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BlueCross BlueShield (BCBS) Insurance Rehab Coverage

Editor Dan Schimmel, LCSW, CAP
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BlueCross BlueShield Association (also known as BCBS) is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. These nationwide companies provide health insurance coverage to more than 106 Million people – One in three Americans are covered by BCBS Health Insurance.

Typically BlueCross BlueShield policies cover addiction treatment, the allowable services will vary state to state as well as on individual policies. BCBS has one of the largest networks of preferred providers in the United States. However many policies allow members to obtain treatment with an out of network provider which gives them the option to choose a treatment program based on their individual needs and greatly widening their options when obtaining treatment for addiction.

BlueCross BlueShield Covered Addiction Treatment Services

While most, if not all, addiction treatment services will be subject to your deductible and coinsurance, commonly there is coverage for the following services depending on your individual policy;

  • Outpatient Treatment
  • Intensive Outpatient Treatment (IOP)
  • Partial Hospitalization (PHP)
  • Residential Treatment
  • Detoxification
  • Acute Inpatient Hospitalization

BlueCross BlueShield Addiction Resources

Since 2017 when President Donald Trump declared the Opioid Epidemic a National Crisis there has been an increase in addiction resources provided to BCBS Members. These resources are in place to assist members in identifying and finding help for substance abuse problems. Using a Mobile platform, OneHealth, members and their families have 24/7 access to support, education and tools to aid in their recovery from addiction.

In efforts to protect its members, BCBS has developed a prescription pain medication safety program to help reduce the risk of drug addictions, especially to high profile painkillers such as Vicodin and Percocet. As well as fostering research through collaborative research partnerships to identify the most effective treatment practices for individuals affected by substance use disorders.

BlueCross BlueShield Substance Abuse Treatment Coverage by Policy

BlueCross BlueShield has many different plan options available, dependent on your state. These plans typically include bronze, silver, gold and platinum levels, with bronze being the lowest plan available. The lowest plans will typically have the highest deductibles with the lowest premiums. Those plans with lower deductibles typically have much higher premiums, increasing the coverage and treatment options available to the member with lower out of pocket costs.

BlueCross Blue Shield also has a Federal Employees Program which consists of two plans; the basic and standard option. The difference in these plan types is those members with the basic plan are required to see preferred providers (also known as in network providers) while those with the standard option can see both in and out of network providers with coverage. Those with the standard plan option may be subject to additional out of pocket costs when receiving treatment with an out of network provider.

Treatment In-Network and Out-of-Network

Depending on the plan type, members may have both in and out of network treatment options. While plan options come with both high and low deductibles, they also come with options such as HMO (Health Maintenance Organization) plans or PPO (Preferred Provider Organization) plans.

When choosing an HMO plan member will be restricted to treatment within the BCBS Network (in network, preferred providers). While those choosing a PPO plan have more options in choosing providers as they do not require they be within the BCBS network, making it possible to obtain treatment in an out-of-network facility. However, choosing an out of network provider can result in your out of pocket expenses being much higher. Speaking to your local BlueCross BlueShield members benefits department can help you in determining what your out of pocket costs will be with both in network and out of network treatment providers.

Selecting a treatment facility will not only be determined by your plan type but also by your individual needs.

BluCross BlueShield Inpatient Treatment Coverage

The type of BlueCross BlueShield plan you have chosen will determine the Inpatient Treatment Coverage you have.  With a wide variety of treatment plans many will vary state to state based on laws and regulations. This coverage can be impacted on where a member is able to seek treatment and at what level of care, as well as what their out of pocket costs will be.

 

Bronze plans have the highest deductible for in network care, out-of-network providers are not covered.
Silver plans typically have a high co-insurance beyond the members deductible for in-network providers, out-of-network providers are not commonly covered.
Gold plans often hold a lower coinsurance after the deductible has been met for in-network providers, out-of-network providers may be covered  at a higher deductible and maximum out of pocket costs.
Platinum plans normally have a copay for in-network providers which applies to the member maximum out of pocket costs, out-of-network providers are covered with a higher deductible and maximum out of pocket costs.

 

Regardless of plan type, BlueCross BlueSheild requires precertification for inpatient level of care in both Hospitals and Treatment Facilities for substance use disorders.

To determine your Inpatient Treatment costs contact your local member benefits department.

BlueCross BlueSheild Outpatient Treatment Coverage

Outpatient treatment coverage with BlueCross BlueSheild will vary on the plan itself, the state, the servicing location and the level of care. All plans typical will cover outpatient treatment with an in-network provider. Bronze and Silver plans will be subject to deductible and coinsurance, while Gold and Platinum plans will be subject to co-pay. Out-of-network coverage will be determined by plan; Bronze and Silver do not hold coverage, while Gold and Platinum plans will cover PHP, IOP and OP services. However these services will be subject to the out-of-network deductible, coinsurance and maximum out of pocket and may hold additional costs based on the provider.

To determine your Outpatient Treatment costs contact your local member benefits department.

Paying for Out-of-Network Treatment

While treatment services are subject to your out-of-network deductible, co-insurance and maximum out of pocket you may incur additional expenses to cover treatment services. These costs are beyond the allowable presented by BlueCross BlueSheild. Your treatment services may not be covered in full, however there may be partial scholarship programs and financing options available to assist you in paying for treatment.

By contacting the treatment facility you will be assisted in choosing the best treatment option that meets your individual needs. The objective is to help you start your recovery, not to break the bank. Speak to one of our admissions counselors today to determine your financial obligations and find out what options are available to assist you in paying for treatment today.


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