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Blue Cross Blue Shield (BCBS) Insurance Coverage for Addiction Treatment [Rehab Coverage]

Blue Cross Blue Shield 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 is covered by BCBS Health Insurance. Typically Blue Cross Blue Shield…
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Blue Cross Blue Shield 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 is covered by BCBS Health Insurance.

Typically Blue Cross Blue Shield policies cover addiction treatment, but the allowable services will vary from 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 allows them to choose a treatment program based on their individual needs and greatly widens their options when obtaining treatment for addiction (including alcohol rehab, alcohol abuse, and mental health care).

Blue Cross Blue Shield 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 policy with the insurance provider (BCBS):

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

Many alcohol rehab facilities are available nationwide to treat these addictions. To learn more about programs available to you based on your unique needs, budget, insurance company and location, contact our rehab advisors online or call (888) 673-9346.

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Blue Cross Blue Shield Addiction Resources

Since 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, including alcohol abuse. By using the mobile platform, OneHealth, members and their families have 24/7 access to support, education, and tools to aid in their recovery from addiction.

Blue Cross Blue Shield Substance Abuse Treatment Coverage by Policy

Blue Cross Blue Shield 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 alcohol rehab coverage and treatment options available to the member with lower out-of-pocket costs.

Blue Cross Blue Shield also has a Federal Employees Program, which consists of two plans; the basic and standard options. 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 might be subject to additional out-of-pocket costs when receiving treatment with an out-of-network provider.

Blue Cross Blue Shield Alcohol Rehab Treatment In-Network and Out-of-Network

Depending on the plan type, members may have both in and out-of-network addiction 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, members 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 Blue Cross Blue Shield 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. If you are unsure how to go about navigating your plan’s benefits or want assistance when speaking to your local Blue Cross Blue Shield Members Benefits Department, call our rehab advisors at (888) 673-9346. We will take the call with you and help you every step of the way.

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

Blue Cross Blue Shield Inpatient Treatment Coverage

The type of Blue Cross Blue Shield plan you have chosen will determine the Inpatient Treatment Coverage you have.  With a wide variety of treatment plans, many will vary from state to state based on laws and regulations. This coverage can be impacted by 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 member’s deductible for in-network providers, and 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, and out-of-network providers might 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’s maximum out-of-pocket costs, and out-of-network providers are covered with a higher deductible and maximum out-of-pocket costs.

Regardless of plan type, Blue Cross Blue Shield requires pre-certification for inpatient level of care in both Hospitals and Treatment Facilities for substance use disorders.

To determine your Inpatient Treatment costs, contact our rehab advisors. We are here to help you maximize your plan’s benefits and minimize your out-of-cost expenses.

Blue Cross Blue Shield Outpatient Treatment Coverage

Outpatient treatment coverage with Blue Cross Blue Shield rehab centers will vary on the plan itself, the state, the servicing location, and the level of care. All plans typically 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 the 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 provider costs, contact our rehab advisors. We are here to help you maximize your plan’s benefits and minimize your out-of-cost expenses.

We’ve Helped Thousands of Individuals Overcome Drug and Alcohol Addiction

If you or a loved one are ready to overcome drug or alcohol abuse, our addiction specialists are here to guide you through every step. Many of our dedicated staff members are in long-term recovery themselves and understand firsthand the challenges of the recovery journey. This personal experience, combined with our professional expertise, allows us to offer compassionate, effective support tailored to your unique needs.
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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 Blue Cross Blue Sheild. 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 us, we will assist you in finding an appropriate treatment facility based on your unique needs. The objective is to help you start your recovery, not to break the bank. Speak to one of our rehab advisors today to understand your financial obligations based on your unique situation and find out what options are available to assist you in paying for treatment today.

Dr Kate Smith

Clinical Reviewer

More about Dr. Kate Smith

Dr. Kate Smith is a licensed professional and has worked in the mental health and substance abuse disorder fields for over 10 years. She earned her bachelor’s degree in Social Work from Florida Atlantic University, graduating magna cum laude from her class. She obtained her Masters in Social Work (MSW) at Barry University in an accelerated program.

More about Dr. Kate Smith

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Quit Alcohol’s helpline is a private and convenient solution for those seeking treatment for addiction or mental illness. Calls to our helpline (all non-facility specific numbers) will be answered by a caring rehab advisor from Treatment Addiction Solutions or one of our verified treatment partners. Calls are routed based on geographic location and will help you navigate:

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  • Additional factors such as co-occurring mental health disorders, family dynamics, and more.
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