Blue Cross Blue Shield Insurance Coverage for Substance Abuse Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) has stated that some 1.2 million people in this country have sought treatment for substance abuse as of March 2011. While this is a huge number, it represents just a small percentage of the people who actually need this kind of treatment. One of the reasons why people have not sought help in the past, however, is because of the associated costs. Now, thanks to the Affordable Care Act, insurance carriers now have a responsibility to provide coverage for mental health services, of which drug and alcohol treatment is one. Exactly how they provide coverage, however, depends greatly on the carrier, on your plan, and on the state where you live.

About Blue Cross Blue Shield

The Blue Cross and Blue Shield Association is actually a collective of 36 individual health insurance companies, known as the Blue System. Some 105 million people in this country are insured through them, including around 50% of all federal employees, who can access the Federal Employee Program (FEP).

Blue Cross Blue Shield offers four levels of coverage:

1. Bronze, covering around 60% of costs with high deductibles and low monthly payments
2. Silver, covering around 70% of costs with a lower deductible but higher monthly payments
3. Gold, covering around 80% of costs, with high monthly payments and low deductibles
4. Platinum, covering around 90% of costs, with very high monthly payments and very low deductibles

It should be noted, however, that these four tiers will be different depending on which state you are in.

Blue Cross Blue Shield and Rehab

In principle, addiction treatment is covered, at least partially, by Blue Cross Blue Shield. However, the policy you have will determine how much. Usually, medical detox is included, so long as there is proof that it is needed.

Your plan will determine the treatment professionals and centers that are right for you. Anyone with an HMO can only go to HMO facilities, whereas those with a PPO are able to make use of more providers, including out of network ones, although the rate will be higher. However, you should speak to a representative to find out exactly what your plan does cover, and how much you will need to pay for.

Treatment Length and Coverage

Under the principles of effective addiction treatment, it is understood that treatment length should be appropriate for the individual. This means that some will have to stay longer than others. What sets Blue Cross Blue Shield apart is that it does not cover policy holders for a specific period of time. Rather, a percentage of the overall stay is covered. This means that you can enjoy a longer stay if need be as well.

For Blue Shield Blue Cross, substance abuse is a mental health issue. The company also allows you to choose your treatment center, often at set fees. For instance, at an approved center, you will pay $250 and the company will cover the rest, or, at an out of network provider, you will pay $350 and insurance will cover the rest. This means that, if you can afford it, you can also choose to go to luxury or executive facilities, something most other insurance companies don’t allow.

Blue Cross Blue Shield Coverage for Alcohol Abuse Treatment

Those who abuse alcohol will usually give up on their important obligations. They become obsessed with drinking despite this causing them relationship, professional, financial, medical, and even legal problems. The longer people abuse alcohol, the more tolerant they become, which means they have to increase their intake. When they stop, the withdrawal symptoms can be so severe that some could actually die. If you are covered under Blue Cross Blue Shield, you will be able to receive coverage for treatment for alcohol abuse, whether you have an individual or a group policy. In group policies, you will usually find that rehab treatment is covered in the same way as a hospital stay. Do make sure to check your maximum per stay and per day, your deductibles, your co-pays, your limits, and so on, as these can vary not just between policies but also between states.

Blue Cross Blue Shield will pay for a range of treatment options for those with an alcohol abuse problem. This includes:

• Outpatient and inpatient care
• Behavior modification treatment
• Counseling

It is very important that you properly review your policy in terms of what is and isn’t covered. Unfortunately, alcohol abuse treatment programs can be very expensive, and you don’t want to end up with a nasty financial surprise. Speaking to your insurance representative is 100% confidential and always recommended.

No Policy Covers 100% of Treatment

With Blue Cross Blue Shield, you will not find a policy that covers 100% of your treatment. You need to understand, therefore, what your out of pocket expenses will be, and what are covered. For instance, if you want to have acupuncture and yoga as part of your treatment, it is unlikely that your carrier will pay for that. But you can pay for that yourself, in full, should you choose to have those.

Inpatient Care Usually Required But Outpatient Care Is Also Possible

Generally speaking, people who suffer from an alcohol addiction require inpatient care. This is the only way they are able to become sober and break through their addiction, not in the least because alcohol is so readily available. During their stay, they learn about triggers and how to respond properly. Avoiding environments where triggers are likely is also very important.

Meanwhile, the same skills are taught in an outpatient center but you will return home at the end of the day, which exposes you to the triggers. Nevertheless, sometimes, because of professional, educational, or personal responsibilities, outpatient treatment is the only viable option.

