Does Your Policy Cover Rehab?

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.

1st Step Behavioral Health is all about making sure finances don’t get in the way of you beginning your road to recovery. 

BlueCross BlueShield Insurance for Drug and Alcohol Treatment

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

Policy Coverage for Substance Abuse with BlueCross BlueShield Insurance

BlueCross BlueShield offers different plans depending on your location. Typically, it falls into either Bronze, Silver, Gold, or Platinum levels. The Bronze Plan is the lowest in coverage and has the lowest monthly premium and highest deductibles. The higher-level plans, like Platinum or Gold, have higher costs but they provide more inclusive coverage with lower deductibles.

If the policy is a Federal Employee Program policy, it it typically holds two plan options, either the basic option or the standard option. The basic Federal employee plan option requires individuals to use providers within a preferred network. 

On the other hand, the standard plan allows its members to choose between preferred and non-preferred providers (also known as PPO).

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.

BCBS Policies Work for Addiction Treatment Centers

BlueCross BlueShield is accepted, at least on some level, by the majority of addiction treatment centers, although coverage varies greatly from state to state. 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.

In certain instances, we have seen really strong stipulations on a policy. For example, such as no substance abuse or mental health benefits at all.

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.

BlueCross BlueShield Covers Inpatient Treatment

Again, a BlueCross BlueShield policy for inpatient drug treatment is different for each state. Coverage depends on each state’s unique laws and regulations.

It is also dependent upon the state and facility where the member receives care and treatment services. For example, coverage for an individual who receives treatment at a hospital may vary from coverage for a member who receives treatment at a residential (inpatient) addiction treatment facility.

In addition, service provided by a physician’s office will cover different amounts than a service provided at a hospital or treatment facility. It is important for us to walk you through all of these details to make sure you can take on this journey with us!

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.

If your insurance policy covers your addiction treatment, it will do so no matter the type of substance abuse issue. That means the policy should be able to help, whether you’ve been suffering from addiction to opioid painkillers or alcohol.

Costs and Services at Inpatient Rehab

Inpatient programs offer the highest level of treatment care, with medically supervised detoxification and 24/7 support. Below are some definitions of general terms regarding health plan coverage:

Premium

This is a monthly payment made to a health insurance company by the policyholder to maintain coverage. In many cases, patients are fortunate enough to have employer-provided insurance. In other words, the company picks up all or part of the monthly premium cost.

Out-of-Pocket Maximum

This is the maximum amount of money you are required to pay for covered services within a  plan year. Once your out-of-pocket maximum amount is spent on deductibles, copayments and/or coinsurance fees, your health care plan will take care of 100 percent of any additional costs of covered health care services.

Policy Effective Date

This is the day your insurance company starts to help you take care of your health care expenses. The open enrollment period is generally a set amount of time once a year, or during a special enrollment period. Your policy effective date is agreed upon after you’ve enrolled, and typically falls a few weeks or months after the date of your official enrollment. 

Deductible

This is the amount you pay for covered health care services in a given plan year before your insurance will start to pay for them. For example, let’s say you have a $5,000 deductible. You would pay for the first $5,000 of services yourself. After that, you only have to pay coinsurance and copayment costs. This is when your health care plan starts to take care of the rest.

Copayment

A copayment is a fixed amount you are required to pay for a covered health care service, such as a doctor’s office visit. Copayments take effect either before or after your deductible is paid, which is dependent upon on your health insurance plan. This information is not shown on our health insurance verification form.

Here is an approximate cost estimate for Inpatient Rehab with commonly used plans with BlueCross BlueShield:

  • Bronze Plan – Holds the minimum deductible amount for in-network providers. Out-of-network Providers are generally not covered.
  • Silver Plan – Typically, a coinsurance percentage in addition to the deductible for in-network. Out-of-network tends not to be covered.
  • Gold Plan – Theses plans require a coinsurance percentage (generally this is a lesser amount than that of the lower level plans), as well as a deductible. Out-of-Network providers are also not covered.
  • Platinum Plans – Any in-network provider services will have one or the other- a copay per day (with a maximum daily amount) or coinsurance percentage. There are instances that out-of-network services are covered. If out-of-network is covered, it will come with a higher coinsurance percentage as well as the deductible.

BCBS Coverage for Mental Health Treatment

If you are living with a mental health condition, BlueCross BlueShield can aid in covering the costs of care. Behavioral and mental health disorders often co-occur with addiction problems, which is known as dual diagnosis. In these instances, addiction and mental health care are both needed in order to help individuals who are suffering from these issues. Having said that, finding care for co-occurring disorders can sometimes be a little difficult. However, it’s best to know which options are available and how your BCBS insurance policy can help you to find the resources you need. 

Insurance plans are expected to provide the same coverage for mental health concerns and challenges as they do for issues with physical health. This means that an insurance plan that provides a certain amount of coverage for treatment for a physical injury or concern, must also provide that level of care for treatment for a mental health issue. 

Common mental and behavioral health disorders may include:

  • Depression
  • Anxiety
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder

Walking You Through Your Blue Cross Blue Shield Benefits

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 substance abuse treatment.
  • We’ll help decide what kind of treatment and how much is covered.
  • Blue Cross Blue Shield health insurance is accepted by almost every treatment center in the U.S., so we’ll sort through which ones will work best with your policy.

We understand that the details of your insurance coverage can be a little complex and not always easy to wrap your head around. 1st Step Behavioral Health will simplify your insurance coverage with Blue Cross Blue Shield for you.

1st Step Behavioral Health Is Here for You

We are here to guide you through every step of the process, ensuring that everything is as smooth as possible. Give us a call at (866) 319-6126 or contact us here, and let us take the first step with you on the road to recovery. 

About the Author: Brittany Polansky

Brittany PolanskyBrittany has been working in behavioral health since 2012 and is a Primary Clinician 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.