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Using Blue Cross Blue Shield for Drug Rehab: How Will It Work?

Many Blue Cross Blue Shield health insurance plans offer comprehensive coverage that includes drug abuse and addiction treatment services. There are many different plan options based on where you are seeking coverage and care.

You can work with a representative from Blue Cross Blue Shield as well as a representative from your prospective drug rehab center to get details on your exact level of coverage. This ensures you will know exactly what you will be expected to pay out of pocket.

Blue Cross Blue Shield

As one of the biggest health insurance companies in the United States, Blue Cross Blue Shield (BCBS) provides health insurance coverage for more than 100 million members in all 50 states and several countries around the globe.

The 36 BSBC providers around the United States operate locally as community-based and independent operators overseen by the Blue Cross Blue Shield Association.

Coverage for drug rehab is provided through Blue Cross Blue Shield health insurance plans, but the level of coverage will be highly variable based on the state and county you live in, the BSBC provider offering coverage, and your specific plan.

Drug addiction treatment is considered one of the 10 “essential health benefits.” All BCBS plans sold on the federal marketplace offer some level of coverage for addiction treatment as a result. The Affordable Care Act (ACA) ensures that mental health, behavioral health, and substance abuse treatment services are covered the same as other medical and surgical services.

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Steps to Use Blue Cross Blue Shield Coverage for Drug Rehab

To best understand your coverage, what plan you have, and how it might work to cover expenses related to drug rehab, your insurance provider can directly offer you the most information. Call BCBS to get specifics on your plan.

In general, coverage can be applied to detox services, outpatient services (including counseling), medication management, evaluations, therapy sessions, and inpatient drug rehab programs.

To use BCBS to cover drug rehab services, follow these steps:

  1. Contact your specific provider through the Blue Cross Blue Shield Association for details on your plan. Your specific BCBS company is your resource for specific coverage information. A drug rehab treatment provider can also offer general information on how health insurance works and the services it may cover
  2. Make an appointment with your primary care provider (PCP). Many BCBS plans will require prior authorization, or a referral for specialty services, which often include drug rehab and addiction treatment services
  3. Obtain an assessment or preauthorization. An evaluation may need to be done to determine that drug rehab is “medically necessary.” Often, this is required for services to be covered under a BCBS plan
  4. Choose your provider or obtain a referral for a provider. Drug rehab providers often need to be considered “in-network” for coverage to be offered. Out-of-network providers may be acceptable under certain plans for a higher out-of-pocket amount
  5. Pay any necessary fees. Coverage varies depending on your plan. You may need to pay a copay at the time you receive outpatient treatment services, or you may need to pay any co-insurance amounts up to your deductible until your annual out-of-pocket maximum is reached.

Be sure you understand your coverage and manage payment information before entering a drug rehab program.

Understanding Coverage Amounts

coverage amounts

There are many Blue Cross Blue Shield plans to choose from, including those for individuals and families, groups (under employers, most often), and Medicare/Medicaid.

Medicare and Medicaid are government-funded health insurance plans for individuals who have limited financial resources, children, families with children, older adults, and people with disabilities.

Group, individual, and family plans may include both HMO (health maintenance organization) and PPO (preferred provider organization) plans. With an HMO, you will use providers that are in your network for all services, and often, you will need a referral for specialty services. A PPO will allow you to see providers outside of the network for a higher cost, and often, a referral will not be needed for specialty services.

You can also use an HSA (health savings account). This is a special account you can put tax-exempt dollars into use for medical expenses. 

There are varying degrees of plan coverage and levels of care. BCBS uses a “metal” tier system that ranges from platinum at the highest to bronze at the lowest. 

  • Platinum: These plans provide high levels of coverage with high monthly premiums and low deductibles. The co-insurance rate is only 10 percent, which means low out-of-pocket costs and coverage up to 90 percent after your deductible is met, up until the annual out-of-pocket maximum is reached.
  • Gold: These plans offer a high level of coverage with a general co-insurance rate of 20 percent, meaning that 80 percent of the services are covered after the relatively low deductible is met.
  • Silver: These plans are often variable, offering coverage and co-insurance rates of around 30 percent. Approximately 70 percent of services are covered after the deductible is reached.
  • Bronze: These plans offer the lowest monthly premiums with the highest deductibles and coinsurance rates of 40 percent. You will be covered at 60 percent for services after your deductible is met. These plans have the highest out-of-pocket fees for services but also the lowest monthly costs.

Blue Cross Blue Shield health insurance offers a variety of options that may cover drug rehab services. Your provider can help you determine how much and what types of services will be included.

Sources

(2019) The Blue Cross Blue Shield System. Blue Cross Blue Shield Association. Retrieved March 2019 from https://www.bcbs.com/about-us/the-blue-cross-blue-shield-system

What Are Essential Benefits? Blue Cross Blue Shield Blue Care Network. Retrieved March 2019 from https://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/essential-benefits.html

Affordable Care Act (ACA). Healthcare.gov. Retrieved March 2019 from https://www.healthcare.gov/glossary/affordable-care-act/

(2019) Member Services. Blue Cross Blue Shield Association. Retrieved March 2019 from https://www.bcbs.com/member-services

(2019) HMO Vs. PPO- Which One's For You? Blue Cross Blue Shield Blue Care Network. Retrieved March 2019 from https://www.bcbsm.com/index/health-insurance-101/basics/hmo-ppo.html

What's the Difference Between Bronze, Silver and Gold Plans? Blue Cross Blue Shield Blue Care Network. Retrieved March 2019 from https://www.bcbsm.com/index/health-insurance-help/faqs/topics/buying-insurance/metal-tiers.html

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