Does BCBS of Texas Insurance Include Alcohol Rehab in Its Coverage?

Blue Cross Blue Shield of Texas is a state-regulated health insurance provider and therefore required by law to provide coverage for behavioral healthcare. This includes substance abuse and mental health disorders. This means that alcohol abuse treatment is covered by the BCBS of Texas when determined to be appropriate, medically necessary, and when it involves evidence-based approaches and FDA-approved pharmacotherapy.¹

BCBS of Texas is in-network with a wide selection of healthcare providers and medical facilities.² This is particularly important for the state of Texas since statistics show that more than 7.000 annual deaths are caused by excessive alcohol use, while as many as 52.3% of deaths are the result of chronic conditions that result from alcohol addiction.³

The National Survey of Substance Abuse Treatment Services (N-SSATS) from 2017 found that when it comes to the total number of substance abuse treatment facilities Texas consistently ranked within the top ten. This survey included data from 431 TX rehab centers that reported having 35,474 clients in treatment for some form of substance abuse.⁴

What Kind of Coverage Does BCBS of Texas Insurance Provide for Alcohol Treatment?

BCBS of Texas offers a variety of healthcare insurance plans. All of them cover essential health benefits and services, so alcohol abuse is covered as part of behavioral health care. Hospitalization, lab services, and prescription drugs are also covered. Coverage is also provided for behavioral and mental health, as well as all forms of substance abuse.²

BCBS of Texas has contracts with a wide selection of hospitals, doctors, specialists, and other healthcare professionals. Those are in-network providers that deliver services to members based on their insurance coverage.⁵

In general, most plans will help you pay for behavioral health services:¹

• Evaluation, interventions, as well as screening for alcohol or drug abuse are available in 99.1% of Texas facilities, while 59.2% of facilities screen for mental health disorders.⁴
• Medically supervised detoxification from alcohol (with or without pharmacotherapy to mitigate the withdrawal symptoms) is offered in 76.5% of Texas facilities.⁴
• Inpatient or residential treatment including room and board.
• Outpatient therapy, as well as intensive outpatient treatment (if medically necessary), is provided to patients who can return home without the need for an overnight stay at the facility.⁵
• Behavioral therapies and treatment for co-occurring disorders are also covered since mental health issues commonly go hand in hand with alcohol or drug abuse. 44.5% of Texas patients get diagnosed with co-occurring mental and substance abuse disorders.⁴

What Parts of Alcohol Addiction Treatment Aren’t Usually Covered by BCBS of Texas?

Quality substance abuse treatment, alcohol addiction treatment included, is usually tailored to the individual characteristics of each patient. Everybody has unique needs, backgrounds, lifestyles, or belief systems. This is why some elements or services included in a personalized treatment program might be highly beneficial to certain patients but not covered by insurance as they’re not considered medically necessary or evidence-based.⁶

Some of those services include:⁶

• All types of non-medical amenities, luxury accommodation, swimming pools, spas, saunas, or gyms.
• Holistic care approaches and services like yoga, meditation, or tai chi.
• Recreation programs like pilates or nature activities and wilderness therapy.
• Nutrition counseling, food delivery, particular diet requirements, professional chefs.
• Private treatment services, personal training, or massage.
• Alternative therapies like hypnosis, acupuncture, energy healing, mind/body techniques, or Chinese herbal therapy.

The cost of these services can be covered by alternative payment options. Cash or self-payment is accepted in 90.3% of Texas rehab centers, while 49% of them offer a sliding fee scale. Completely free treatment for patients without the financial means to pay for rehab is provided at 47.8% of substance abuse treatment facilities in Texas.⁴

Additionally, BCBS of Texas may not cover the cost of services provided out of network. If you go to a doctor or other healthcare provider that doesn’t have a contract with BCBS of Texas you’d have to pay for either part of the cost or all of it. Out-of-network coverage depends on your health plan so some services may not be covered at all, or might be covered at a lower level. ⁵

How Much Does Treatment for Addiction to Alcohol Cost?

The cost of alcohol rehab will depend on numerous factors. Not everybody’s addiction is equally severe, and people come from diverse backgrounds and have different personality traits, so the treatment must be tailored accordingly. These variations also result in different prices of treatment.^{7, 8}

The main factors that determine the cost of alcohol rehab are:⁷

• The number end type of offered services.
• The intensity of services in all types of settings.
• Duration of treatment, whether it’s an inpatient/residential or outpatient program.
• The type of amenities that specific rehab centers offer, as some high-end, luxury ones, aren’t usually covered by health insurance plans.

