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Paying for Rehab: Blue Cross Blue Shield Insurance

Paying for Rehab: Blue Cross Blue Shield Insurance

If you live in the United States and are fortunate enough to have health insurance coverage, there’s a pretty good chance your coverage is through one of 36 companies that make up the Blue Cross Blue Shield Association. That’s because Blue Cross Blue Shield companies together currently cover more than 106 million people in the U.S. If you are sick or injured, however, the size of your health insurer isn’t that important. What really matters to you is whether or not your illness or injury is covered under your policy. That’s certainly bound to be the case if you’re looking for help for a drug or alcohol addiction problem. And that’s what this guide is all about: how to make the most of your Blue Cross Blue Shield insurance when paying the costs of drug and alcohol rehabilitation.

If you live in the United States and are fortunate enough to have health insurance coverage, there’s a pretty good chance your coverage is through one of 36 companies that make up the Blue Cross Blue Shield Association. That’s because Blue Cross Blue Shield companies together currently cover more than 106 million people in the U.S. If you are sick or injured, however, the size of your health insurer isn’t that important. What really matters to you is whether or not your illness or injury is covered under your policy. That’s certainly bound to be the case if you’re looking for help for a drug or alcohol addiction problem. And that’s what this guide is all about: how to make the most of your Blue Cross Blue Shield insurance when paying the costs of drug and alcohol rehabilitation.

Does Blue Cross Blue Shield Cover Drug Rehab?

The simple answer is yes. As you might expect, however, the forms of treatment and amounts of coverage allowed under BCBS plans vary depending on a number of important factors. Let’s start with the basics.

Drug Rehab and the Affordable Care Act

Everyone has heard of the Affordable Care Act (ACA), widely known as Obamacare, but few realize its impact on insurance coverage for drug and alcohol rehab services. Prior to the ACA’s passing in 2010, the extent of health insurance coverage for drug rehab varied substantially from insurer to insurer and plan to plan. And, in many cases, health insurance failed to cover any costs associated with drug or alcohol rehabilitation. All of that changed with the ACA.

The ACA established a wide range of requirements for all healthcare insurers – Blue Cross Blue Shield included – with several goals in mind. Among those goals was to ensure that all insurance plans provided coverage for a basic set of “essential benefits,” such as preventative care and prescription drugs. Included in that set of essential benefits was coverage for mental health and substance use disorder treatment. While its future remains in question, as of this writing, the ACA is still the law of the land, and its attendant benefits remain in place. And that means drug and rehab services continue to be covered by healthcare insurers, including Blue Cross Blue Shield.

Does the ACA Ensure Full Blue Cross Blue Shield Rehab Coverage?

Not necessarily. The ACA does not require insurers to cover all types of rehabilitation services, and the services that are covered are almost always subject to the particular insurance policy’s specified deductible and co-pay. More on this below. However, it’s important to note that under the ACA, Blue Cross Blue Shield (and all other insurers, for that matter), must offer “parity protections” in the coverage of mental health services, including those for substance abuse disorders. Parity protection means that limits to coverage are acceptable, but those limits may not be more restrictive than ones applied to medical and surgical services.

Blue Cross Blue Shield Rehab Coverage: How it Works

This is where the simple answers run out. The reality is that the details of Blue Cross Blue Shield rehab coverage are very much tied to the specific language in each individual policy, and that language can vary substantially depending on a number of important factors, such as the particular BCBS company issuing the policy, and the type and level of coverage obtained. Keep in mind, though, that regardless of the specific plan, all Blue Cross Blue Shield insurance policies must provide coverage for substance use disorder treatment, per the ACA.

There are two main types of plans offered by Blue Cross Blue Shield companies: HMOs and PPOs. There are actually a few other types, like EPOs and HSAs, but most customers opt for either an HMO or PPO plan. With an HMO (health maintenance organization) plan, the insured must choose a primary care physician (PCP), and all of the insured’s health care services under the policy are handled through the PCP. That means the insured must always get a referral from the PCP to receive further specialized services (except in an emergency). Additionally, HMO customers are limited to services available from in-network (those that have contracted with the HMO) providers. Pre-certification for most Blue Cross Blue Shield HMO drug rehab services is also required.

Individuals covered under a PPO (preferred provider organization) plan enjoy more flexibility in their treatment options compared to those with a HMO plan. PPO plans do not require choosing a PCP and, in most cases, customers are free to seek treatment from health care professionals, both in-network and out-of-network, without a referral (although a patient’s out-of-pocket costs are likely to be higher for out-of-network providers). So, the bottom line is that while all BCBS customers are covered for rehab services, those with a PPO plan will likely have a much broader range of treatment options to choose from than customers with an HMO plan.

Covered Blue Cross Blue Shield Drug Rehab Services

Blue Cross Blue Shield rehab coverage extends to a wide range of substance abuse treatment services. The kinds of services covered (such as specific therapies), and the extent to which they are covered (such as length of stay) will vary depending on the specific BCBS company and plan. Nevertheless, most BCBS policies will help pay for the following:

  • Detoxification
  • Acute inpatient hospitalization
  • Residential treatment
  • Outpatient treatment
  • Intensive outpatient treatment
  • Partial hospitalization
  • Treatment for co-occurring disorders
  • Individual and group therapy
  • Family therapy
  • Maintenance addiction and other necessary medications

In addition, BCBS plans may help pay for transitional or sober living housing, as well as such aftercare services such as 12-step programs, relapse prevention programs, counseling, and other community-based services. Whether or not a particular treatment service is covered under a Blue Cross Blue Shield plan depends on its “medical necessity,” meaning that rehab-related services must be “needed to diagnose or treat an illness, injury, condition, disease or its symptoms” and “meet accepted standards of medicine”.

