Does Blue Cross Blue Shield Insurance Cover Drug and Alcohol Rehab?
Drug 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 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.1 (section titled “Does Blue Cross Blue Shield Cover Mental Health & Substance Abuse Treatment”) Many BCBS insurance plans also cover family, group, and individual counseling as part of drug rehab services to treat co-occurring mental health disorders.1 (4th paragraph under “Using Blue Cross Insurance to Find and Cover Rehab”) Some BCBS insurance plans may also cover relapse prevention services and drug education programs.1(4th paragraph under “Using Blue Cross Insurance to Find and Cover Rehab”) However, some plans may set a lifetime limit on drug rehab services.1 (5th paragraph under “Using Blue Cross Insurance to Find and Cover Rehab”)
BCBS insurance consists of 35 independent and locally operated companies across all 50 states, the District of Columbia, and Puerto Rico.2 (top of page) In the U.S., 1 in 3 Americans are covered by an individual or family BCBS insurance plan.2 (top of page) BCBS also offers employer-sponsored insurance plans and insurance plans specifically designed for federal employees. 1 (top of page) Over 5 million federal employees, retired federal employees, and their families are covered under the federal BCBS plan.2 (top of page) BCBS also provides international insurance plans for people who live, work, or travel outside of the U.S. 2 (top of page)
BCBS plans are provided at different levels, each with its own monthly premiums and deductibles.3 A deductible refers to the amount of money you will pay before your insurance is activated. The following is a breakdown of the different insurance plan levels offered by BCBS:3
- Bronze: These plans typically cover about 60% with high deductibles and low monthly premiums.
- Silver: These plans typically cover about 70%. Deductibles are low, but monthly premiums are higher than bronze plans.
- Gold: These plans typically cover about 80% with lower deductibles and higher monthly premiums than the bronze and silver plans.
- 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.
In addition to the level of plan chosen, your monthly premium and plan deductible under BCBS are also determined by whether you choose a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan.4
BCBS offers both HMO and PPO plans. An HMO plan allows you to select a primary care physician (PCP) who will provide you referrals for other providers, hospitals, and specialty clinics within your network as needed.4 HMO plans typically have lower monthly premiums but higher deductibles.4 With a PPO plan, you will not need to choose a PCP, and you are not confined to a network.4 You can visit any provider, hospital, or specialty clinic. PPO plans often have higher monthly premiums but lower deductibles.4
BCBS also offers a Health Savings Account (HSA), which allows you to save money for your healthcare-related expenses.3
BCBS has recently introduced the Blue Distinction Center for Substance Use Treatment and Recovery.5 This new program allows you or a loved one to access nationally accredited and evidence-based drug rehabs in one database.5
Before selecting a drug rehab center, you should verify your coverage. Contact BCBS by calling the number on the back of your insurance card or by visiting the BCBS website. You can also contact the drug rehab center directly. American Addiction Centers (AAC) will verify your BCBS insurance plan drug rehab coverage. You can visit their website or call 877-640-1943 and speak with an Admissions Navigator.
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:6
- 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. While it doesn’t require living at the treatment facility, it does require more frequent visits (at least 9 hours a week). IOPs also involve care from medical professionals including doctors, nurses, therapists, psychologists, and social workers.
- 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. It involves both individual and group counseling, and may also provide medication-assisted treatment to address withdrawal symptoms.
Does Blue Cross Blue Shield Insurance Cover Mental Health Care?
The Affordable Care Act requires that all insurance plans provide coverage for behavioral health services, including mental health and substance abuse issues.1 (third paragraph) This means that there must be some type of insurance coverage, whether you are looking for a heroin drug rehab facility or a treatment program that addresses a co-occurring disorder, which means that someone has mental health and substance issues that occur simultaneously.1 (third paragraph)Treatment that addresses both mental health and substance use disorders are not only beneficial, but are necessary for those who wish to address both the mental health issue and substance abuse issue simultaneously. This integrated treatment has been shown to help people stay sober, reduce hospitalizations, help people live independently, and provide stable employment for those who receive treatment for both issues.1 (Under “Benefits of integrated treatment”)
Many BCBS insurance plans cover individual therapy and other services for people with co-occurring disorders. Even with BCBS insurance plan mental health coverage, you or a loved one may have to pay some costs such as a copayment or the remaining balance of the plan’s deductible.
How Long Does Blue Cross Blue Shield Insurance Cover Rehab?
There is no specified period that BCBS insurance or any insurance will cover drug rehab services. This is because many factors determine coverage, such as the specific plan’s parameters, the drug rehab program chosen, and the person’s treatment needs. However, some study results have shown that people who remain in treatment for 3 months or longer are more likely to have positive treatment outcomes (i.e., abstinence from drugs and/or alcohol).7 (under #5)
To learn more about your BCBS coverage for drug rehab, call the number designated for mental health/substance abuse on the back of your BCBS insurance card or visit the BCBS website. You can also verify your coverage by contacting the drug rehab center directly. AAC can verify your Blue Cross Blue Shield coverage, too; visit their website or call 877-640-1943.
What if My Blue Cross Blue Shield Policy Does Not Cover Heroin or Alcohol Rehab?
If your BCBS policy does not cover heroin rehab or drug rehab, you can pay in cash or with a credit card. Some drug rehab centers also offer payment plans or scholarships if up-front payment in full is not possible. You or your loved one may also research nonprofits and grants available to assist with paying for drug rehab services.
Money should not keep you or a loved one from receiving immediate drug rehab treatment. Waiting could result in a more severe substance abuse issue, which may require longer or more costly treatments.
Blue Cross Blue Shield In-Network vs. Out-of-Network Rehab Centers
BCBS insurance is connected to a large network of providers. These providers are referred to as in-network. Providers outside of this network are out-of-network.
If you or a loved one has a BCBS HMO plan, you may be required to obtain a referral from your PCP to receive drug rehab services, and you must use drug rehabs that are only in-network.4 With a BCBS PPO plan, you may not need a referral, and you may use any in-network or out-of-network facility.5
To check if a drug rehab center is in-network, contact BCBS directly by calling the number designated for mental health/substance abuse on the back of your insurance card or visit the BCBS website. You can also contact the drug rehab center directly. Many, including AAC, can verify your drug rehab coverage.
Find Rehabs That Take Blue Cross Blue Shield
There are many different ways for you to check your or a loved ones’ BCBS benefits. You can refer to your BCBS insurance paperwork you received when you enrolled in your insurance plan. You can also visit their website or contact them directly by calling the number on the back of your BCBS insurance card.
AAC can also verify your BCBS substance abuse treatment coverage. AAC offers several ways to find out what type of substance abuse treatment coverage you have through BCBS. You can visit their website and complete the online insurance verification form. Or call them at 877-640-1943 and speak with an admissions navigator.
Let’s verify your coverage for treatment at an American Addiction Centers location. Your information is always confidential.
- American Addiction Centers Treatment Solutions. (2021). Does Blue Cross Cover Drug and Alcohol Rehab Insurance?
- Blue Cross Blue Shield. (2021). BCBS Companies and Licensees.
- Blue Cross Blue Shield. (2021). What’s the difference between bronze, silver, and gold plans?
- Blue Cross Blue Shield Blue Care Network of Michigan. (2021). What’s the difference between HMO and PPO plans?
- Blue Cross Blue Shield: Substance Use Resource Center. Supporting Your Journey to Recovery.
- John Hopkins Medicine. Center for Substance Abuse Treatment and Research. Treatment Settings.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).