Using BCBS for Drug & Alcohol Rehab
Blue Cross Blue Shield (BCBS) is a global healthcare provider offering insurance coverage to over 106 million members in every state in the U.S. BCBS has 35 independent companies that are locally operated and community-based.1 In California, the BCBS providers are Anthem Blue Cross* and Blue Shield of California.2,3
As one of the most comprehensive insurance companies in America, over 1.7 million doctors and hospitals contract with BCBS companies – more than any other provider nationwide.1 BCBS offers a wide range of policies and insurance coverage for its members.
*Recently, Anthem rebranded as Elevance Health; however, it is still operating as Anthem Blue Cross in CA and offering the same plans.
Does Blue Cross Blue Shield Cover Addiction Treatment?
Substance abuse treatment became much more accessible when the Affordable Care Act made it an “essential health benefit.”4 Because all marketplace plans must now provide coverage for this type of care,4 you should be covered in whole or in part for treatment if you hold a Blue Cross Blue Shield plan that you purchased on the marketplace. If you have a BCBS plan through an employer, it is very likely you will have these benefits as well.
However, the specific amount of coverage varies from policy to policy. The insurance provider is the best resource for determining what services are covered, to what extent, and how to use these services to pay for things like drug addiction treatment.
Costs will also vary based on whether you choose a facility that is inside or outside your plan’s network of treatment providers. Costs will be higher if you choose to go out of network.5 Fortunately, Laguna Treatment Hospital is in-network with many BCBS plans offered in Southern California.
Which BCBS Plans are In Network at Laguna Treatment Hospital?
Laguna is in-network with certain BCBS and Elevance Health (operating as Anthem) providers. We are in-network with Anthem Blue Cross Network. Accepted plans include:
- Blue Cross of California d/b/a Anthem Blue Cross.
- Blue Cross HMO (CaliforniaCare).
- Blue Cross PPO (Prudent Buyer).
We are also now in-network with:
- Blue Shield of California.
- Some healthcare plans written or delivered in the State of California utilizing Magellan Health for behavioral health services, including:
- The Summit Network (Non-HMO).
- The Pinnacle Network (HMO).
- The Navigator Network (Customized network).
How to Use BCBS Insurance to Pay for Drug & Alcohol Rehab
When you wish to use Anthem/BCBS insurance coverage for substance abuse treatment, you can contact a treatment facility in your network which can, in turn, contact your insurance provider and determine the extent of your coverage and your estimated costs.
Facility staff may also obtain preauthorization (or pre-approval) for services when necessary. Generally, all inpatient/residential services require preauthorization. This is a very important first step; BCBS providers may reduce or deny their payment for certain services that are provided without preauthorization.6
Verify Your Blue Cross Blue Shield Benefits
A quick and easy way to verify that Laguna or another American Addiction Centers facility takes your BCBS insurance is to fill out our simple online insurance coverage check. It only takes a couple of minutes to fill out and is entirely confidential. You’ll receive an email with your results in just minutes when you provide some simple information, such as:
- Your name, phone number, and email.
- Your insurance carrier.
- Member ID.
Which Addiction Treatment Services does Blue Cross Blue Shield Cover?
Blue Cross Blue Shield policies provide a range of coverage for the treatment of substance abuse and addiction. The drug and alcohol rehab options programs and services available to you will depend on your state and the specific benefits that are outlined in your individual plan.
Generally speaking, Blue Cross Blue Shield provides their policyholders with coverage for addiction treatment services. These may include:7,8
- Medically supervised detox.
- Inpatient or residential programs.
- Partial hospitalization programs.
- Intensive outpatient programs.
- Outpatient individual or group therapy.
While some or all of the above services may be covered under your plan, the percentage of expenses that is actually paid by Blue Cross Blue Shield will be based on the level of coverage specified by your policy.
Laguna offers both hospital-based medical detox and inpatient/residential rehab.
How Much Does Rehab Cost with BCBS Insurance Coverage?
Depending on the plan, coverage for services can vary. Some plans may require a copayment for office and outpatient office visits, for example.6 A copayment is a set amount that is paid up front for services.9
Different plans will also have different deductible amounts, coinsurance rates, and out-of-pocket annual maximums. These terms may be confusing. Here are some easy definitions:9
- Deductible: The amount that must be reached in a calendar year before coverage begins to kick in.
- Example: If your deductible is $500, you will need to reach $500 before your plan begins paying for most covered services.
- Coinsurance: The percent of costs for services you pay after you’ve met your deductible.
- Example: If your coinsurance for a hospital stay is 20% and you’ve met your deductible for the year, your insurance company pays 80% of the hospital stay and you pay 20%.
- Out-of-pocket maximum: The maximum amount you will be required to pay in a year for covered services.
- Example: If your out-of-pocket maximum is $5000 and you’ve paid a $1000 deductible and $3,800 for covered services, you would only need to pay $200 more until your insurance company begins paying 100% of the costs of covered services for the remainder of the year.
It is likely that you will be responsible for at least some of the costs of your addiction treatment. However, there are ways to make paying for rehab easier, such as flexible payment plans, financing, and loans. You may also explore options such as crowdfunding from people who love and care about you and want to see you recover.
Why Use BCBS Insurance for Addiction Treatment?
Elevance Health (Anthem) and BCBS companies provide the coverage you need to get lifesaving addiction treatment. Addiction is a chronic disease that usually requires professional treatment.10 By using your benefits to get the care you deserve, you can begin your recovery today.
BCBS plans allow you to choose the right level of care for you, whether it is medical detox, inpatient rehab, or outpatient treatment. If you need more details on your plan’s coverage, you may call the number on the back of your insurance card or reach out to us at any time.
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