As a global healthcare provider offering insurance coverage to over 106 million members in every state in the United States, Blue Cross Blue Shield (BCBS) operates 36 independent companies that are locally operated and community based. In California, the BCBS providers are Anthem Blue Cross and Blue Shield of California.
As one of the most comprehensive insurance companies in America, over 95 percent of doctors, specialists, and hospitals contract with BCBS companies – more than any other provider nationwide. BCBS offers a wide range of policies and insurance coverage for its members.
Including plans for employees through their employers, plans for families and individuals, and Medicaid coverage options, BCBS provides various coverage options ranging from preferred provider organization (PPO) plans and health maintenance organization (HMO) plans to health savings accounts (HSA). PPO plans allow members to use providers that are out of network, while HMOs expect members to remain in network with contracted providers for care. HSAs are tax-exempt accounts where the money is used to pay for medical expenses.
Plans are offered at all of the “metal” levels, including bronze, silver, gold, and platinum. Insurance 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. Many drug addiction treatment providers are able to work with families directly to use Blue Cross Blue Shield insurance to help pay for services.
Is Laguna In-Network?
Laguna Treatment Hospital is in-network with certain BCBS providers. We are in-network with the 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)
Blue Cross Blue Shield Policies and Addiction Treatment Coverage
In order to use BCBS insurance to enroll in drug addiction treatment, the first step is to contact the insurance provider directly. Many times, these services require preauthorization in order to be covered. This preauthorization can be done over the phone or by filling out and submitting a form. Most BCBS plans do not require referrals to see a specialist, just the verification for services.
Depending on the plan, coverage for services can vary. Some plans may require a copay for office and outpatient visits, for example. A copay is a set amount that is paid up front for services.
Plans will also have deductible amounts, coinsurance rates, and out-of-pocket annual maximums. The deductible is an amount that must be reached before coverage begins while coinsurance is the rate that policyholders will pay out of pocket. For instance, a coinsurance rate of 20 percent would mean that BCBS covers 80 percent of the cost of services while the individual is responsible for the remaining 20 percent. The out-of-pocket maximum is the cap on the amount of medical expenses a person pays out in a year; BCBS will cover the rest at 100 percent after this amount is reached. In general, the higher the “metal” level, the lower the deductible amounts and higher the monthly premiums to continue coverage.
BCBS plans vary; however, plans like the Gold 80 HMO Trio cover the following behavioral health, mental health, and substance abuse treatment services:
- Office visits
- Outpatient services
- Psychological testing
- Partial hospitalization
- Inpatient services
- Hospital services
- Residential care
Verification is required before enrolling in a program that must be offered through a contracted BCBS in-network provider. Inpatient and outpatient services will typically include therapy, relapse prevention skills training, educational programs, medical and mental healthcare, medication management, support groups, and detox services. A BCBS representative can direct members to contracted providers, and drug addiction providers can help individuals optimize their insurance coverage to pay for services prior to enrollment.