Blue Cross Blue Shield Insurance For Addiction Treatment

Blue Cross Blue Shield is one of the largest healthcare providers in the United States, providing coverage to more than 115 million Americans.

An important distinction with BCBS is that it’s a federation of 33 independent regional insurance companies, not a single national insurer. This means that coverage details, in-network providers, and prior authorization requirements can differ substantially depending on your regional plan.

People seeking drug and alcohol addiction treatment can get their rehab program paid for using BCBS plans. The amount of coverage will vary based on the specifics of the plan, however.

Insurance plans through BCBS may greatly reduce the costs of a rehab program, and some beneficiaries may even be able to have the entire cost of treatment covered.

Does Blue Cross Blue Shield Cover Rehab?

Yes, Blue Cross Blue Shield covers drug and alcohol rehab services, as mandated by the Affordable Care Act (ACA) in the health insurance exchange.

BCBS provides a Substance Use Resource Center—available at bcbs.com—that provides free educational materials and treatment guides. It also hosts a provider search tool for people seeking behavioral health care.

The resource center is accessible to non-members, too, making it a useful starting point for anyone exploring treatment options, regardless of their current coverage.

In addition to the ACA, the Mental Health Parity and Addiction Equity Act requires BCBS plans to provide substance use disorder benefits that are no more restrictive than benefits for comparable medical conditions.

If a coverage decision seems inconsistent with this requirement, policyholders have the right to file a grievance or contact their state’s insurance commissioner for review.

Substance Abuse Treatment Services Covered By Blue Cross Blue Shield

People with BCBS insurance will find that an array of drug and alcohol treatment services and levels of care are at least partially covered under their plans.

Blue Cross Blue Shield Coverage By Treatment Type

Below are some of the treatment options and levels of coverage available under BCBS insurance.

Blue Cross Blue Shield Plan Types

Plans available through Blue Cross Blue Shield are categorized into tiers, with each tier offering a certain amount of coverage for healthcare costs.

Tiers include:

• Bronze — Bronze covers about 60% of medical costs and features a high deductible, but will have lower monthly premiums.
• Silver — Silver plans will cover 70% of the total cost of care, with a slightly higher monthly premium and lower deductible than Bronze.
• Gold — Gold covers approximately 80% of treatment costs and has a low deductible. Monthly premiums are higher than the Silver and Bronze tiers.
• Platinum — Platinum provides the lowest deductible and highest coverage, at around 90%. Monthly premiums under Platinum insurance will be the most expensive.

Choosing the right tier is dependent on a person’s needs. For example, people who are young and healthy may only need a Bronze or Silver plan, while people who need a lot of medical care may benefit the most from Gold or Platinum coverage.

How To Use Blue Cross Blue Shield Coverage For Substance Use Disorder Treatment

Upon purchasing BCBS insurance, members can then begin their search for substance abuse treatment centers that accept this type of insurance.

Depending on the details of the plan, some policyholders may need to seek pre-authorization from BCBS to ensure that addiction treatment is medically necessary.

If precertification is needed, clients can talk to their primary care doctor for written approval that addiction care is necessary.

In most cases, people can contact a rehab center directly to ask about what types of insurance they accept. Upon admission, the billing department at the facility will work out the details of the insurance payment.

Blue Cross Blue Shield Co-Pays And Deductibles For Addiction Treatment

Deductibles are the amount paid for healthcare services before insurance kicks in. If the deductible is $1,500, clients will have to pay 100% of healthcare costs up to that amount.

After the deductible is met, members will share the cost by paying coinsurance. For example, a Silver plan at BCBS may require a person to continue to pay 30% of costs even after paying the deductible.

Co-pays are the fixed amount a policyholder will pay for covered medical services. Health plans will differ in co-pay amounts depending on the type of service and other variables.

People with BCBS can use their member ID card to see the co-pays required for some visits. They can also log in to their member account online to see their plan’s co-pay.

What Addictions Does Blue Cross Blue Shield Cover?

BCBS covers at least some level of treatment for a wide range of addictions.

Addictions to the following substances may be covered:

• cocaine
• opioids
• illicit drugs such as methamphetamine
• benzodiazepine drugs
• prescription medications
• alcohol
• marijuana

For more information about the specifics of what is covered by a BCBS insurance plan, contact a customer representative.

What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?

BCBS insurance may not cover some services deemed unnecessary, such as massage therapy, acupuncture, and other holistic treatments.

In the event that their BCBS plan does not cover the costs associated with treatment, some people may need to seek alternative payment methods to get the care they need.

Other payment options may include:

• Medicaid or Medicare insurance
• payment plans
• sliding fee scale
• self-pay using a credit card or cash
• crowdfunding
• government grant funds

People can also find free addiction treatment at some nonprofit or faith-based programs that are funded entirely through third-party donations.

It’s important to know that coverage for medications for opioid use disorder (MOUD) is required under federal law when medically necessary. However, specific requirements such as step therapy, quantity limits, or preferred drug lists vary by plan and region.

If you currently receive or plan to start MOUD, contact your regional BCBS plan directly to confirm which formulations are covered and whether any approval steps are required before filling a prescription.

Finding A Rehab Center That Accepts Blue Cross Blue Shield

The BCBS member website will provide a wealth of information for people seeking in-network behavioral health treatment.

If a facility cannot be found on the BCBS website, policyholders can also call a BCBS representative for assistance in finding an addiction recovery program in the area that accepts their plan.

The Substance Abuse and Mental Health Services Administration (SAMHSA) treatment finder can also be used to locate local rehab centers based on the types of payment accepted at the facility.

If you cannot locate an in-network residential treatment facility in your area, ask your BCBS representative whether your plan provides out-of-network benefits for inpatient behavioral health care.

PPO and POS plans typically offer some out-of-network coverage, though at a higher cost. In some cases, BCBS may authorize out-of-network care if no adequate in-network option is available, though this requires a formal request and supporting documentation from a treating clinician.

Find Substance Use Disorder Treatment Today

Reach out to AddictionResource.net today for more helpful information on finding a drug rehab facility that works for you.

Written by the Addiction Resource Editorial Staff