BlueCross BlueShield insurance makes it easy for people to get access to addiction treatment services. For policyholders with BlueCross BlueShield, recovery services are often merely a phone call away. The health insurance company offers long term coverage for outpatient programs, therapy, and medical services related to addiction. These treatment services are essential for long term recovery from substance use disorders. While all BlueCross BlueShield plans offer some degree of coverage for substance addiction treatment, the specific benefits depend upon an individual’s state of residence and the nature of their specific health plan. Read on for more information about BlueCross BlueShield’s coverage for addiction treatment.
BlueCross BlueShield Insurance
BlueCross BlueShield, sometimes known as BCBS, is actually not one insurance company, but a federation of 36 distinct health insurance companies that operate in the United States. Together, they provide health insurance to over 106 million people. Blue Cross was founded in 1929 and Blue Shield was founded in 1939. In 1982, a merger resulted in the formation of the Blue Cross Blue Shield Association. Both Clue Cross and Blue Shield are licensees, working independently of each other and offering insurance plans through subsidiary companies.
Affiliated companies that work with BlueCross BlueShield include:
- Anthem Insurance
- Anthem BlueCross and BlueShield
- Blue Shield of California
- Cambia Health Solutions
- Health Care Service Corporation
- Wellmark Blue Cross Blue Shield
- Anthem Blue Cross
Substance Abuse Treatment Coverage with BlueCross BlueShield
BlueCross BlueShield has extensive coverage for drug and alcohol treatment. As a recognized health insurance provider, BlueCross BlueShield insurance is accepted at a wide variety of treatment facilities and rehabs. Its coverage is especially comprehensive at treatment centers within its approved network, including NuView Treatment Center.
BlueCross BlueShield recognizes that addiction treatment is generally a long term process that requires a variety of treatment modalities. While the exact type of coverage a person received from BCBS depends upon their state of residence and the details of their specific health insurance plan, BlueCross BlueShield is generally willing to pay for a significant portion of most evidence-based treatment programs. These include but are not limited to the following:
- Drug testing and drug screening
- Medical detox centers
- Inpatient rehabs
- Outpatient rehabs
- Individual and group therapy
- Aftercare planning
- Medication-assisted treatment (MAT)
BlueCross BlueShield Tiers
BCBS, also sometimes colloquially known as “The Blues,” owns 36 different insurance companies. These health insurance companies, which operate independently, locally, and nationwide, together make up the BlueCross BlueShield network — or Blue System. With such an extensive network at their disposal, it is no surprise that BlueCross BlueShield is able to offer plans suitable for any level of care and financial situation.
BlueCross BlueShield provides coverage to over 50% of all federal employees. Their Federal Employee Program offers three different options for federal employees, retirees, and their family members. These insurance option for federal employees include:
Federal Employee Program Plans
The standard option is ideal for individuals who want flexibility. It allows people to get addiction treatment from a wide selection of in-network rehabs, but policyholders also have the option of signing up for care at an out-of-network rehab.
The basic option has slightly less comprehensive coverage than the standard option, but clients who are okay with staying within BlueCross BlueShield’s network benefit from having to pay no deductibles.
FEP Blue Focus
FEP Blue Focus is BCBS’s most budget-friendly plan, offering in-network coverage with limited out-of-pocket expenses.
Individual and Family Plans
BlueCross BlueShield also offers a wide range of family plans and individual plans. The details of these plans vary from state to state. In general, however, they can be divided into 3 or 4 categories, ranging from Bronze to Platinum. The bronze plans, which offer the least comprehensive coverage, have lower monthly costs. Meanwhile, platinum plans have somewhat higher monthly premiums but offer flexible and comprehensive coverage. BCBS does not offer the platinum plan in every US state. For most healthy people, the bronze-level plan is sufficient.
The bronze-level plan with BCBS covers approximately 60% of medical fees. Policyholders pay a minimal monthly payment but have a high deductible.
The silver-level BCBS plan covers approximately 70% of medical fees. Policyholders have a somewhat higher monthly premium. Their deductible is lower than the bronze plan.
The gold-level BCBS plan covers roughly 80% of medical fees. Policyholders are responsible for a higher monthly payment, and their deductible is lower than the silver plan.
