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Blue Cross and Blue Shield Insurance for Addiction Treatment

Blue Cross and Blue Shield insurance policies provide a range of benefits to cover addiction treatment. The amount of coverage for different recovery services often depends on the state you reside in, as well as your individual plan.

Blue Cross and Blue Shield Addiction TreatmentBlue Cross and Blue Shield Insurance for Addiction Treatment

Collectively, Blue Cross and Blue Shield companies nationwide cover roughly 105 million people – that’s about one in every three people. While many of its policies provide a range of benefits to cover addiction treatment, options and programs vary depending on the state you reside in and your individual plan.

Blue Cross and Blue Shield commonly covers some costs associated with:

  • Outpatient treatment
  • Residential treatment/detox
  • Partial hospitalization
  • Acute inpatient hospitalization

Blue Cross and Blue Shield Addiction Resources

With the growing number drug or alcohol addictions across the nation, Blue Cross and Blue Shield has increased its resources in identifying and finding help for substance abuse problems. Most recently, the company has pushed out a prescription pain medication safety program to help reduce the risk of drug addictions – specifically for painkillers such as Vicodin and Percocet.

Blue Cross and Blue Shield’s mobile platform OneHealth provides members and their families with 24/7 support, education and tools to help recover from substance abuse.

Blue Cross and Blue Shield Policy Coverage for Substance Abuse

Blue Cross and Blue Shield offers different plans, depending on your state. The most common plans include bronze, silver, gold and platinum. The lowest plan – bronze – typically has the lowest monthly costs but the highest deductibles. Whereas platinum, the highest level plans, involves higher monthly costs with more comprehensive coverage and lower deductibles.

The company also offers a Federal Employee Program which consists of two plans: a basic option and a standard option. Although the Basic Option requires members to use preferred providers, the Standard Option allows policyholders to choose between preferred and Non-PPO providers. However, an individual may be responsible for the difference between the plan allowance and the billed amount if they choose not to use a preferred provider.

Do Treatment Centers Need to be In-Network?

Another aspect of insurance policies is whether you have an HMO (Health Maintenance Organization) plan or a PPO (Preferred Provider Organization) plan. With an HMO, you will only be covered at HMO-contracted facilities. However, with a PPO, you have more options in regards to the number of providers you have access to. With this type of plan, you can also visit a facility out-of-network, but your expenses will be higher. Speak with your insurance provider about specific details in regards to your plan’s coverage.

Selecting a treatment center usually depends on what your insurance policy covers and what costs will be passed along to you.

Blue Cross and Blue Shield Coverage for Inpatient Treatment

Blue Cross and Blue Shield policies vary greatly between each state depending on its laws and regulations. Coverage is also impacted by where an individual receives care – a physician’s office, hospital or treatment facility.

Inpatient Rehab Service and Costs

Here are rough inpatient rehab cost estimates for the most common types of Blue Cross and Blue Shield plans:

Inpatient Rehab Cost Estimates
Bronze plansCarry the minimum deductible for in-network providers. Any programs out-of-network are generally not covered.
Silver plansUsually a coinsurance percentage in addition to the plan’s deductible for in-network. Out-of-network is generally not covered.
Gold plansRequires a coinsurance percentage (usually smaller than that of silver plans), as well as the deductible. Out-of-network is generally not covered.
Platinum plansIn-network services will have either a copay per day (with a maximum amount) or a coinsurance percentage. Out-of-network is sometimes covered; however, it comes with a higher coinsurance percentage in addition to the deductible.
Blue Cross and Blue Shield plans often require a pre-certification for any inpatient hospital and facility services for substance abuse.

Other inpatient treatment benefits include:

  • Standard option: Starts at $35 per admission for unlimited days
  • Basic option: A copayment of approximately $175 per day, up to $875 per admission for unlimited days. Depending on a person’s plan, there may be an increase or decrease in the copayment amount.

Blue Cross and Blue Shield Coverage for Outpatient Treatment

Outpatient rehab services for substance abuse is similar to that of inpatient services. Treatment options can fluctuate significantly between a physician’s office, hospital or facility.

Outpatient Rehab Services and Costs

Approximate coverage for the company’s more popular plans may include:

Outpatient Rehab Cost Estimates
Bronze plansFrequently require policyholders to meet the deductible for in-network providers. Typically, out-of-network providers are not covered in bronze plans.
Silver plansThere may be a coinsurance percentage in addition to the plan’s deductible for services that are in-network. Out-of-network is usually not covered.
Gold plansAfter meeting the deductible, there is sometimes a coinsurance percentage required. Most often, any services out-of-network will not be covered.
Platinum plansOffers varying copays or coinsurance percentages for anything in-network. While out-of-network providers may be covered, it often comes with a higher deductible or coinsurance percentage.

In regards to the Federal Employee Program with Blue Cross and Blue Shield, outpatient professional care services differ based on the type of plan. For example:

  • Standard option: Covers roughly 15 percent of the plan allowance.
  • Basic option: Typically involves a copayment per day, per facility.

How Can I Pay the Costs Not Covered By My Blue Cross and Blue Shield Insurance Plan?

You don’t have to break the bank to get started on the path toward recovery. Our team of dedicated specialists can show you the best treatment options available that fit your budget and needs. We can also show you how much coverage you may receive from your insurance provider, as well as additional private costs that may incur.

For help verifying your insurance plan and finding treatment solutions, contact us today.

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