Does Blue Cross cover drug rehab? If you need treatment for substance abuse or addiction and you’re covered by Blue Cross Blue Shield, your insurance will pay at least part of your treatment expenses. However, the amount your insurance will pay varies substantially depending on your benefit plan and location. It is not uncommon for someone with a policy in one state to have all of their claims approved and, in the neighboring state, have all of their claims denied.

Blue Cross Blue Shield Substance Abuse Treatment: Does BCBS Cover Drug Rehab?

BCBS insurance companies are spread all over the nation and they provide insurance to nearly 105 million individuals and families. In other words, they cover almost one in every three people! General BCBS coverage includes taking care of some of the costs associated with the following levels of care:

  • Inpatient Hospitalization 
  • Residential Detox or Non-Medical Detox
  • Residential Treatment
  • Partial Hospitalization Treatment
  • Intensive Outpatient or Outpatient Treatment

When you signed on with BCBS, you should have received a Summary of Benefits and Coverage (SBC), which provides a basic explanation of what your specific insurance plan covers and doesn’t cover, along with information about your share of costs. All insurance companies are required to provide this information, along with a glossary of commonly used terms. You can request a copy at any time.

If you’ve created an account, you can log in to the BCBS member website to find specific information about your plan, or you can call the member services number listed on your membership ID card. 

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.

To continue, 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.

Blue Cross Blue Shield Drug Rehab: Understanding Your Benefits Plan

Your Blue Cross Blue Shield 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. 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. Additionally, BlueCross BlueShield plans might call for a pre-certification for those who are planning to enroll into an inpatient hospital or facility for substance abuse treatment and services.

Residential treatment: You may receive treatment for a more extended period lasting up to a full year.

Sober living: You may temporarily live at a sober living home while transitioning from intensive treatment to independent living.

MAT (Medication-Assisted Treatment): MAT involves certain prescription medications, along with therapy, support, and counseling. The meds 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. 

Blue Cross Blue Shield offers a variety of different benefit plans. Understanding the following terminology will help you select a treatment provider:

Blue Cross Blue Shield Drug Rehab Coverage Details

Network: Nearly all Blue Cross drug rehab plans use a network, which means that in-network healthcare providers offer services at a lower cost. Your specific benefit plan determines your network.

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. 

Prior authorization (pre-certification): When it comes to drug rehab, Blue Cross 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.  

Your share of treatment costs: If you’re like most people, understanding your share of treatment costs is one of the most confusing things about insurance coverage. In short, your deductible is a set amount you must pay before BCBS makes any payment. 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. 

Blue Cross Blue Shield Drug Rehab Facilities: Finding Drug Rehabs That Accept Blue Cross Blue Shield

BCBS Provider Finder 

If you’re looking for a drug treatment center in your plan’s network, you can use Blue Cross Blue Shield’s Provider Finder. Before you look for Blue Cross Blue Shield addiction treatment providers, be sure you know the name of your benefit plan, listed on your member ID card. You can use the Provider Finder to search for a treatment provider in or outside the United States.

Blue Distinction Center for Substance Abuse Treatment and Recovery 

The Blue Distinction Center for Substance Abuse and Recovery is a national program that designates accredited centers for substance use treatment that offers safe and effective, scientifically proven treatment for addiction, including opioid drugs. Check the Directory of Providers to find a Blue Distinction Treatment Center in your state. Call the treatment center to verify the information, as the list is updated frequently. 

Additional BCBS Drug Rehab Information

The Substance Abuse Resource Center (SURC) is a helpful resource for anybody looking for substance abuse treatment, or those who are worried about a friend or family member. Insurance coverage isn’t required, and SURC is available to anyone.

Does Blue Cross Blue Shield Cover Drug Rehab & Addiction Treatment for Opiate Treatment?

According to Blue Cross Blue Shield, more than 100 Americans die from opioid overdoses every day, and millions more are at risk. BCBS member insurance companies have joined with community groups, pharmacists, medical providers, and others to devise solutions and to care for those who need treatment. 

BCBS has also established several strategies to prevent addiction to opioid drugs, including education, alternative meds for pain control, proper disposal of unused drugs, and tighter control of unnecessary or fraudulent prescriptions.

Seek Treatment: The Sooner, The Better

It can be intimidating to start understanding your BlueCross BlueShield policy and trying to figure out how to cover the cost of substance abuse treatment for you or a loved one. Fortunately, we have a professionally-trained staff of addiction experts ready to walk you through every step of the way. Here are some other benefits to being a BCBS policyholder and enrolling into a 1st Step Behavioral Health treatment program:

  • We’ll review and walk you through your Blue Cross Blue Shield health insurance plan.
  • We’ll help you figure out if you are covered for specific detox, substance abuse treatment, and mental health services.
  • We’ll help you decide what kind of treatment is best and how much BCBS will cover.

Feel free to give us a call or text at (855) 425-4846, or verify your benefit plan here. The sooner you get started, the sooner you can be on the road to a happier, healthier life, free of substance abuse and addiction.

Reviewed for Medical & Clinical Accuracy by Brittany Polansky, MSW, LCSW

Brittany has been working in behavioral health since 2012 and is the Assistant Clinical Director at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.