Possible Costs Associated With Inpatient Rehab

If the team of healthcare professionals determines that an inpatient alcohol treatment program (also called residential or live-in rehab) is the most effective solution for you, this means that you will live at the facility for the duration of the treatment. The cost of this type of treatment will depend on the length of time you spend at the rehab facility, as well as all the services that your specific treatment program involves.⁶

Inpatient rehab programs can be short-term, in case of less severe addiction, or long-term, if one’s situation requires a longer, more thorough treatment. Patients with less severe forms of substance abuse usually complete short-term treatment programs that last for about a month and usually include up to a week of detoxification. Longer programs can last for 60 days, or 90 days if an even longer stay is needed. In most severe cases, usually ones accompanied by mental health disorders, treatment can last for 6 months up to a year.⁶

Inpatient treatment in a non-hospital setting is available in 25.1% of all Texas rehab facilities.⁴

Possible Costs Associated With Outpatient Rehab

Outpatient rehab is usually recommended for patients with less severe or moderate forms of alcohol addiction. They attend treatment at the rehab facility but live at home. The cost of this type of therapy will depend on the number of provided services and hours of treatment at the rehab center.⁶

Intensive outpatient rehab is also an option, in case of more severe addiction, if a patient can’t take the time off from professional or personal responsibilities. This type of outpatient treatment is inherently more costly.⁶

In the state of Texas, 84% of rehab facilities offer outpatient programs, while intensive outpatient care is offered in 53.8% of all TX rehab centers.⁴

Possible Costs Associated With Partial Hospitalization Programs (PHP)

Partial hospitalization programs don’t require that the patient lives at the rehab facility, but they do involve more hours spent at the rehab center in comparison to outpatient programs. They usually last for a couple of months and involve a minimum of 20 hours of treatment services per week. The cost will depend on the number of hours of therapy, other included services, and the duration of treatment.¹⁸

Possible Costs Associated With Medication-Assisted Treatment (MAT)

Since all BCBS of Texas healthcare plans offer prescription drug coverage, the price of this type of treatment will depend on the tier of the prescribed medication, and the benefits your insurance plan provides. Drugs in a lower tier will cost less than drugs in a higher tier.⁵ Depending on these factors you might have to pay a set amount (copay) out of pocket, or cover a determined percentage of your medication cost.²

The duration of treatment also influences the overall cost, and from time to time your progress will be evaluated by your primary care physician and addiction specialists. In collaboration with the insurance provider, it will be determined if it’s necessary to continue with treatment.⁹

Drug coverage also requires that the prescribed medication be FDA-approved. Currently, three drugs are used for alcohol addiction. The most common one is naltrexone in oral tablet form.¹⁰ This medication is offered as pharmacotherapy in 18.6% of Texas rehab facilities.⁴

The Cost of Rehab in Comparison to the Cost of Alcohol Addiction

The main factor that deters people from getting the help they need is the cost of addiction treatment. According to the National Survey on Drug Use and Health (NSDUH) from 2019, only 7.3% of people over the age of 18 who were diagnosed with alcohol abuse disorder during the past year received any kind of treatment.¹¹

While the cost of rehab may seem cost-prohibitive to a lot of people, it’s important to take into consideration the cost of active addiction, which is much higher, for both the individual and the society. Aside from the cost of alcohol itself, there are other costs and losses to be mindful of.^{12, 13, 14}

Excessive drinking leads to diminished productivity losses, health care expenses, and various criminal justice expenses, usually involving motor vehicle crash costs or property damage.¹⁵ Alcohol-related emergency department visits are also quite common.¹⁶

People suffering from alcohol addiction are more likely to require care for a wide range of medical issues arising from alcohol abuse and leading to various chronic conditions. The most common causes of alcohol-attributable deaths are liver disease and cirrhosis, heart disease and stroke, various forms of cancer, heart problems, and high blood pressure. The risk of injuries is also significantly increased while intoxicated – falls, drownings, car crashes, and injuries resulting from violence.¹⁶

Alcohol addiction also leads to negative effects on families and children of addicted individuals. Direct effects of alcohol abuse may lead to parental abuse or neglect. However, there are also significant long-term consequences since children of parents suffering from any form of addiction are more likely to have lower socioeconomic status and difficulties in school and/or social settings.¹⁷

What Length of Alcohol Rehab Is Covered by BCBS of Texas?

