Find Rehabs That Accept HCSC Insurance

Health Care Service Corporation (HCSC) is a health insurer that operates in Illinois, Montana, New Mexico, Oklahoma, and Texas. They are affiliated with Blue Cross Blue Shield. What really stands out is that they are a customer owned health insurer. The company was founded in 1936 and today has 23 million members and 28,000 employees. They focus on connecting members to excellent care, helping them get quality outcomes.

Does HCSC Cover Drug Rehab?

There was a law passed in 2010 that dramatically changed how addiction treatment and mental health care were covered by insurance. The law, the Affordable Care Act (ACA), requires most long term health insurance plans to cover 10 essential health benefits. The list includes mental health and addiction treatment. The law has some exceptions, so make sure to verify your insurance.

That means your HCSC insurance plan may cover at least some of the costs of drug rehab. You can also get help with co occurring mental health disorders. Every HCSC is different and will have different in network providers and costs you are responsible for. That’s why it’s important to understand the details of your plan before you begin treatment.

Insurance Plans Offered By HCSC

HCSC offers Blue Cross Blue Shield (BCBS) insurance policies in five states. They generally don’t call themselves HCSC but instead use company names like Blue Cross Blue Shield of Illinois or Blue Cross Blue Shield of New Mexico. Through BCBS, they also have Medicare and Medicaid plans for those who qualify.

Many BCBS insurance plans are Health Maintenance Organizations (HMOs). The best part of these plans is that they cost less. You need to use providers that are in the plan’s network, and there are no out of network benefits. You also choose a doctor to be your primary care provider, and that doctor will provide referrals to specialized care like drug rehab.

Some Blue Cross plans are Preferred Provider Organizations (PPOs). These plans give you more choice in providers, but they are also more expensive each month. With a PPO you have a broader provider network and you don’t need referrals for specialized care. One thing that’s unique about a PPO is that you may also be able to get out of network coverage, although you’ll pay a higher percentage of the costs.

If you qualify, Medicare and Medicaid plans are also available through each state’s BCBS company. Medicare is generally available to those who are 65 and older, or those who are permanently disabled. Medicaid is free or low cost insurance for lower income residents of the state.

What Inpatient Rehab Does HCSC Cover?

HCSC will focus on covering evidence based treatment that’s in line with your doctor’s recommended care plan. Depending on your insurance, you may need a referral and/or preauthorization to get care. Here are some of the inpatient treatment options that might be covered.

Medical detox allows you to have medical help while substances leave your body, so you can get a fresh start in treatment. You don’t have to be afraid of detox when medical professionals are by your side to help you with withdrawal symptoms.

Residential treatment gives you a distraction free environment to start your recovery. One thing that’s neat about residential treatment is that you often get access to holistic treatment as well as traditional counseling. You’ll also have regular activities, recreation, and outings.

What Outpatient Treatment Does HCSC Cover?

Outpatient treatment lets you partake in your everyday life at home while receiving care so you can maintain contact with family and keep working or attending school. Outpatient programs can be challenging as you might encounter addiction triggers in your daily environment.

Most HCSC plans cover research supported treatments delivered via outpatient addiction programs. Outpatient treatments include different levels of care, such as standard outpatient programs, intensive outpatient programs (IOP), and partial hospitalization programs (PHP). They all rely on clinically effective validated interventions like individual counseling and group therapy sessions. They also offer life and coping skills workshops and education on addiction and recovery.

A PHP is a full time day program where you go home at night and on weekends. These programs typically have a minimum of 20 hours per week of treatment and may last up to 90 days. IOP clients have three hour sessions three to five days per week. IOP and PHP programs are characterized by a more structured approach which can be key to accomplishing your recovery goals.

Medication assisted treatment (MAT) might also be covered as part of outpatient care — combining medications with counseling and behavioral therapies.

It’s best to verify your coverage details with HCSC before initiating an outpatient treatment plan. Remember that you may need a referral or preauthorization for certain outpatient treatments and services. A medical professional’s thorough assessment is the best way to determine the right level of care for your individual needs.

Does HCSC Cover Methadone & Suboxone (MAT)?

Most HCSC plans will cover MAT—including methadone and Suboxone—when it’s considered a medical necessity. MAT is utilized in two phases of the recovery journey: During medical detox and as part of long term treatment.

The medical detox value of MAT lies in its capacity to manage acute physical withdrawal symptoms and reduce initial cravings. Medical professionals employ prescription medications like Suboxone or methadone to ease the physical distress of drug withdrawal. The FDA approved medicines can bind to the same chemical receptors as the drugs individuals abuse which minimizes discomfort and reduces the risk of dangerous complications as you get the drug out of your system. MAT in the medical detox phase is invaluable for individuals battling addiction because it helps them navigate safely—and comfortably—the first steps of their recovery journey which increases the likelihood of successful treatment completion.

During the long term treatment stage MAT helps tackle ongoing obstacles that get in the way of recovery. Medications like buprenorphine or methadone may be prescribed for their beneficial effects in diminishing drug cravings that can persist for many months. Prolonged substance abuse disrupts brain chemistry so prescription drugs with normalizing properties can be very helpful in establishing long term recovery.

The combination of FDA approved medications with counseling and behavioral therapies makes MAT a valuable tool that improves treatment adherence and reduces relapse risk.

Remember to verify coverage before committing to a plan. You may need a referral or reauthorization as plans can differ regarding individual medications and coverage duration.

Does HCSC Cover Other Mental Healthcare?

Mental healthcare is listed in the Affordable Care Act as one of 10 essential health benefits so most plans will cover at least part of the cost.

Mental health can be addressed evidence based ways. Individual and group therapy may be covered as part of your plan as well as psychiatric medication management. Your plan may also cover assessments and evaluations. Depending on your insurance coverage inpatient and outpatient treatment options may be available for mental health.

It’s critical to understand that certain mental health conditions like anxiety or depression along with borderline personality disorder (BPD) and other disorders are associated with an elevated risk of substance abuse. Having a mental health diagnosis along with substance use is known as a co occurring disorder or dual diagnosis. If you have a dual diagnosis an integrative approach to addiction treatment and mental healthcare is fundamental for improving your chance of recovery long term.

It’s important to verify your insurance coverage before getting treatment. Some plans may have limitations or exclusions for certain services so always check with HCSC about the benefits that apply to you.

Does Addiction Treatment Need to Be In Network?

HCSC’s coverage for out of network addiction treatment depends on your plan’s characteristics. PPO plans provide some out of network coverage but you’ll pay much more out of pocket for these services. HMO plans do not cover out of network care. Many Medicare Advantage plans are HMOs, and Medicaid plans are limited to providers that accept the insurance plan in the state.

Using in network providers is strongly recommended as your best choice to keep out of pocket costs low and maximize your insurance’s benefits. Before initiating treatment double check your provider’s network status and other coverage details with HCSC. Out of network care may sometimes be necessary. However it can seriously increase your expenses so it’s best for you to use the network to your advantage.

Health Care Service Corporation Coverage for Addiction Treatment