Blue Cross Blue Shield Drug Rehab Coverage

Blue Cross Blue Shield is a nationally recognized and highly regarded health insurance provider that provides insurance to more than 115 million people and their families. They offer a variety of health plans, including those designed to support individuals in need of addiction treatment and rehabilitation services.

Your substance abuse treatment options vary depending on your specific needs and the severity of your addiction, usually based on a clinical assessment by a treatment provider or your doctor. Some or all of your treatment may be financially covered by your BCBS plan. Your BCBS insurance may cover the following treatments:

• Detox and withdrawal management – Detox ensures you’re safely stabilized and ready to enter a substance abuse and recovery program.
• Outpatient treatment – You may receive therapy and counseling at a treatment facility, but you will live at home.
• Inpatient treatment – You may be admitted to a rehab clinic or hospital where you will receive inpatient treatment lasting several days or a few weeks. BlueCross BlueShield plans might call for a pre-certification for those who are planning to enroll in an inpatient hospital or facility for substance abuse treatment and services.
• MAT (Medication-Assisted Treatment) – MAT involves certain prescription medications, along with therapy, support, and counseling. The medications work by blocking the effects of drugs and alcohol or minimizing withdrawal symptoms and cravings. The most common medications include naltrexone, buprenorphine, or methadone.
• Interim care is an option if a waitlist or other problem prevents you from getting into treatment immediately.

Telemedicine – Treatment is delivered remotely, often when local treatment isn’t available and is covered by BCBS.

Blue Cross Blue Shield offers a variety of different benefit plans, each of which has varying coverage. First, it’s important to note that nearly all BCBS insurance plans use a network, which means that in-network healthcare providers offer services at a lower cost. Your specific benefit plan determines your network.

BCBS policyholders may be responsible for the difference in cost between the plan allowance and the specific billed amount by the provider if an out-of-network or non-preferred provider was used. In these cases, you may need to pay the entire amount.

When it comes to drug and alcohol rehab, BCBS plans typically require prior authorization for inpatient treatment, and many require authorization for outpatient treatment as well. BCBS may also require a full clinical assessment to confirm your need for treatment.

Finally, if you’re like most people, understanding your share of treatment costs is one of the most confusing things about insurance coverage. Your deductible is a set amount you must pay before BCBS makes any payment. Your copay is a specific amount you must pay out-of-pocket at the time of service. You may also have to pay coinsurance, which limits your coverage to a certain percentage. Most plans are 80-20 coinsurance, which means BCBS will pay 80 percent, and you will pay the remaining 20 percent once your deductible is met.

Due to the intricate details of Blue Cross Blue Shield insurance coverage from state to state, 1st Step Behavioral Health helps you find the highest possible level of care at the lowest expense.

Contacting BCBS directly may not guarantee the best options for you, as we base most of our referrals on the past experiences of actual clients who have gotten their alcohol and drug rehab treatment programs covered by insurance.