Blue Cross Blue Shield Insurance for Addiction Treatment


The cost of drug and alcohol rehab is a major barrier that inhibits many people from seeking the addiction treatment that they desperately need. Fortunately, many rehab centers will accept public and private health insurance, including plans provided through Blue Cross Blue Shield, as a form of payment for treatment and services.

What Is Blue Cross Blue Shield?

Couple having insurance consultation

Blue Cross Blue Shield is a large association of 36 separate health insurance organizations and companies in the United States. Tracing its roots back 90 years to the founding of Blue Cross, a local company that offered prepaid hospital plans to teachers in Texas,1 the current organization is now one of the largest providers of health insurance in the United States. Blue Cross Blue Shield offers some form of personalized healthcare coverage in every state as well as in the District of Columbia and Puerto Rico, and with 106 million members they currently insure nearly 1 in 3 Americans.2

Because the independent Blue Cross Blue Shield companies are licensees, health insurance plans may have different names across states. A comprehensive list of Blue Cross Blue Shields insurance plans by state includes:3

Blue Cross Blue Shield also acts as administrators of Medicare and Medicaid in many states and provides healthcare coverage to federal government employees through the Federal Employees Health Benefits Program.

Blue Cross Blue Shield Addiction Resources

Blue Cross Blue Shield provides several resources that can assist individuals in identifying and finding help for their substance abuse problems.

The Prescription Pain Medication Safety Program was developed in partnership with physicians, pharmacists, pain management experts, and addiction experts and aims to reduce the risk of abuse and addiction to opioid painkillers such as Vicodin and Percocet. Some of the features of this program include:4

  • Requests doctors and pharmacists follow a 3-step checklist to ensure that patients are not receiving more medication than is needed.
  • Encourages doctors to consider non-narcotic treatment options.
  • Limits the amount of opioid medication that patients can be prescribed.
  • Requires prior authorization for opioid prescriptions lasting more than 30 days.
  • Requires doctors to perform a risk assessment for addiction before prescribing any opioids.
  • Requires doctors and patients to co-sign an opioid agreement.

Blue Cross Blue Shield  has also arranged to provide its members with access to OneHealth, a private online health community that offers an innovative approach to addiction and recovery.5 Members dealing with substance abuse are able to use this mobile platform to get real-time intervention from recovery professionals, learn from guest experts who will answer their questions, and anonymously participate in online peer support meetings 24 hours a day, 7 days a week.

Pharmacists Teach is a program that brings pharmacists partnered with Blue Cross Blue Shield into schools to provide teens with important information about prescription drug abuse.6 This unique program is offered free of charge to students in grades 7-12 and groups of parents and other adults.

Aware Recovery Care is an innovative in-home addiction treatment program that has recently become available to Blue Cross Blue Shield members.7 Built on the visiting nurse model, the Aware Recovery Care treatment approach features a multi-disciplinary rehabilitation team that visits and treats clients in the comfort and privacy of their homes. The team (consisting of an addiction psychiatrist, an addiction nurse, a licensed marriage and family therapist, an individual therapist, and a certified recovery advisor) delivers private, individualized drug and alcohol addiction rehab treatment services that include the latest evidence-based practices and innovative technologies. Extensive research and preliminary studies have already shown that individuals who receive addiction treatment and monitored support in their home experience faster recovery and improved outcomes.8

Blue Cross Blue Shield Policy Coverage for Substance Abuse

Doctor with patient

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 the state you live in and the specific benefits that are outlined in your individual plan. Most plans will cover medically supervised detox, as long as your doctor deems that such treatment is necessary. Generally speaking, Blue Cross Blue Shield provides their policyholders with coverage for addiction treatment services that include:

  • Medically supervised detox.
  • Outpatient treatment.
  • Inpatient or residential programs.
  • Medication-assisted treatment.
  • Counseling.
  • Behavioral therapy.
  • Long-term treatment.
  • Short-term treatment.
  • Partial hospitalization programs.

While 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. Depending on the details of your plan, only a portion of your addiction treatment may be covered by your insurance. For this reason, it is important to speak with a Blue Cross Blue Shield plan specialist to verify your exact level of coverage. Alternatively, you can allow American Addiction Centers to quickly and privately check your insurance benefits for free. We promise to keep your information confidential, and we will provide you with a rapid response.

Do Treatment Centers Need to be In-Network?

The manner in which you select a treatment center will be dependent on the type of health plan that your insurance policy falls under. Typically, there are two major categories of health insurance plans: health maintenance organization (HMO) plans and preferred provider organization (PPO) plans.

An HMO plan gives you access to certain doctors, hospitals, and other health care providers within its network, although to keep costs low your chosen primary care physician (also referred to as primary care provider or PCP) must refer you to specialists when needed.9 With a Blue Cross Blue Shield HMO plan you will only be covered for care received at HMO-contracted facilities, so you must select a rehab treatment center that is in the HMO network in order to receive coverage for any treatment.

With a PPO plan you have much more flexibility. You have access to a greater number of providers and do not need a primary care physician. PPO plans allow you to be treated by any health care professional you want to see, and no referral is required.9 A Blue Cross Blue Shield PPO plan gives you the ability to undergo rehab anywhere that you choose, whether it be inside or outside of your network.  Selecting a treatment center that is inside your network usually means smaller copays and better coverage. On the other hand, if you decide to be treated at an out-of-network facility, your out-of-pocket costs will likely be higher, and not all services may be covered.

Laguna Treatment Hospital currently accepts many forms of private health insurance and is now an in-network provider with Anthem Blue Cross.