The platinum plan, which is available in some US states, covers approximately 90% of medical fees. Of all BCBS’s plans, it has the highest monthly premium, but it has the lowest deductible and out-of-pocket expenses.
Outpatient Addiction Treatment with BCBS
BlueCross BlueShield plans allow policyholders to take advantage of BCBS’s extensive network of outpatient rehabs. Outpatient rehabs are generally covered by most BCBS health insurance plans, because they are both highly effective and affordable. Unlike residential treatment centers, outpatient rehabs allow clients to engage in addiction treatment without having to physically live in their treatment center. This not only makes treatment more affordable and therefore more appealing to insurance providers, but it also has countless advantages for clients themselves. Outpatient rehabs are flexible treatment programs, allowing clients to gradually build their autonomy and develop their lives in the outside world.
Outpatient programs covered by BlueCross BlueShield include a variety of levels of care. These levels of care are designed to address the unique needs of people experiencing addiction at different levels of severity. Moreover, many clients transition from more acute to less acute levels of care as they develop stronger foundations in recovery. Research shows that this kind of long term addiction treatment significantly decreases clients’ chances of relapsing even years after graduating from an outpatient program. BlueCross BlueShield is generally willing to provide coverage for whatever length of time an individual needs in order to make a solid recovery.
Outpatient levels of care covered by BlueCross BlueShield include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
These outpatient treatment programs help people achieve recovery from substance use disorders using a variety of distinct treatment modalities. Individual and group therapy, including cognitive-behavioral therapy, are used to help clients address underlying issues that may have led to their substance abuse in the first place. Meanwhile, clients work daily to develop new coping tools to deal with potential triggers and avoid relapse. They also gain life skills and take concrete steps toward building new lives for themselves.
BlueCross BlueShield and the Affordable Care Act
Since the passing of the Affordable Care Act, health insurance companies like BlueCross BlueShield have had to radically change the way they cover addiction treatment. One of the most important changes that the Affordable Care Act has created is that addiction treatment is now legally considered an “essential health benefit.” This means that all insurance companies are legally obliged to offer benefits pertaining to addiction treatment. While the specifics of such benefits vary from plan to plan, all policyholders can expect some degree of coverage.
The ACA, as the Affordable Care Act is sometimes known, has also ensured that no insurance company can deny someone coverage just because they have a substance use disorder. Previously, it was common for health insurance companies to deny coverage to people who already suffered from potentially expensive health conditions like addictions. The ACA has stipulated that substance use disorders can no longer be considered “pre-existing conditions,” which means that anyone, no matter how serious their addiction, can purchase a health insurance plan through BlueCross BlueShield.
Mental Health Coverage with BlueCross BlueShield
BlueCross BlueShield has extensive coverage for mental health-related issues. In fact, the Affordable Care Act, in addition to making substance abuse treatment an essential benefit, also ensures that mental health treatment is covered by all health insurance plans. BlueCross BlueShield has access to a particularly large network of rehabs that not only treat mental health conditions, but provide support for dual diagnosis patients who suffer from addiction as well.
According to the National Institute on Drug Abuse, among people with mental health conditions, roughly 50% suffer from addiction as well. The same is true of people who suffer from addiction. As two mutually reinforcing health conditions, addiction and mental illness must of necessity be treated together. In the absence of comprehensive treatment, it is likely that one condition will trigger a relapse of the other. As such, BlueCross BlueShield provides coverage for outpatient rehabs that offer integrated treatment, an approach that combines multiple therapeutic modalities to tackle addiction and mental health disorders simultaneously.
How Long Will BlueCross BlueShield Cover Outpatient Rehab?
In most cases, addiction treatment is a long term process. Not only do individuals in recovery need to physically withdraw from drugs and alcohol, but most need to spend learning new skills to avert the potential for relapse, rebuild their lives, and develop new coping skills. For most people, this is a lifelong process, one that is best facilitating by participating in supportive treatment programs for extended periods of time.
BlueCross BlueShield recognizes that covering long term addiction treatment is in their best interests financially — since relapses are expensive for insurance providers. For this reason, they generally are willing to cover people for as long as they need. The exact length of time for which BlueCross BlueShield will cover treatment, however, will vary depending on the individual’s specific health care plan. BlueCross Blueshield also evaluated the specific behavioral health needs of each policyholder to determine what length of treatment is appropriate.
