Blue Cross Blue Shield Rehab Coverage
Blue Cross Blue Shield (BCBS) is a national network of insurance providers comprised of 34 independent companies. To get a BCBS plan, you’ll need to go through your nearest company. For instance, people in Idaho would go through Regence BlueCross BlueShield of Idaho while those in New Jersey would have Horizon Blue Cross Blue Shield of New Jersey.
If you have a BCBS insurance plan from an independent company within the network, you will have coverage in all 50 states. All BCBS health insurance plans cover a portion of mental health and addiction treatment services, but the amount covered varies widely depending on your location and chosen plan.
Would you like help locating and understanding your insurance benefits? Find out more about your insurance coverage for drug and alcohol rehab. Reach out to our team at Zinnia Health by calling (855) 430-9439. Our helpline is completely free and available 24 hours a day.
Does Blue Cross Blue Shield Insurance Cover Alcohol Rehab?
Blue Cross Blue Shield is required to cover at least a portion of the costs associated with alcohol rehab and substance use disorder (SUD) treatment. This is because the Affordable Care Act of 2010 established these services as “essential benefits,” meaning that all health insurance providers must offer some coverage for them, typically 60% or more.
Alcohol addiction is sometimes treated with an outpatient program, in which case you may need to consider things like per-visit copays. There may also be a limit on the number of visits per calendar year before you no longer receive coverage.
Does Blue Cross Blue Shield Insurance Cover Substance Abuse Treatment?
Yes, Blue Cross Blue Shield offers insurance benefits to cover both inpatient and outpatient substance abuse treatment programs. While coverage can be as low as 60% based on your plan type, some BCBS plans cover anywhere from 80% to 90% of the treatment costs.
Substance abuse treatment is often done with an inpatient program, but it’s important to consider exclusions and restrictions. For instance, the rehab center may need to request prior authorization before providing services.
Does Blue Cross Blue Shield Cover Mental Health Treatment?
Yes, Blue Cross Blue Shield offers coverage for mental health treatment. The coverage amounts for substance use disorder treatment and mental health services are equal on your plan, as they fall under the same category.
This may also mean that getting help for drug rehab may reduce the coverage available to you for mental health services. Health benefits typically reset at the start of the calendar year.
Blue Cross Blue Shield Inpatient Coverage
The level of coverage provided by BCBS for inpatient treatment options will depend on your plan. For example, the Regence BlueShield of Idaho Bronze Virtual Value plan with an $8,500 annual deductible covers:
- 20% for in-network substance abuse and mental health treatment
- 60% for out-of-network substance abuse and mental health treatment
This plan document goes on to explain that certain services are not covered. For instance, hypnotherapy and outdoor camps — including those aimed at rehabilitating individuals with mental health or substance use disorders — are not covered at all.
Blue Cross Blue Shield Outpatient Coverage
Outpatient treatment is covered for those with a BCBS health insurance plan, but the coverage level once again depends on the type of plan you have. Sticking with the above example, the bronze plan covers:
- 20% for outpatient services for in-network providers
- 60% for outpatient services for out-of-network providers
When assessing these benefits, it’s important to consider caps on coverage. For instance, habilitative and rehabilitative outpatient services are limited to 20 sessions per calendar year for the Bronze Virtual Value plan described above.
Intensive outpatient programs, also known as partial hospitalization programs, sometimes require multiple appointments each day, which is why it’s helpful to speak with your insurance company for more specific information on the level of care and coverage available to you.
Rehabs That Accept Blue Cross Blue Shield Insurance Near You
No matter which state your Blue Cross Blue Shield insurance plan originates from, you have coverage in all 50 states.
Several Zinnia Health facilities are in-network with Blue Cross Blue Shield insurance, including inpatient and outpatient rehab facilities.
- Newport Beach, California
- Lake Arrowhead, California
- South Bend, Indiana
- Washington County, Rhode Island
- Denver, Colorado
- Miami, Florida
- Lake Okeechobee, Florida
- Deerfield Beach, Florida
How to Check Your Blue Cross Blue Shield Coverage
With 32 independent providers making up the national Blue Cross Blue Shield insurance network, it’s essential that you get direct answers from your BCBS insurance carrier. To determine your out-of-pocket costs and coverage, you can use the coverage locator tool.
- Find your BCBS insurance card. You will need to know the first three characters of the Identification Number shown on your card.
- Head to the Member Benefits locator on the Blue Cross Blue Shield website. Enter your three-character prefix into the search bar.
- You will be taken to your state’s BCBS provider website. From here, you can search and compare plans or log in to your account to view your benefits.
If you don’t have an insurance card or are having trouble using this online service, it’s best to make a direct call to your state’s BCBS provider.
Types of Blue Cross Blue Shield Plans That Cover Addiction Treatment
All Blue Cross Blue Shield health insurance plans cover addiction treatment, but the coverage amount varies depending on the type of plan.
- Bronze plans typically cover 60% of the costs of most services, including mental health and substance use disorder treatment. This means you are responsible for 40% of the costs.
- Silver plans typically cover 70% of the costs of most services, including mental health and substance use disorder treatment. This means you are responsible for 30% of the costs.
- Gold plans typically cover 80% of the costs of most services, including mental health and substance use disorder treatment. This means you are responsible for 20% of the costs.
These plan tiers align with the standards set by the Affordable Care Act. However, your Blue Cross Blue Shield plan may cover substantially more, depending on variables like your deductible and whether you have vision or dental care included in your plan.
Aside from checking your level of coverage, you also need to assess aspects like your annual deductible and out-of-pocket maximum. For instance, if your plan has an annual deductible of $1,500, you may need to pay that much yourself before you unlock full coverage.
Likewise, if you exceed your coverage limits and reach your out-of-pocket maximum (which includes your deductible), your insurance policy will begin covering all of your costs.
Frequently Asked Questions
What Length of Stay Will Blue Cross Blue Shield Cover?
There are caps on how long you can stay in an inpatient facility and how many outpatient visits you can make each calendar year. These limits vary from one plan type to the next, which is why it’s important to contact your local Blue Cross Blue Shield Association for more information about your benefits.
How to Pay for Costs Blue Cross Blue Shield Doesn’t Cover?
Insurance rarely covers 100% of treatment costs for drug and alcohol abuse or any other type of treatment. If you’re concerned about how you will cover the out-of-pocket expenses like copays, deductibles, and treatments that BCBS may not cover, the best thing to do is speak to the treatment facility directly. Many offer payment plans and some can eliminate your out-of-pocket expenses with grants and other programs.
What to Do if Blue Cross Blue Shield Doesn’t Cover Rehab?
Blue Cross Blue Shield covers some of the costs of rehab treatment in most cases, but certain facilities may not be covered, especially those that employ nontraditional techniques. If you have chosen a treatment provider but are worried about the cost of drug or alcohol recovery, speak to the treatment center. They can give you information on grants, payment options, and alternatives to ensure you get the care you need.
Do Rehab Facilities Need to Be In-Network?
The type of health insurance plan you have will determine whether an inpatient rehab center needs to be in-network. With HMO plans, you will only receive coverage if you see someone in your network. With PPO plans, you have some coverage for all providers, but you may have less coverage for those out of network.