Check Your Coverage

Laguna Treatment Hospital offers a free, private, and easy benefits verification check for your convenience if you’re in need of mental or behavioral health services. See the form below:

Blue Cross Blue Shield Coverage for Inpatient Treatment

Woman discussing payment

Blue Cross Blue Shield policies can greatly vary between states, and the coverage that is provided for inpatient treatment is often dependent on specific state laws and regulations. In addition to the state that you live in, the coverage you receive is also impacted by where you receive treatment. For example, your coverage for treatment at a hospital may be different from your coverage for treatment at a residential addiction treatment center.

Many Blue Cross Blue Shield plans require precertification that shows treatment at an inpatient hospital or addiction treatment center is a medical necessity. In order for you to receive the maximum benefits and avoid unnecessary charges or penalties, Blue Cross Blue Shield must authorize any inpatient treatment that is covered prior to the rendering of any actual services.10

To find out the specific details concerning inpatient treatment coverage under your Blue Cross Blue Shield health insurance plan, please visit your local Blue Cross Blue Shield company’s website. Here you will be able to estimate the cost of treatment and access all of your benefits and services. If you do not know the name of your local company, you can use the Find My Local BCBS Company tool on the Blue Cross Blue Shield Association website by entering the first 3 characters of the Identification Number from your member ID card.

Inpatient Rehab Service and Costs

Depending on the state you live in, Blue Cross Blue Shield offers up to 4 different tiers of plans for individuals and families.11 These different plans specify how you and your insurance company will share medical costs and can include bronze plans, silver plans, gold plans, and platinum plans. Within each plan level, you may also have the option to choose how your healthcare is managed (such as by an HMO or PPO).

  • Bronze plans typically provide about 60% expense coverage. These plans have the lowest monthly premiums but also have high deductibles. Although you may have lower monthly fees with a bronze plan, you will be required to pay more for healthcare services before your insurance kicks in.
  • Silver plans pay an average of 70% of covered medical expenses and usually have lower deductibles than bronze plans.
  • Gold plans provide about 80% expense coverage. These plans will likely have a higher monthly premium than silver plans, but you will not be required to pay as much toward a deductible before your insurance kicks in.
  • Platinum plans typically cover around 90% of medical expenses. The deductibles, copays, and co-insurance for these plans are typically lower than those for gold plans. And although these plans provide the most comprehensive coverage, they also have the highest monthly premiums.

Many federal workers and retirees enrolled in the Federal Employees Health Benefits program receive their insurance benefits from the Blue Cross and Blue Shield Federal Employee Program (FEP). Under the Standard Option of this PPO plan, members are responsible for a $350 per admission copay that is good for an unlimited amount of days.12 With the Basic Option, members pay a $175 copay per day up to $875 per admission for unlimited days of inpatient addiction treatment.13 Members enrolled in the Blue Focus FEP plan are responsible for paying a $500 deductible and 30% of their allowance for addiction treatment provided at an inpatient hospital or treatment facility.14 Precertification is required for any inpatient addiction treatment services that are covered by Blue Cross Blue Shield FEP.

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

Please do not let financial concerns prevent you from getting started on the path toward recovery. Contact our team of dedicated specialists today to learn about the best treatment options available that will fit your budget and meet your needs. We can also verify your insurance plan to help you figure out how much coverage you will receive from your insurance provider. Once the treatment costs that are not covered by your Blue Cross Blue Shield insurance plan are determined, we will work with you to develop an individualized payment plan. If needed, we can also offer you various resources for payment assistance, including private financing and sliding fee scales.

People Also Ask

Does Blue Cross Blue Shield cover methadone treatment?

Several Blue Cross Blue Shield companies have addressed addiction to opioids through programs that work to increase member access to intensive medical treatment options. These options include expanded coverage of medication-assisted treatment offerings, including methadone, Suboxone (buprenorphine and naloxone), and naltrexone. A prior authorization will be required for these medications, and your doctor will need to provide evidence demonstrating the necessity of these medications for treatment.

Sources

  1. Blue Cross Blue Shield. (2012). Health insurance from invention to innovation: A history of the Blue Cross and Blue Shield companies.
  2. Blue Cross Blue Shield Association. (2018). Blue Facts.
  3. Blue Cross and Blue Shield. (2019). BCBS Companies and Licensees.
  4. Blue Cross Blue Shield. (2016). Responding to the U.S. opioid crisis: What’s working in Massachusetts?
  5. Blue Cross Blue Shield. (2014). Blue Cross Blue Shield of Massachusetts Partners with OneHealth.
  6. Blue Cross Blue Shield. (2017). Program teaches students about the dangers of opioid misuse and abuse.
  7. Blue Cross Blue Shield. (2017). New Innovative In-home Treatment Program for Addiction Comes to New Hampshire.
  8. Aware Recovery Care. (2019). Aware Recovery Care Approach in Connecticut, New Hampshire, and Southern Maine Producing Outcomes 6x Better than the National Average.
  9. Blue Cross Blue Shield of Michigan. (2019). What’s the difference between HMO and PPO plans?
  10. Anthem Blue Cross and Blue Shield. (2019). Precertification.
  11. Anthem Blue Cross. (2017). Tips for Choosing Between the 4 Levels of Affordable Care Act Plans.
  12. Blue Cross Blue Shield Federal Employee Program. (2019). 2019 Standard Option Benefits Chart.
  13. Blue Cross Blue Shield Federal Employee Program. (2019). 2019 Basic Option Benefits Chart.
  14. Blue Cross Blue Shield Federal Employee Program. (2019). 2019 FEP Blue Focus Benefits Chart.


About The Contributor

Dr. Michael Kaliszewski is a freelance science writer with over 15 years of experience as a research scientist in both academia and industry. He has an undergraduate degree in biology from Johns Hopkins University, a master’s degree in biochemistry... Read More


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