Blue Cross Blue Shield (BCBS) Insurance Coverage for Rehab

Does Blue Cross Blue Shield Cover Rehab?

Blue Cross Blue Shield (BCBS) insurance does offer coverage for detox, rehab, and other forms of substance use treatments. Blue Cross Blue Shield addiction treatment coverage varies from state to state, so it is important to verify your coverage before receiving addiction treatment. American Addiction Centers is in-network with Blue Cross Blue Shield, which we can help you verify your exact BCBS coverage details.

Types of Substance Use Treatment Covered by BCBS Insurance

Blue Cross Blue Shield insurance covers a variety of substance use and mental health services. The following types of addiction treatments are generally covered:

• Detox Treatment
• Inpatient Rehab
• Outpatient Rehab
• Medication-assisted Treatment

Substance use disorder treatment refers to a broad range of services including detox, inpatient rehab, outpatient rehab, and aftercare. Detox, often the first of many steps on the road to recovery from drugs and alcohol, is composed of a set of medical interventions designed to aid in the safe withdrawal from alcohol and drugs.⁸ It can be dangerous and often involves medication use under the supervision of medical professionals.

Your BCBS coverage may cover detox services that help make a withdrawal from substances as comfortable and safe as possible.

Checking Your BCBS Rehab Coverage

To determine whether or not your BCBS plan offers coverage for rehab services you can call the number on the back of your insurance card and speak to a BCBS insurance representative. You can also obtain information by going to the login page. Here you will find information about your specific plans, including your BCBS coverage, in-network providers, co-pays, and deductibles. You can also verify what services are covered and which rehab centers that accept Blue Cross Blue Shield.

How to Use BCBS to Pay for Rehab

Given that detox and rehab are costly, it is important to understand what services are covered under your specific plan. Also, consider whether your substance abuse treatment requires a pre-authorization and if the program is within the approved provider network. These two factors are important in ensuring that you maximize your insurance coverage and pay the least amount of out-of-pocket expenses for treatment.

The exact out-of-pocket cost will depend on your plan. Reach out to a BCBS representative to verify your level of coverage. You can also verify your Blue Cross coverage with American Addiction Centers (AAC). Our representative can help you verify your exact BCBS coverage details for detox or rehab.

How Much Does BCBS Cover?

The Affordable Care Act (ACA) requires that all health insurance plans, including the ones offered by Blue Cross Blue Shield, provide some degree of coverage for the medically necessary treatment of behavioral and mental health disorders. This oftentimes includes coverage for the treatment of substance use disorder. However, how much your BCBS plan will cover depends on a variety of factors, such as:

• Type of BCBS insurance plan.
• Where you receive treatment.
• Whether a rehab center is in-network with BCBS.
• Intensity of treatment.
• Length of treatment.
• Accommodations and amenities offered by a rehab facility.

It’s important to reach out to a BCBS insurance representative to determine the extent of your coverage before committing to treatment.

Do Rehab Facilities Need to Be In-Network with BCBS?

Oftentimes, in order to maximize your BCBS insurance benefits, you’ll need to receive treatment at an in-network rehab facility. In-network facilities work directly with BCBS to provide their members with quality care. You may still attend treatment at an out-of-network rehab facility, however your BCBS benefits may be reduced or even nonexistent. It’s important to talk to any potential rehab facilities to confirm they are in-network with BCBS.

Finding Rehabs that Accept Blue Cross Blue Shield

Navigating the world of health insurance can feel intimidating, such as finding local drug treatment centers that accept Blue Cross Blue Shield. It is important to gather as much information about your coverage options as possible if you are considering entering drug or alcohol treatment.

Many alcohol and drug rehab centers across the U.S. accept Blue Cross Blue Shield. It is your job to make sure that your Blue Cross Blue Shield plan is accepted by the rehab provider.

American Addiction Centers provide detox in a safe and controlled environment with support staff and licensed physicians. AAC is in-network with most insurance providers, including Blue Cross Blue Shield. You can call our rehab hotline for information on how American Addiction Centers can help you and your loved ones recover from alcohol or substance use.

Types of BCBS Insurance Plans

Blue Cross Blue Shield is a private insurance company that offers detox & rehab coverage for members across the United States and Puerto Rico.

Blue Cross Blue Shield offers several plans to help ensure you receive the benefits specific to your healthcare needs. It is important to note that plans vary from state to state. Insurance options are available to employers, individuals, and families.

With the Basic plan, you must use an in-network provider and you must receive a pre-authorization.⁴ You will most likely have a co-pay for substance abuse services under the basic plan. Coverage for an individual is roughly $35 a week.

The FEP Blue Focus Plan is the least expensive option; you can expect to pay around $26 a week for individual coverage.⁵ A stipulation with this plan is that services and providers must be in-network. There are no co-pays for inpatient mental health or substance abuse services; however, you are required to pay a percentage of services received. For outpatient substance abuse and mental health services, you can expect to pay a $10 co-pay.

For individuals, families, and employees, Blue Cross Blue Shield offers several plans including Bronze, Silver, Gold, and in some states, Platinum. Things to consider when picking a plan include out-of-pocket costs (including co-pays) and whether your provider is in-network or out-of-network. Bronze plans have the lowest monthly costs and the highest out-of-pocket costs; they cover about 60% of the total cost of services.⁶ The Silver plan has higher monthly costs than Bronze, with roughly 70% of services covered. ⁶ Where the Platinum plan is available, it has the highest monthly cost with the lowest out-of-pocket costs for services (90%).

BCBS HMO vs. PPO

Consider whether a preferred provider organization (PPO) or a health maintenance organization (HMO) is right for you; each option has its own advantages. A PPO allows you to receive services from any healthcare professional, whether or not they are in the provider network.^{7(blue box)} You do not need a referral. However, it is important to understand that some services may not be covered by an out-of-network provider. This is also true for alcohol and drug rehabilitation services, so make sure that your services are covered under your plan.

With an HMO you pick a primary care physician who coordinates all other medical services for you.⁷ You can expect to need a referral for specialized services. Blue Cross Blue Shield has created an interactive tool to help you determine whether a PPO or HMO is right for you, based on your specific healthcare needs.

BCBS, Medicare, & Medicaid

Blue Cross Blue Shield has Medicare supplemental insurance plans for individuals age 65 and older. Medicare is a federally funded health insurance plan for people 65 and older. BCBS offers supplemental Medicare plans to help reduce the cost of healthcare for people who qualify for Medicare.²

The Federal Employee Plan (FEP) provides services to federal employees, retirees, active military, and veterans. Under the FEP you can choose from among 3 different plans: Standard, Basic, and FEP Blue Focus. With the Standard plan, you can use in-network or out-of-network providers, and, depending on your plan, you can expect to pay a co-pay for inpatient mental health or substance abuse services.³ It is the most expensive plan, with weekly payments around $59 for an individual plan. Pre-certification is required for inpatient hospital services.