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Using Blue Cross Blue Shield Insurance for Drug and Alcohol Treatment

Does Blue Cross Blue Shield Cover Rehab or Detox?

If you have Blue Cross Blue Shield (BCBS) insurance, some or all of your drug and alcohol rehab and detox expenses will be covered. How much BCBS covers depends on the plan you have.

Under the Affordable Care Act, insurance companies like BCBS have to cover mental health care and treatment in some way. This includes treatment for substance use disorders (SUDs).2

If you are searching for SUD treatment for yourself or a loved one living with addiction, knowing what your insurance policy covers can give you peace of mind.

How Do I Know What Blue Cross Blue Shield Covers?

Insurance coverage for drug and alcohol addiction treatment varies by plan. It’s important to check with BCBS to understand what your plan covers and how much you’ll be expected to pay for yourself. This is called “out-of-pocket” costs and can include things like copays, deductibles, and monthly premiums.

There are a few ways to check what rehab and detox services your Blue Cross Blue Shield plan will cover:

  • BCBS plan members have access to a Member Services portal online. Log in to your account on the website to learn more about what your plan covers.
  • Call the number on the back of your insurance card to speak with customer service. They can walk through your plan details with you and help you estimate the costs of treatment.
  • Call the treatment center you’d like to go to. Most can check your benefits with you while you’re on the phone.

Treatment Types Blue Cross Blue Shield Covers

Blue Cross Blue Shield may cover some or all of the costs for different types of addiction treatment, including:3

  • Detox services: Quitting drugs and alcohol sometimes means withdrawal symptoms. Medical detox helps you safely withdraw from substances. Your care team gives prescription medicines as needed and is on hand to address your needs.
  • Inpatient or residential care: This is 24/7 care and support in a residential treatment center or hospital. Treatment may involve counseling, prescription medicine, and support from staff and peers. Most people stay anywhere from a month to a year in these facilities.
  • Partial hospitalization: This type of program, sometimes called “day treatment,” lets you live at home during treatment while spending your days at the treatment center.
  • Intensive outpatient: Intensive outpatient programs typically involve attending treatment programs about 3 nights per week. You can live at home and go to work during the day.
  • Sober living home: This is a short-term living situation in a home or treatment center to help people transition from inpatient treatment to living on their own.

How to Use Your Insurance Plan for Drug and Alcohol Treatment

There are many things to think about when you’re ready for drug and alcohol treatment. The most important thing is your desire to get and stay sober. Thinking about these topics ahead of time can help you focus on what matters most—your health and well being. Things to consider include:

Talking to your doctor or care team. The first step in getting help is often seeing your primary care doctor to let them know about your addiction. They can help you get the treatment you need and ensure continued care when you leave the treatment facility.

Get pre-authorization for rehab coverage. Some insurance companies ask for proof that you need rehab and treatment before coverage kicks in. This is called a pre-authorization. Your doctor can help with this paperwork, as well as suggest treatment centers that may fit your needs.

Understanding coverage and any out-of-pocket costs. Get to know what parts of SUD treatment your insurance plan covers and what you will have to pay for out-of-pocket. Many insurance plans have deductibles you must meet before they’ll pay for services. Most plans also have copays that you must pay for certain services, such as prescriptions or doctor appointments. A copay is a small portion of the overall fee, and your insurance covers the rest.

Finding a treatment center that accepts your plan. Whenever possible, choose a rehab facility or treatment center that takes your insurance. In-network treatment centers have an agreement with BCBS that lets them offer services at a lower cost.

Beginning the admission process. Once you’ve chosen a treatment center, it’s time to begin the admissions process. A staff member will work with you or your loved one to help you begin your stay in treatment and get on the path to recovery. This is the time to ask any questions you may have, such as if you can have visitors and if the center offers family counseling.

Finding Rehabs that Accept Blue Cross Blue Shield

It should be fairly easy to find a detox or rehab center near you that accepts Blue Cross Blue Shield. Blue Cross Blue Shield offers health insurance in all 50 states.1 And many treatment centers work with BCBS, including American Addiction Centers.

In-Network vs. Out-of-Network

When a treatment center is in-network, it means they have an agreement with an insurance company—in this case, BCBS—to offer care for people at a lower rate. So, choosing an in-network treatment center will often cost you less.

If a treatment center is out-of-network, this means that BCBS does not have an agreement with them and may not cover costs. This may mean higher out-of-pocket costs. And, in some cases, you may need to pay for all services yourself.

If you can, work with an in-network provider for your drug and alcohol treatment. Try to find a detox or rehab center that is within your BCBS network so you can keep your treatment costs down.

Types of Blue Cross Blue Shield Insurance Plans

Blue Cross Blue Shield plans are broken into metal tiers: bronze, silver, gold (and in some states, platinum). Bronze plans have the lowest monthly premiums but the highest deductibles. Platinum plans have the highest monthly premiums but the lowest copays and deductibles.4 After you meet your deductible: 4

  • Bronze plans cover about 60% of your medical costs.
  • Silver plans cover about 70% of your medical costs.
  • Gold plans cover about 80% of your medical costs.

Medicare and Medicaid

Medicare is a federal health insurance plan for people age 65 and older, and those under 65 with certain disabilities or medical conditions. With Blue Cross Blue Shield, you add supplemental insurance plans for any healthcare needs that aren’t covered by Medicare alone. These supplemental plans include Medicare Advantage, prescription coverage (Medicare Part D), and Medigap.5

Medicaid offers health insurance to poor people and those who have certain physical and mental health conditions. BCBS offers Medicaid plans in 24 states and Puerto Rico.6

Check My Coverage Now

Note: We try to offer the most updated information available about insurance. But insurance health plan information does change quickly. Please check with your insurance company to ensure that you have the most recent and correct information about your coverage.

Sources

  1. Blue Cross Blue Shield. (2021). The Blue Cross Blue Shield system.
  2. Healthcare.gov. Mental health and substance abuse coverage.
  3. Blue Cross Blue Shield. (2021). Substance use resource center.
  4. Blue Cross Blue Shield Network. What’s the difference between bronze, silver and gold plans?
  5. Blue Cross Blue Shield. (2021). Medicare coverage options.
  6. Blue Cross Blue Shield. (2017). Medicaid: A primer on America’s biggest health insurance program.
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