However, as a health insurance provider, BCBS also takes into account the recommendations of the rehabs that they work with. If an outpatient rehab recommends that a policyholder needs to spend more time in treatment, BCBS is generally willing to negotiate and be flexible.
What Does BlueCross BlueShield Cover For Me?
Figuring out what kind of addiction treatment you are entitled to with your health insurance plan can be difficult. In many cases, even after speaking to your BlueCross BlueShield representative, the finer details of your specific insurance plan can be confounding. For those who need treatment, however, questions about payment or insurance should be put aside so that they can focus on recovery goals.
NuView Treatment Center is available at all times to help individuals determine their addiction treatment coverage levels. Instead of trying to figure out your coverage yourself, contact us at (323) 307-7997, and we will work on your behalf to determine what services are right for you. Even if NuView Treatment Center is not your intended rehab, we will nonetheless work hard to find a treatment program that is suitable for your unique needs.
Addiction Treatment at NuView Treatment Center
NuView Treatment Center, an outpatient treatment center in West Los Angeles, offers quality evidence-based treatment programs in a modern facility. It is our goal to help people from all backgrounds recover from the devastating effects of substance use disorders and mental health conditions. NuView Treatment Center has a longstanding relationship with BlueCross BlueShield, and we are in-network with most health insurance plans.
At NuView Treatment Center, our staff emphasize compassion above all else while designing individualized treatment plans for every client. It is our belief that addiction recovery goes well beyond mere physical abstinence. We work with clients to help them address underlying issues, develop new coping skills, and rebuild new lives for themselves in sobriety.
Our in-network rehab programs cover all levels of care, from partial hospitalization programs to aftercare planning. If you are ready to make a change and escape the vicious cycle of substance addiction, reach out to NuView Treatment Center today.
Frequently Asked Questions
Blue Cross Blue Shield (BCBS) requires preauthorization for addiction treatment, which is a process that must be completed before any benefits are paid. The preauthorization process helps BCBS determine if the requested service is medically necessary and appropriate and if benefits will be covered.
For addiction treatment to be authorized, the request must include medical records demonstrating the diagnosis and treatment plan. This information will be reviewed to ensure it meets BCBS medical criteria and State and Federal guidelines. If approved, a preauthorization number will be issued and used when submitting a claim for payment.
Blue Cross Blue Shield Insurance may require a co-payment for addiction treatment services. Co-payments vary based on the type of service and provider. It is essential to check with the insurance plan's customer service representative before scheduling an appointment to understand any additional costs associated with treatment. Additionally, some providers or plans may work on a sliding-scale basis. This means that the cost of treatment may be adjusted to fit within one's financial ability. It is best to check with the provider to understand any potential co-payments or additional costs associated with addiction treatment services.
Yes, Blue Cross Blue Shield provides coverage for addiction treatment medications. Coverage may vary depending on the individual plan, but various options are available that provide coverage for substance abuse and mental health services. Medicines used in addiction treatment will be covered up to certain limits, such as copayments or prescriptions per month. In addition to medication management, many plans also cover behavioral health counseling services. Blue Cross Blue Shield is committed to helping those in need overcome addiction and providing the necessary resources for successful recovery. It is essential to check the terms of your individual plan to understand what coverage you are eligible for.
Yes. Many addiction treatment centers partner with Blue Cross Blue Shield to provide comprehensive health care services, and they can provide a case manager knowledgeable about their insurance plans and benefits. The case manager will work directly with the insurance company to ensure you receive all the coverage you qualify for, including any mental health or substance abuse treatments. They can help you understand precisely what your coverage includes and how to get the most out of it. Additionally, they can answer any questions about costs and billing information and provide support throughout the entire treatment process.
At NuView Treatment Center, we accept most major health insurance plans. To find out if your Cross Blue Shield Insurance is accepted, please call our office at 323-307-7997. Additionally, you can fill out this verification of insurance benefits form. Our staff will be more than happy to answer any questions you may have and help determine the best plan for your treatment.