What Is Blue Cross Blue Shield Rehab Coverage?
Deciding to seek rehabilitation treatment for drug or alcohol addiction can be a step in the right direction, but you may have some concerns about treatment. Paying for treatment, rehab, and navigating rehab insurance coverage levels can be confusing. However, the majority of insurance plans do offer some addiction treatment coverage for substance abuse.
Blue Cross Blue Shield is a group of companies that provides health insurance coverage throughout the United States of America and to over 100 million people. The Blue Cross Blue Shield network is extremely wide, covering more than 9 out of every 10 doctors and hospitals in the country. In addition, millions of federal government workers receive their health insurance through Blue Cross Blue Shield.
There are a variety of perks and benefits associated with Blue Cross Blue Shield coverage that could be useful to individuals struggling with mental health or addiction. While many Blue Cross Blue Shield policies provide a range of benefits to cover addiction treatment, options and programs vary depending on the state you reside in and your individual plan.
Blue Cross started in 1929 as a plan to make healthcare affordable for Baylor University hospital patients. Blue Shield had a similar start, offering health services to workers in exchange for a monthly payment. These two plans spread rapidly and merged in the 1940s. Blue Cross Blue Shield (BCBS) Health Plans provide coverage to one-third of Americans. Coverage is available in all 50 states and is widely accepted nationwide.
Blue Cross Blue Shield Insurance Coverage for Drug and Alcohol Rehab Treatment
Drug and alcohol rehab coverage provided by a Blue Cross Blue Shield (BCBS) plan depends on many factors. Such factors include the state you live in, the type of BCBS insurance plan you have, and your specific substance abuse treatment needs. If medical detox services are needed for substances such as opiates, alcohol, or benzodiazepines, part or all of the cost may be covered if it is determined to be medically necessary.
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Blue Cross Blue Shield Rehab Coverage Levels and Plans
Many BCBS insurance plans also cover family, group, and individual counseling as part of drug rehab services to treat co-occurring mental health disorders. Some BCBS insurance plans may also cover relapse prevention services and drug education programs. However, some plans may set a lifetime limit on drug rehab services.
While BCBS plans can vary based on which state you are in, most plans are broken into different levels:
- Bronze plans have the lowest premiums, but out-of-pocket costs are higher. BCBS pays about 60% of the costs of your medical care once your deductible is met.
- Silver plans have higher premiums compared to bronze plans, but you pay less out of pocket than with a bronze plan. BCBS pays about 70% of your medical care after your deductible is met.
- Gold plans have higher premiums compared to silver plans and low out-of-pocket costs. BCBS pays about 80% of your medical care once your deductible is met.
- Platinum: Platinum plans are not available in all states or locations. These plans typically cover about 90% and have low deductibles and very high monthly premiums compared to the bronze, silver, and gold plans.
BCBS participates in Medicaid, which is a health insurance program for people with low incomes who often have severe health conditions. Medicare, a federal insurance program for people aged 65 and older, is also administered through BCBS.
The advantage of a large, nationwide insurance company like BCBS means that you can easily access treatment in other states. The BlueCard program allows you to benefit from local BCBS plan rates even if you decide to seek treatment outside your home state.
Does Blue Cross Blue Shield Insurance Cover Rehab?
The short answer is yes, it will cover at least some of the cost, but this page is intended to help you figure out what your BCBS healthcare does and does not cover. Almost all Blue Cross Blue Shield plans include coverage for mental health conditions, but the amount of coverage for treatment depends on your policy. The Mental Health Parity and Addiction Equity Act  requires that health insurance companies and group health plans provide equal coverage for mental health services, such as drug and alcohol abuse treatment, as they do medical coverage.
This act was created to expand mental health and substance abuse coverage for people across the country. As a result, many BCBS companies may provide you with affordable coverage, and that is reflected in the pricing.
The amount of coverage you have can vary widely based on your state of residence, whether the facility is in or out-of-network, the length of your stay, and your insurance plan level. In addition, the cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.
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Blue Cross Blue Shield HMO and PPO Plans
BCBS offers both HMO and PPO plans. An HMO plan allows you to select a primary care physician (PCP) who will provide you referrals to other providers, hospitals, and specialty clinics within your network as needed. HMO plans typically have lower monthly premiums but higher deductibles. With a PPO plan, you will not need to choose a PCP, and you are not confined to a network. You can visit any provider, hospital, or specialty clinic. PPO plans often have higher monthly premiums but lower deductibles.
