Horizon Blue Cross Blue Shield provides coverage for addiction treatment no matter what specific plan a policyholder has. The extent of an individual’s coverage, however, depends on which plan they pay for. Certain plans offer benefits for longer lengths of time, while others have higher fees. Out-of-network coverage also varies from plan to plan. Nonetheless, for individuals who are insured through Horizon Blue Cross Blue Shield, it is easy to begin a drug or alcohol addiction treatment program without breaking the bank. This is especially true for in-network providers, such as NuView Treatment Center, Los Angeles’ preeminent outpatient rehab.
Horizon Blue Cross Blue Shield
Horizon Blue Cross Blue Shield is New Jersey’s largest and most long-standing health insurance company. This not-for-profit health service corporation offers broad coverage for a wide variety of medical needs, including medical, dental, and behavioral health services like addiction treatment. Horizon is an independent licensee of the Blue Cross and Blue Shield Association, which serves over 3.7 million members. With thousands of relationships with in-network doctors and specialty treatment centers both in and outside of New Jersey, Horizon Blue Cross Blue Shield is well prepared to meet policyholders’ needs no matter what.
Substance Abuse Treatment Coverage with Horizon
Horizon Blue Cross Blue Shield offers comprehensive coverage for drug and alcohol treatment. Horizon insurance recognizes that addiction recovery is a process. Individuals often require different services at different points of their recovery journeys. Given that fact, it should come as no surprise that Horizon offers benefits for multiple treatment modalities. These include:
- Drug testing and drug screening
- Medical detox centers
- Inpatient rehabs
- Outpatient rehabs
- Individual and group therapy
- Aftercare planning
- Medication-assisted treatment (MAT)
Horizon is often praised for the customizability of their treatment plans. Their goal is to reach as many patients in need as possible, and to that end they work to ensure that each client has access to an individualized treatment plan. Despite being based in New Jersey, Horizon Blue Cross Blue Shield coverage is available in all 50 states.
Horizon Blue Cross Blue Shield Plan Types
Horizon Blue Cross Blue Shield aims to cover as many people as possible by offering a wide variety of plans. All of these plans provide coverage for substance abuse treatment, though they vary in terms of how much and how long they are willing to pay. Certain plans also give policyholders significantly more flexibility in terms of which rehabs or service providers they can make use of.
This plan is the nation’s preeminent Blue Cross and Blue Shield Preferred Provider Program. It allows members to see any provider they wish, even out-of-network providers, though coverage is significantly improved for those who use in-network providers.
EPO (Exclusive Provider Organization)
This plan allows clients to get benefits as long as they stay within the Horizon network. This network of providers is identical to that of the BlueCard PPO plan.
Horizon Direct Access
Horizon’s Direct Access Plan is a plan that allows members to be very flexible while planning their medical care and choosing providers.
Health maintenance organizations, often shortened to HMOs, require minimal out of pocket costs. They are slightly less flexible, since members need to receive health care services through their primary care physician. Specialized services require a referral from this physician.
Horizon POS (Point of Service)
Horizon’s Point of Service plan allows members the flexibility to select their own medical service providers.
OMNIA Health Plans
Horizon’s OMNIA health plans include a wide variety of plan types. These plans have lower premiums and do not require members to get referrals for specialized treatment services when they use providers in Horizon’s enormous New Jersey network.
Horizon’s Indemnity health plan is what is known as a fee-for-service health plan. It provides policyholders with the flexibility to choose any hospital, rehab, or doctor they wish.
Outpatient Addiction Treatment with Horizon
Horizon Blue Cross Blue Shield has one of the nation’s largest networks of rehabs. In particular, Horizon’s coverage for outpatient rehabs is especially strong. This is because outpatient rehabs are widely recognized as effective long term programs. Because there is no residency requirement, they are also significantly cheaper than residential treatment programs. This makes health insurance companies like Horizon more amenable toward the idea of paying for the long term treatment that individuals often need in order to get sober.
Outpatient programs require participants to stop by for treatment services for an hour on a weekly basis, or sometimes more frequently. Outpatient rehabs utilize the latest evidence based therapeutic modalities, such as cognitive behavior therapy and dialectical behavioral therapy. They also employ medical professionals who are able to get clients they help they need for any comorbid physical or mental health disorders. While engaged in an outpatient program, clients work to develop the coping tools they need to maintain their sobriety, address underlying issues, and develop new life skills so that they can enjoy meaningful lives in sobriety.
Outpatient rehabs are ideally suited for individuals at all stages of recovery, because they are quite flexible. Individuals who have recently graduated from an inpatient rehab program are often advised to use an outpatient program as part of an aftercare plan; via outpatient treatment, they can continue to receive support while building their new sober lives in the outside world. Outpatient programs are also ideal for individuals who have families or jobs to attend, since they do not require people to abruptly stop their lives.
How Long Does Horizon BCBS Cover Outpatient Treatment?
Horizon Blue Cross Blue Shield provides comprehensive coverage for all levels of care offered by outpatient rehabs. In many cases, individuals move through these levels of care as they progress in their recovery journeys. In fact, studies show that those who make use of clinical addiction treatment programs for longer are more likely to stay sober over the long term. By supporting clients as they move from more acute treatment programs to less acute ones, Horizon Blue Cross Blue Shield helps ensure that their members can develop autonomy and confidence at their own pace.
