverage and any copays involved depend on where you live, the treatment provider, and your specific plan.
It’s common to have both a mental health diagnosis and substance use disorder, which are known as co occurring conditions. In that case getting integrated care that address both mental health and addiction is essential to successful long term recovery, so be sure to take advantage of coverage for mental health as well as rehab.
What Are CareFirst Plans?
CareFirst offers individual, group, Medicaid, Medicare, dental, and prescription drug healthcare coverage. The individual plans are designed to address individuals and their family’s needs. The plans have different policy limitations based on location. CareFirst offers employer group insurance to companies with 2 to 20,000 employees.
The Medicaid plan covers individuals of all ages living in Maryland from children to the elderly as well as persons with chronic disabilities.
CareFirst offers a range of Medicare Advantage and Medicare Supplement plans for Maryland, Northern Virginia, and Washington DC residents. They also offer dental coverage for individuals and families and prescription drug plans that cover a network of 66,000 pharmacies nationwide.
What Inpatient Addiction Treatment Does CareFirst Cover?
Most insurance companies focus on medically necessary care, and inpatient care is for those who need help to become medically stable and ready to start a less intensive treatment program. You must have a treatment plan set up with your doctor that shows what’s medically necessary in your case.
Inpatient treatment may include medically supervised detox, during which a group of professionals oversee your detoxification and ensure that you’re safe. Medications and other treatments are often used to help lessen the blow of withdrawal.
Inpatient and residential treatment programs are highly structured, supportive programs that have a high rate of success. While an outpatient treatment program may involve four to five hours of care a day, inpatient treatment is around the clock, and you have the support of medical staff and your peers during this time.
With inpatient treatment, you have a safe place to uncover triggers and develop coping mechanisms without the noise and temptations of the outside world. Inpatient programs also help you transition back to “real life” once you’re ready in a way that is best for you.
What Outpatient Rehab Does CareFirst Cover?
Outpatient care comes in several forms. Partial hospitalization programs (PHPs) offer treatment while allowing the patient to return home daily. These programs are highly structured and include medical and therapeutic care, with a commitment of about 20 hours a week. These flexible and cost-effective programs ensure a recovery community as you transition back to life after treatment. They also provide autonomy and accountability that will help you stay sober long-term.
Intensive outpatient programs (IOPs) are ideal for those who don’t need round-the-clock support or supervision. They’re designed to offer support, prevent relapse, and help develop coping strategies. With an IOP, you’ll engage in group, individual, and alternative therapies, as well as support groups. These programs are often structured, flexible, and affordable and provide opportunities to practice recovery skills.
General outpatient treatment takes place in designated addiction rehab facilities, community mental health centers, and hospitals. Most require a commitment of 3-4 hours a day, 3-4 days a week, and usually last about 10 weeks. These programs are ideal for those with more moderate addictions.
As always, consult with your doctor to determine which treatment program is most beneficial for you if outpatient treatment is the path you choose.
Does Addiction Treatment Need to Be in Network?
Some CareFirst plans will cover out-of-network care, and others won’t. If you choose an out-of-network facility or provider, your deductibles and copayments will likely be higher even if your insurance covers it.
If you can find a provider or facility within your network, it’s a great way to maximize your insurance policy. If you choose an out-of-network provider, study your plan carefully and get answers to any questions you have before you get started.
How to Verify Coverage With CareFirst
It is crucial to understand your insurance coverage limits before admission into an inpatient or outpatient addiction treatment program. This will save you from unexpected medical bills later. They have a member services and customer service inquiry website and phone number where you can get information about your medical benefits.
Most drug rehab and addiction treatment facilities will verify your insurance policy. This service can give you far more information than calling the member services hotline. Drug rehab facilities can help estimate your out of pocket costs after verifying your coverage.
Many can offer an initial assessment over the phone to determine if you would be a good fit for their facility and will connect you with their financial counselor who can help you set up a payment plan and offer you sliding scale fees. They may also help connect you with financial assistance in the community.
Calls to any general helpline will be answered or returned by one of the treatment providers listed, each of which is a paid advertiser: Recovery Helpline or Alli Addiction Services.
By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
Who Answers?
800-784-1361
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