How to Check Your Blue Cross Blue Shield Coverage
We can help you verify your insurance plan in three easy steps:
Fill out the verification form: Simply fill out the information on our form and let us check with your insurance provider. Most BlueCross BlueShield PPO plans will cover your treatment. Keep in mind that some plans will require you to make a small co-payment. We can go over the details of what your plan offers.
Treatment consultation: In addition, we also provide a consultation, which may include an assessment of your condition and your needs. We can help you develop the right treatment so that you can get the help you need.
Choose your treatment: Although we can make some recommendations, you are ultimately in charge of what treatment you want to participate in.
If you are interested in drug rehab at We Level Up NJ, we can confirm your Blue Cross Blue Shield benefits for you. We can also let you know how much your insurance will cover, the types of services that you can receive using your insurance, and any other details about your insurance that you may have questions about.
We aim to help you access the services you need as quickly as possible, so we are happy to help you in any way we can during the preliminary steps of seeking care.
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What Will Blue Cross Blue Shield cover?
Depending on your specific plan, BCBS may cover a portion or the entire cost of drug rehab. The levels of rehab care include:
- Inpatient/residential rehab—You or a loved one live at the facility throughout the duration of treatment, which is typically anywhere from a few weeks to several months in length. You will receive 24-7 care from medical professionals, as well as attend individual and group counseling. This type of treatment is best for those who don’t have the support needed at home or those who need constant supervision.
- Outpatient rehab—Outpatient rehab services allow patients to continue living at home while they attend an outpatient facility a few times per week. The focus on outpatient rehab is group therapy. This type of treatment is for those without a severe addiction and/or family support at home.
- Intensive outpatient program (IOP)—An IOP is a type of outpatient treatment program that is more structured than a standard outpatient program, but less intensive than an inpatient facility.
- Partial hospitalization programs (PHP)—PHP services are another type of outpatient treatment for people who require more supervision than a traditional outpatient program offers, but not as much supervision as an inpatient program. This type of program usually takes place in a hospital setting and requires approximately 20 hours of treatment per week.
Frequently Asked Questions About Blue Cross Blue Shield health insurance Coverage for Rehab
How can I verify my BCBS health insurance benefits?
Verifying your BCBS insurance benefits is easy at We Level Up NJ. Get accurate, up-to-date information regarding your policy and coverage for rehab by calling us now or filling out the confidential form on this page. You will need to have the following information ready when you call or fill out the form:
- Company name of your insurance provide
- Your member ID number
- Your date of birth
- Your insurance provider’s telephone number (found on the back of your insurance card)
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How much does it cost to verify my benefits and begin the admissions process at We Level Up NJ?
The insurance verification process at We Level Up NJ is a free service we provide to make the treatment-seeking process easier and less complicated for you. We are happy to contact BCBS on your behalf, free of charge. If, during the initial insurance and admissions screening process, we find that our addiction treatment services will not meet your or your loved one’s needs, we will provide alternative suggestions for qualified treatment.
Who else will be notified when I verify my Blue Cross Blue Shield insurance benefits?
No one else on your insurance policy will be notified when you verify your medical benefits through We Level Up NJ. This process is completely confidential when completed online or over the phone.
Do I have to commit to treatment at We Level Up NJ if I complete an insurance benefits verification?
You have no obligation to enroll in drug and alcohol rehab at We Level Up NJ, even if we verify your insurance benefits for you. This is done with no strings attached as a complimentary service to you.
We Level Up NJ Makes It Easy to Verify Your Blue Cross Blue Shield Insurance Benefits for Drug Rehab
We understand that combing through the Blue Cross Blue Shield Insurance policy can be challenging, time-consuming, and frustrating. Fortunately, you don’t have to do it alone. At We Level Up NJ, our admissions staff works with many BCBS customers during the admissions process.
Once we determine the appropriate level of care for you or your loved one, we will quickly verify your insurance benefits and have an open and honest conversation with you about the cost of drug rehab and your BCBS insurance coverage options.
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