Does Blue Cross Blue Shield Cover the Cost of Addiction Treatment?

paying for rehab, using Blue Cross Blue Shield to pay for rehab, paying for rehab with insurance

Blue Cross Blue Shield Overview

Blue Cross Blue Shield is a well-known provider of medical insurance coverage. Many people who have coverage through Blue Cross Blue Shield might not know if their policy covers the cost of addiction treatment.

The Blue Cross and Blue Shield Association owns 36 health insurance companies located across the nation. This group of companies create what is called the Blue System.  The Blue System insures more than 105 million people across the country. More than half of the federal employees through the Federal Employee Program.

Insurance plans offered by Blue Cross Blue Shield fall into a few different categories, which are dependent on your state. These are platinum, gold, silver, and bronze plans. The lowest costs are associated with the bronze plan, while the highest premiums accompany the platinum plans.

Individuals who don’t require frequent physician visits can go with the bronze plan, which offers lower monthly premiums but higher deductibles. The tiered plans offered by Blue Cross Blue Shield offer different amounts of coverage.

  • Platinum – with the highest monthly premiums, this plan will cover about 90% of medical cost and have the lowest possible deductible
  • Gold – this has a higher monthly premium than the platinum plan, but covers about 80% of medical expenses and has a low deductible
  • Silver – with slightly higher monthly premiums, this plan has a slightly higher deductible and covers about 70% of medical expenses
  • Bronze – with the lowest monthly premiums, these plans have a higher deductible and pay only about 60% of medical expenses

Using Your Blue Cross Blue Shield Plan for Rehab

You need to check on your policy and its specific coverages, Blue Cross Blue Shield plans cover addiction treatment programs at least in part. The specific details regarding coverage is based on the specific policy that you bought.

If it is determined medically necessary, most insurance plans will cover medical detox. Usually medical detox is needed for addiction to alcohol, opiates, or benzodiazepine. These substances can have serious withdrawals and the detox process can be dangerous, so it requires supervision from a medical professional.

Your plan will affect the kind of treatment center that you can choose, the specific physicians and medical professionals who treat you, and how your treatment proceeds as well as the length of the treatment process.

If you have a Blue Cross Blue Shield Health Maintenance Organization (HMO) plan, your insurance only covers medical facilities that are in the HMO. If your plan is a Preferred Provider Organization (PPO), you are giving the option to choose from wider selection of providers, or you can choose a provider that is out-of-network if you are willing to pay higher costs. Just as with any medical condition, sometimes only part of your treatment for addiction or detox care is covered by your medical insurance.

You need to contact your insurance company directly and speak with a representative and talk with the rehab center to determine the specific dollar amount you will be responsible for paying yourself.

Coverage and Out-of-Pocket Costs

The coverage your specific Blue Cross Blue Shield plan offers is dependent on your plan and your situation. The network for Blue Cross Blue Shield is large, so there is bound to be a center offering addiction treatment and substance abuse rehab in your area.

You can go to the website for Blue Cross Blue Shield to conduct a search for providers in your area who accept your Blue Cross Blue Shield plan. With a little research, you can choose a detox program that will provide the care you need, help you overcome your addiction, and provide the best possible coverage that you can get from your specific plan.

If your out-of-pocket cost for care is going to be more than you can afford, there are scholarships and financial assistance programs available to help you get the care you need. Talk with your rehab center admissions department to learn how they can help you afford the program that you need to recover.

While you can count on your Blue Cross Blue Shield plan covering at least part of the cost of your rehab, how much is covered depends on your specific policy and the kind of rehab center you choose for your treatment.

There are several things that come into play, but with some consultations with your insurance company and your rehab center, you can determine how much you will pay for care and how to cover your share of the costs.

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