How to Find Blue Cross Blue Shield Rehab Providers

Finding Blue Cross Blue Shield substance abuse providers is easier than you might expect. The reason is that most drug and alcohol treatment centers accept payment from many, if not all, of the big insurers. And in the world of healthcare insurers, they don’t get much bigger than Blue Cross Blue Shield. Here are a few ways to go about locating a rehabilitation center that accepts Blue Cross Blue Shield.

The obvious option. Simply call the toll-free number on the back of your insurance card. You can also search for provider information by visiting the BCBS website, or the website of your specific BCBS member company. Links to all BCBS companies can be found here. In addition, many BCBS companies provide members access to confidential care coordination through a behavioral healthcare coordinator. An example can be found here. Contact your BCBS company or insurance agent for more information.

Anyone seriously considering treatment for a drug or alcohol dependence issue has likely begun seeking out potential treatment providers in his or her area. If you’ve put together a treatment center list, the best way to determine if the centers on the list accept Blue Cross Blue Shield is to pick up the phone and give each one a call. Each center should be able to immediately provide you with information about insurers accepted, as well as discuss all payment plans and funding assistance available.

Most treatment centers today maintain websites that provide a wealth of information on their facilities, staff, the types of treatment available, payment options – and insurance companies accepted.

An excellent source for locating rehab centers is the Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Health and Human Services. SAMHSA’s Behavioral Health Treatment Services Locator search engine and map are two great tools for locating potential rehabs offering treatment services for specific substance abuse and other mental health issues. These tools will not tell you whether specific centers accept Blue Cross Blue Shield insurance (you’ll still need to make some calls), but will allow you to narrow your options and save time in your search.

How to Pay for What Blue Cross Blue Shield Doesn’t

Even with an excellent Blue Cross Blue Shield plan in place, policy holders are going to have to shell out some hard-earned cash to pay their deductibles and copayments. Fortunately, treatment centers stand ready and willing to help potential clients find ways to cover these out-of-pocket costs. Many offer payment options of their own, such as:

Scholarships: Many rehab centers offer scholarships to patients in financial need who demonstrate a particularly strong commitment to recovery. Scholarships sometimes cover the entire cost of treatment, but may be available to cover those costs not paid by insurance.

Sliding fee scales: Treatment centers often allow clients to pay according to a sliding fee scale that bases costs on a number of factors, such as client income, family obligations, personal expenses and debt, etc.

Low-interest loans: Through arrangements with outside lenders, some treatment facilities are able to offer clients loans with exceptionally low interest rates and generous payoff period terms.

Apart from the above treatment center options, individuals may be able to find funding for rehab through the following means:

  • Credit cards
  • Home refinancing
  • Loans from friends and/or family
  • Personal loans
  • Retirement accounts
  • Personal savings

Finally, a few lenders offer special financing programs that provide low-interest loans directly to borrowers specifically to help fund drug and alcohol rehab. Examples include My Treatment Lender.com and Prosper Healthcare Lending. These programs offer terms similar to those available for low-interest loans obtained through treatment centers themselves.

FAQs

  • What is Blue Cross Blue Shield?

    Blue Cross Blue Shield – properly titled the Blue Cross Blue Shield Association (BCBSA) – is a national association of 36 independent and locally-operated companies that deliver health care insurance coverage throughout all 50 U.S. states, Puerto Rico and the District of Columbia. The size and reach of BCBSA is enormous, with one in three Americans receiving some form of health care coverage through BCBS companies. BCBSA also provides health insurance to over five million U.S. federal employees, retirees, and their families through its Federal Employee Program. In addition, Blue Cross Blue Shield Global offers a range of health insurance products to persons working, living and traveling internationally.

  • Is there any distinction between Blue Cross and Blue Shield?

    Blue Cross and Blue Shield started out as two separate entities (one called the Blue Cross Association, the other the Association of Blue Shield Plans). The two organizations merged in 1982 to form the Blue Cross Blue Shield Association. Today, there are no real differences between Blue Cross and Blue Shield.

  • What is Anthem?

    Anthem, Inc. is a BCBS health insurance company, and the largest for-profit company in the BCBSA. It operates a number of healthcare-related companies throughout the U.S., including many carrying some form of the Blue Cross Blue Shield name. Examples include Anthem Blue Cross, Anthem Blue Cross Blue Shield, Empire BlueCross Blue Shield, and Blue Cross and Blue Shield of Georgia. In California, Blue Shield and Anthem Blue Cross are separate PPO providers who actually compete against each other. In other states, however, they are parts of the same company.

  • Does insurance cover drug and alcohol services provided by faith-based rehabilitation centers?

    Generally speaking, yes, as long as the faith-based center meets the same provider requirements (accreditations, certifications, etc.) as all other centers. As with any treatment provider, program or service, be sure to contact your BCBS plan if you have any coverage questions.