What Does Blue Cross Blue Shield Cover for Alcohol and Drug Rehab?

Does Blue Cross Blue Shield Cover Rehab for Drugs and Alcohol?

Blue Cross Blue Shield covers some or all of the cost of rehabilitation for drug and alcohol addiction. It’s one of the largest and most well-known insurance providers in the U.S., and many treatment facilities accept it.

Blue Cross Blue Shield owns 3 dozen different insurance companies that are independently owned and operated. These are a part of the Blue’s System. 

Additionally, it provides coverage to more than half of all federal employees as part of the Federal Employee Program (FEP).

Coverage varies depending on your plan and state of residence but usually includes:

• Detox
• Therapy
• Aftercare planning

Blue Cross Blue Shield provides coverage for addiction treatment at a variety of facilities, including:

• Traditional
• Luxury
• Gender-specific
• Dual-diagnosis
• Adolescent 

Blue Cross Blue Shield’s website also offers several resources for those struggling with addiction, including:

• Directories of recommended treatment centers
• Diagnostic criteria for substance abuse
• Educational resources for friends and family members
• Advice for how to talk to a doctor about safe opioid prescription management

How to Check Your Coverage 

There are 2 ways to check your Blue Cross Blue Shield rehab coverage for drug and alcohol addiction:

1. Contact Your Treatment Facility

If you’ve chosen a treatment provider or rehab facility, contact your chosen facility for more information. The staff will help you determine what coverage is available and how much, if anything, you’ll pay out of pocket for care.

2. Contact Blue Cross Blue Shield

If you haven’t chosen a facility, contact Blue Cross Blue Shield directly. They can provide information about your policy and recommend substance abuse treatment resources local to your community.

It’s important to know what benefits your coverage provides before committing to a treatment provider. Nobody should make their drug or alcohol addiction treatment decisions based on cost alone. 

Factoring in coverage helps you make an informed decision about drug and alcohol rehab.

Many Blue Cross Blue Shield rehab plans have deductibles, copays, coinsurance, or a combination.

What is a deductible?

A deductible is the amount the customer must pay for covered services before the insurance provider begins to pay any expenses. 

For example, if your treatment costs $7,000 and you have a $500 deductible, you’ll pay the first $500, and Blue Cross Blue Shield will cover the remaining $6,500 owed to the treatment facility.

What is a co-pay?

A co-pay is a set amount a customer pays for a covered service before and after they’ve met their deductible. 

For example, you might pay $15 out of pocket when you visit the doctor. Blue Cross Blue Shield then covers the remaining cost of care once you meet your deductible.

What is coinsurance?

Coinsurance is the percentage of a covered service you pay before and after you’ve met your deductible.

For example, if your coinsurance is 10%, you’ll pay 10% of the cost of all medical care, in addition to your deductible and co-pay.

In addition to understanding your out-of-pocket payment obligations, it’s also important to determine if you need pre-authorization for care. 

In some cases, you’ll need to have Blue Cross Blue Shield approve a service and/or service provider to guarantee coverage.

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Paying for Uncovered Rehab Costs 

Sometimes substance abuse insurance coverage isn’t enough for the entire cost of drug and alcohol rehab. If you’re struggling to pay out-of-pocket costs for rehab, don’t give up. There are resources and support available to help you.

It’s important to be aware of any additional costs. Be sure to speak to your health insurance and treatment providers to fully understand how much you’ll pay. 

Substance abuse treatment providers can help you find ways to cover the gap between your coverage and what you owe. 

Some programs offer grants or scholarship programs. Others accept incremental payments so you don’t pay the entire amount upfront. 

Many rehab facilities also accept credit card payments. Ask your treatment provider if this is an option.

Nobody should have to back out of addiction treatment or choose an unsuitable program because they can’t afford treatment. The staff at the facility of your choice can help you determine the best way to proceed regardless of your situation.

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Which Rehab Services Does Blue Cross Blue Shield Cover?

Blue Cross Blue Shield offers coverage for a variety of rehabilitation services. The company categorizes plans as bronze, silver, gold, and platinum. They vary in premium cost and coverage.

Covered addiction treatment services include:

Detoxification

Detoxification is the first stage of recovery. Most people require medical supervision and attention during this phase.

Symptoms can be uncomfortable or painful during detox. In some cases, detox symptoms are life-threatening. This is true for people struggling with alcoholism and addiction to certain types of drugs like opioids. 

Medical detox programs include prescription medications that ease withdrawal symptoms and speed up the recovery process. 

Inpatient Treatment

Inpatient programs allow participants to live onsite at the treatment facility. They are residential programs that provide around-the-clock care and supervision. Programs range from a week to 90 days.

Outpatient Treatment 

Outpatient addiction treatment includes access to many of the same recovery tools as inpatient programs. In outpatient programs, though, participants don’t live at the treatment facility.

Most outpatient programs operate for 10 to 12 hours a week or more. Participants can work, spend time with family and friends, and sleep in their own homes throughout treatment.

Intensive Outpatient Programs (IOPs)

These programs blend the intensity of inpatient addiction treatment with the flexibility and affordability of outpatient programs.

They are not overnight programs. However, in many programs, the majority of a person’s time is spent in treatment. Some programs allow for work and school attendance.

Partial Hospitalization Programs (PHPs)

PHPs are the most comprehensive outpatient program for addiction treatment. Participants live at home but attend the program during the day. Instead of attending school or work, they “work” on recovery full-time.

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