Choosing Between Inpatient and Outpatient Care

At the end of the day, choosing between inpatient and outpatient treatment is a personal decision. Both have significant pros and cons. Overall, it would be best to follow the advice of an addictions counselor. Blue Cross Blue Shield does cover both inpatient and outpatient treatment, so that should not be a major factor in your decision. The exception is if you want to go out of state for treatment, or to an out of network center. In that case, it is very important that you speak to your insurance representative in order to find out what they will and will not pay. One of the things, for instance, that you will not be covered for is transportation to your treatment center.

What makes Blue Cross Blue Shield unique, however, is that it will also cover luxury or private treatment, depending on your policy, although only a small percentage will be covered in this case, meaning you will have higher out of pocket expenses. That said, the level of treatment you will receive there would be far greater than anywhere else, so you may want to consider it anyway. This is particularly true if you are a busy executive who requires inpatient treatment but cannot abandon your professional responsibilities.

Generally, inpatient treatment is 30, 60, or 90 days in length, and this can be extended. In fact, some people can remain under treatment as long as a year. Just how much of this Blue Cross Blue Shield will cover will depend on your individual policy. There are usually annual and daily maximum amounts to take into consideration.

Blue Cross Blue Shield Coverage for Opioids and Opiates

Opiates include heroin, Oxycodone, Percodan, codeine, morphine, and so on. These are all highly addictive substances. Generally speaking, if you require opioid addiction treatment, then Blue Cross Blue Shield will pay for it. Again, however, how much they pay will depend on your plan, your policy, and your state.

While the exact coverage you will receive will depend on your plan and the type of treatment, opiate addiction treatment is covered under the mental health provisions. If, after speaking to your insurance representative and you feel that you want to access services that are not covered for you, you always have the option to pay for it yourself. If you can demonstrate that there is a medical need for treatment not covered as standard, however, it is likely that your insurance will pay for it.

As with treatment for alcohol addiction, there is no set maximum period of time for which you will be covered. This means that you can really find the treatment that is based on your personal needs, rather than one that is based on your financial capability. Opioid addiction is a complex addiction that covers a broad spectrum and it is not possible to say that a certain length of treatment is required for a certain drug.

It is very important that you speak to an addictions counselor about the type of treatment that is most appropriate to your needs. You have to consider the particular challenges that you will face and the best way to surpass them. Based on that, you should decide whether to choose an inpatient or outpatient treatment center. Blue Cross Blue Shield may even pay for out of state treatment so long as it is an in-network provider. It is more likely that a local center will be within the company’s network, but you do have the flexibility to consider other centers as well. With Blue Cross Blue Shield you really have the opportunity to find something that really works for you.

Frequently Asked Questions about Blue Cross Blue Shield

Q. Can I attend rehab multiple times under Blue Cross Blue Shield?

A. Considering that relapse rates for substance abuse are incredibly high, similar to those of other chronic conditions such as asthma, diabetes, and high blood pressure, this is a very good question. In fact, the vast majority of people will require multiple stays in rehab before having their addiction under control. Luckily, Blue Cross Blue Shield is likely to cover multiple treatments, although you may need to show proof of medical necessity.

Q. Is aftercare included in my insurance package?

A. While this will depend on your exact policy, aftercare is usually included, particularly if you can demonstrate that it is required in order for you to properly recover.

Q. Will my premiums go up if I go to rehab?

No. Blue Cross Blue Shield policies cover rehab, which means your premiums should stay the same even if you use the services. It is very rare for insurance companies to raise their premiums when someone uses their policy.

Q. What has been the effect of Obamacare on substance abuse treatment?

A. Thanks to the Affordable Care Act (Obamacare) insurance coverage for mental health and substance abuse has been tremendously expanded. This type of coverage is now an essential benefit.

For Those Without Insurance

Since the implementation of the Affordable Care Act, every person in this country should have at least some medical coverage. Also, it has been agreed that addiction treatment is classed as mental health treatment, which means that it should be covered as well. However, it is possible that you do not have Blue Cross Blue Shield, or that there is some other reason as to why you cannot receive coverage for your addiction treatment. For instance, some insurance companies only pay for detox and not for the other services needed for a successful recovery.

Generally speaking, however, treatment facilities understand that those who have a substance abuse disorder often also have financial difficulties because they have spent substantial amounts of money to buy their chosen substance. Because of this, they generally have flexible payment options in place as well. The SAMHSA also offers treatment grants for people who meet certain specific criteria. There are even nonprofit organizations out there where you may receive treatment completely free. Clearly, therefore, if you do not have coverage, or insufficient coverage, there is still help out there that you could use.

If you don’t have Blue Cross Blue Shield or other insurance, you can still get help. Many rehab facilities will work with you to set up a payment plan that is feasible for you. Further, there are some non-for-profit facilities that will help you for free. Talk to a doctor or treatment expert, or call us at 1-888-341-7785 to learn how you can get help without insurance.