Horizon Blue Cross Blue Shield Rehab Coverage for Drugs & Alcohol

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Horizon BCBS Rehab Coverage

Horizon Blue Cross Blue Shield of New Jersey provides healthcare coverage for millions of New Jersey residents, including those suffering from substance abuse, substance use disorder (SUD), and other behavioral and mental health conditions requiring partial hospitalization programs (PHPs). Since the inception of the Affordable Care Act (ACA) in 2010, most health insurance companies are required to cover at least a portion of drug abuse addiction treatment and recovery services. 

If you’re unsure about the specifics of your Horizon BCBS insurance policy, contact Zinnia Health online or call (855) 430-9439 to find out more about your insurance coverage for drug and alcohol rehab.With your permission, we can contact Horizon BCBS on your behalf to learn what’s covered so you can make an informed decision regarding treatment and your out-of-pocket costs, if any.

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Does Horizon BCBS Insurance Cover Alcohol Rehab?

Yes, Horizon BCBS insurance offers coverage for all or a portion of your costs for alcohol rehab, or alcohol addiction treatment, but your specific level of coverage depends on your unique policy and other factors, such as:

  • Your state of residence.
  • Whether you have an employer-, state-, or federal-sponsored policy.
  • If you purchased a Marketplace policy under the umbrella of the ACA.
  • Your plan’s healthcare deductibles for mental and behavioral health services.

Additionally, drug and alcohol treatment, such as inpatient rehab, must be deemed medically necessary and recommended by a board-certified, licensed healthcare provider.

How much Horizon BCBS covers for alcohol treatments or other inpatient rehab services also depends on the type of plan you’re enrolled in.

Horizon Blue Cross Blue Shield plans include:

  • Health maintenance organizations (HMOs)
  • Exclusive provider organizations (EPOs)
  • Preferred provider organizations (PPOs)

Learn More: Horizon Behavioral Health Program & Services

Does Horizon BCBS Insurance Cover Substance Abuse Treatment?

Yes, Horizon BCBS insurance offers coverage for substance abuse treatment. The ACA paved the way for a broader swath of individuals from varying backgrounds and income levels to obtain healthcare coverage, and most insurance companies are required by this law to provide certain types of service coverage and care levels.

Addiction treatments your Horizon BCBS insurance may cover include (but aren’t limited to):

  • Detox
  • Counseling programs
  • Inpatient care and outpatient treatments
  • Medication-assisted treatment and therapy

Your policy’s provisions depend on many variables, such as where you live. Horizon policies are designed for residents of New Jersey but can be extended out of state if traveling or temporarily living outside New Jersey. Your costs (and what you may have to pay out of pocket) depend on what your specific policy covers, the intensity of the treatment plan you require, how long your treatment may take, and where you’ll receive treatment.

Horizon BCBS’s preventive care appointments are of no cost to policyholders, but for visits considered non-preventive, you may need to:

  • See only in-network doctors.
  • Obtain a referral from your primary physician.
  • Receive treatment from hospitals or other facilities considered in-network.
  • Set up appointments with in-network specialists when required or recommended.
  • If you have coinsurance, obtain a statement of payments/coverage.

Calculate how much you’ve paid toward your deductible for the policy period (typically 12 months), then if you have a portion of your deductible remaining unpaid, you must pay this amount before Horizon BCBS pays their portion for your treatment.

Horizon BCBS insurance benefits offer coverage to begin the treatment process, and your plan might also include benefits such as:

  • Confidential counseling or therapy sessions
  • Multiple substance abuse treatment options
  • Ongoing access to recovery treatment specialists, outpatient rehab, and aftercare programs
  • Personalized life skills coaching or support that can work around your personal schedule and unique challenges

Does Horizon BCBS Cover Mental Health Treatment?

Yes, Horizon Blue Cross Blue Shield offers coverage for mental health services and treatment for policyholders. Benefits vary, but your policy may provide access to:

  • Referral services, including:
  • Outpatient programs
  • Initial consultations
  • Case management and follow-up
  • Provision of mental health treatment
  • A network of licensed behavioral and mental health services providers

Horizon BCBS Inpatient Coverage

Horizon BCBS policies may provide inpatient hospital care coverage for substance abuse treatment according to each policy. The injury or illness that causes the policyholder to submit to hospitalization must be included on Horizon BCBS’s list of covered injuries and illnesses.

Horizon BCBS Outpatient Coverage

Horizon BCBS insurance offers healthcare coverage for outpatient visits at clinics, urgent care locations, and other medical facilities that don’t require overnight stays in a hospital, such as:

  • Physical therapy
  • Counseling sessions
  • Weight-loss support programs
  • Drug rehab and alcohol rehab services
  • Preventive and wellness checkups
  • Lab tests, MRIs, and other diagnostics
  • Surgery, chemotherapy, and other outpatient treatments

To determine the terms of your policy, review your Summary of Benefits.