Levels of care offered by outpatient rehabs include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
Horizon Blue Cross Blue Shield and the Affordable Care Act
Horizon follows the legal guidelines set forth by the Affordable Care Act, or ACA. This act requires health insurance companies to provide health insurance plans to individuals who already suffer from addictions. This means that no one can be denied coverage simply because they already suffer from a pre-existing condition such as addiction.
The Affordable Care Act also specifies that addiction treatment, as well as mental health services, are what is known as “essential health benefits.” Essential health benefits, according to ACA, are benefits that all insurance companies in the United States must offer. This means that all health insurance plans through Horizon provide coverage for substance addiction treatment, though the nature of this coverage varies from plan to plan.
How Much Will I Pay Out of Pocket?
The amount of money that a client will need to pay out of their own wallet depends upon a range of factors. These factors include the details of their specific insurance plan, their location, the specific service provider they’re seeing, and how long they intend to receive treatment. In most cases, the costs for the policyholder are minimal while insured through Horizon, especially for individuals who use in-network rehabs like NuView Treatment Center.
The main costs that most people end up facing while receiving treatment are deductibles, coinsurance fees, and copays. Deductibles are certain thresholds, which vary from one plan to another, that clients are responsible for meeting before their insurance will begin paying. Coinsurance fees are based on a specific percentage of the cost of a treatment, so these fees can vary. Copays, however, are set fees. Clients are often responsible for paying a small pay when they see a service provider or attend a rehab.
What Does Horizon Blue Cross Blue Shield Cover For Me?
Given the enormous variety of plans that Horizon offers, it can be difficult for an individual doing research online to determine their coverage levels. In fact, navigating the finer details of one’s health insurance plan can be confusing, even intimidating. You may recognize an urgent need for treatment but struggle to figure out how much it will cost you, or which rehabs are considered in the network. Calling your health insurance representative, whose phone number is generally listed on the back of your insurance card, can help answer preliminary questions.
For those who are confused, staff at NuView Treatment Center are available at all times for free and confidential consultations. We have extensive experience in addiction treatment and understand the ins and outs of the health insurance world. NuView Treatment Center has a longstanding relationship with Horizon Blue Cross Blue Shield, and we are considered in network with them. By calling us, you can obtain an advocate who will work hard to determine your treatment needs and get you connected to the services you need. Contact us today at (323) 307-7997.
Addiction Treatment at NuView Treatment Center
NuView Treatment Center is an outpatient rehab that offers all levels of care. Located in West Los Angeles, our modern facility offers the latest evidence-based therapeutic modalities. NuView Treatment Center’s goal is to help anyone suffering from a substance use disorder or mental health condition, whether they are only just beginning to recognize the symptoms or have struggled for decades. Our programs are in-network with Horizon Blue Cross Blue Shield, making them not only effective but affordable.
It is our treatment philosophy that everyone deserves to be treated as a unique individual while recovering from addiction. Treatment at NuView is not one-size-fits-all. Our staff develop individualized treatment plans for each client. While working with clients’ unique strengths and weaknesses, our highly trained staff help them develop new coping skills and rebuild their lives.
Whether you are enrolling in our partial hospitalization program, our intensive outpatient program, our outpatient program, or are looking for support while developing an aftercare plan, we are here for you — and Horizon has you covered. If you are ready to take your first step toward a new way of life, reach out to NuView Treatment Center today.
Frequently Asked Questions
Horizon Blue Cross requires all addiction treatment to be preauthorized before it can be covered. The preauthorization process follows the Substance Use Disorder (SUD) care management guidelines, which include determining whether there is a medical necessity for addiction treatment services. To determine this, Horizon Blue Cross may require additional documentation, such as:
- Medical records
- Treatment plans
- Psychological evaluations
- Lab results
- Diagnostic testing
The preauthorization process also includes verifying that the provider is in-network or out- of-network with Horizon Blue Cross. All of this information is reviewed by Horizon Blue Cross's clinical professionals, who will decide whether to approve or deny coverage.
When it comes to addiction treatment through Horizon Blue Cross, there are usually co-payments and/or additional costs associated. Generally, these fees depend on the type of treatment service being received as well as the type of plan that you have enrolled in. For example, if you are receiving outpatient treatment services such as counseling or medication management, you may be required to pay a co-payment or coinsurance for each visit.
Additionally, some plans require the patient to pay a deductible before any treatment services are covered. It is important to review your plan documents carefully and contact Horizon Blue Cross if you have any questions about co-payments or additional costs associated with addiction treatment through their program.
Yes, Horizon Blue Cross provides coverage for medications related to addiction treatment. Coverage is based on each individual plan, and the drugs covered may vary by state and region. The medicines covered include, but are not limited to, buprenorphine, naltrexone, and methadone. In some states, coverage also includes generic versions of these drugs. Please refer to the Horizon Blue Cross Drug List or contact your local pharmacy to determine whether your insurance plan covers a particular medication.
Yes, Horizon Blue Cross and the addiction treatment center you seek care from should be able to provide a case manager that can help you understand your insurance and its benefits. The case manager will be knowledgeable about different health insurance plans, including Horizon Blue Cross, and can explain all the details to you. They can also discuss what services and treatments would be covered by your insurance policy and how much you may have to pay out of pocket. In addition, the case manager can provide information about any additional resources you may qualify for with your plan (e.g., mental health services, rehab programs, etc.)
At NuView Treatment Center, we accept most major health insurance plans. To find out if your Blue Cross 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.