Rehabs That Accept Horizon BCBS Insurance Near You

Zinnia Health has locations across the United States to reach as many individuals as possible. We provide substance abuse, drug addiction, and alcohol addiction recovery services to help ease the pain of addiction and offer a helping hand on the road to recovery.

We are an in-network provider for BCBS and we accept Horizon Blue Cross Blue Shield insurance and many other health insurance plans, such as Cigna and Aetna, at our locations.

Start your journey to healing at one of these Zinnia Health locations:

If you or a loved one has been diagnosed with a co-occurring disorder, such as a drug addiction paired with depression or anxiety, Zinnia Health can help. From residential inpatient treatments to convenient outpatient programs and group therapy sessions, our compassionate substance abuse treatment specialists can jumpstart your recovery. Contact Zinnia Health at (855) 430-9439 to learn how you can live a life of sobriety.

How to Check Your Horizon BCBS Coverage

To check your Horizon Blue Cross Blue Shield coverage:

  1. Gather the necessary information. Write down your policy ID number, along with any other information you might need, such as doctor’s name and location, and any prescriptions you’re currently taking in the event you have to answer any questions requesting personally identifiable information — having it handy will make the process smoother.
  2. Sign into your My Health Manager account or download the Horizon Blue app. On your My Health Manager account, all of your policy information, including past doctor office visits, copays, and deductible amounts paid for the period, are easy to find. The online account and smartphone app are relatively user-friendly with easily navigable pages and tabs to find the information you’re looking for.

Note: If you don’t have a policy with Horizon BCBS, you cannot navigate to certain Horizon Blue Cross Blue Shield website pages.

On the other hand, you also can:

  1. Call Zinnia Health at (855) 430-9439.
  2. Speak to one of our caring admissions specialists.
  3. Provide the insurance information (policy number, plan type, etc.) that you wrote down earlier.
  4. Zinnia Health will contact Horizon Blue Cross Blue Shield for you, find out exactly what your policy covers, and let you know your out-of-pocket costs for substance abuse treatment if your policy doesn’t cover the entire amount.

Navigating the many nuances of your Horizon Blue Cross Blue Shield policy is challenging. Obtaining a medically necessary judgment and knowing exactly what your policy covers and for how long is essential. While most facilities offer payment options and can put you in touch with assistance programs, it’s still important to understand your coverage, how much assistance you might need, and your total out-of-pocket costs.

Types of Horizon BCBS Plans That Cover Addiction Treatment

The Horizon BCBS Mental Health Program plan (and other Horizon medical plans) cover addiction treatment with a few caveats:

  • You likely need to obtain a referral from your primary healthcare provider to access benefits to cover substance abuse treatment, such as a partial hospitalization or intensive outpatient program, especially if it’s out-of-network.
  • Horizon Blue Cross Blue Shield may not cover mental or behavioral health services or substance abuse treatment provided by a physician or facility that’s out-of-network.
  • Horizon Blue Cross Blue Shield may cover a majority of the total costs of mental health issues, behavioral health services, and/or substance abuse treatment if the medical professionals or rehab center is in-network.

If you haven’t yet met your deductible, you must pay the remainder of your deductible plus your share of the total cost of treatment, and then Horizon BCBS pays its portion.

There are no other limitations or exceptions.

Frequently Asked Questions

What Length of Stay Will Horizon BCBS Cover?

Hospital stays for substance abuse and mental health treatments require prior authorization. Treatment for addiction is important, but ensure you’ve received proper authorization before beginning a treatment stay or you could end up owing the full cost of treatment with no insurance coverage.

How to Pay for Costs Horizon BCBS Doesn’t Cover?

If your policy doesn’t cover all the costs of inpatient rehab, there are state- and federally-funded assistance programs that can help you cover treatment costs, in addition to sliding fee scales and payment plans.

What to Do if Horizon BCBS Doesn’t Cover Rehab?

Most Horizon BCBS plans cover all or a portion of rehab treatment services as long as certain criteria are met, such as prior authorization.

Do Rehab Facilities Need to Be In-Network?

Horizon Blue Cross Blue Shield doesn’t require treatment facilities to be in-network — however, for inpatient substance abuse treatment and inpatient mental health services, there’s a large gap in per-stay deductible between in-network and out-of-network. If you have Horizon BCBS insurance and a treatment program is not in the Horizon BCBS network, you can consider other payment options.

You can also choose a different treatment center that’s in-network, like Zinnia Health. Our caring treatment professionals are available 24/7 to answer questions, verify insurance coverage, or just lend an ear if you need someone to talk to. Contact Zinnia Health at (855) 430-9439.

Call us
Ready to get help?
(855) 430-9439
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