The length of rehab coverage provided by the Blue Cross Blue Shield of Texas will depend on the type of insurance plan you have. Any duration of treatment, in any licensed setting, can be covered if it’s determined to be appropriate and medically necessary for the specific case.¹

Even though longer treatment times have proven to be more effective when it comes to achieving lasting recovery and reducing the risk of relapse, the medical necessity criterion is what determines the coverage you will get from your health insurance since there are many different types of policies and tiers of coverage.¹⁸

However, since every patient’s needs are different, the most effective treatment program for you might involve approaches and services that are not covered by your health plan. If this is the case, there are alternative financing options for the costs that are not covered.^{7, 18}

To determine the scope of insurance coverage your health plan provides, contact the BCBS of Texas helpline, or check your insurance contract.

BCBS of Texas-Covered Inpatient or Outpatient Alcohol or Drug Rehab Facilities: How to Choose?

This decision should be made according to the professional recommendation of substance abuse specialists. However, there are cases when the most efficient treatment programs in Texas might not be entirely covered by your insurance. If this happens you can explore alternative payment options and still get the best possible care.⁶

Long-term inpatient treatment generally results in longer-lasting sobriety and a lower relapse rate. This is achieved through:¹⁸

• A high-quality level of care. Look for treatment centers that are licensed by federal, state, or local agencies. 95.8% of Texas rehab facilities have some form of accreditation. The Joint Commission and CARF accreditations are also a sign of high-quality treatment.⁴
• The intensive treatment ecosystem of inpatient programs engages patients in activities that help them focus on recovery and get to the underlying cause of addiction.
• Support groups that are available in both outpatient and inpatient programs. There are also family and marital counseling sessions, and 12-step facilitation.
• A specifically focused environment involving therapy approaches like cognitive-behavioral therapy (CBT), is available in 94% of TX facilities, while 91.9% offer motivational interviewing.⁴
• Accountability for personal choices and adherence to the recovery program is personal and different for each patient. Some patients need the structured setting of an inpatient program to be able to resist temptation, and avoid triggers and the enabling environment they may come from, so they can stick to their recovery program.

BCBS of Texas: How to Use Your Insurance for Alcohol Rehab?

After realizing that your alcohol abuse issues need to be addressed by a specialist, the process of initiating alcohol addiction recovery usually involves these steps:^1,5

• Consult your primary care physician (PCP). They will coordinate your care, and refer you to appropriate specialists. Some health plans don’t require a referral from your PCP.⁵
• Finding an appropriate rehab program. You can do your research on top-rated rehab facilities in Texas or ask your PCP for a recommendation. BCBS of Texas can recommend a substance abuse treatment facility or program they can provide maximum rehab coverage for.
• To determine the ability to use the insurance you might have to go through preauthorization. This means that you or your doctor need to get approval from the insurance provider before starting a treatment or being admitted to an inpatient facility.⁵
• The rehab facility you end up choosing will collaborate with BCBS of Texas to determine the coverage you’re eligible for.

How to Find Alcohol Rehab Facilities That Will Accept BCBS of Texas Insurance

Finding an appropriate rehab center near you shouldn’t be a challenging task since Texas is one of the states with the largest number of substance abuse facilities. Alcohol abuse is treated in 66.6% of TX facilities, while 65.4% treat clients battling both alcohol and drug addiction. Since addiction issues often co-occur with mental health issues, 89.4% of TX facilities treat clients with diagnosed co-occurring mental and substance abuse disorders.⁴

One of the most highly rated substance abuse providers that are in-network with Blue Cross Blue Shield is the American Addiction Centers (AAC), a nationwide network of top-notch rehab facilities. To find out if your insurance covers treatment at one of the AAC facilities you can call the AAC helpline and speak to one of the admission navigators who can check your benefits during the call, and guide you through the payment options. You can also submit an online verification of benefits form to check if your insurance provider is in-network with AAC.

AAC admission navigators can explain what to expect when you arrive at the rehab center. They can also answer any questions about the intake process and evaluation, or help you with the same-day admission if you feel you need to start the treatment as soon as possible.

AAC offers a wide selection of evidence-based treatment options, approaches, and services. A full continuum of care is available in the Greenhouse Treatment Center, one of the leading rehab facilities in Texas which offers personally tailored treatment programs in its luxurious setting with high-end amenities.

Additional Options and Special Programs

American Addiction Centers offer a wide variety of approaches and programs designed specifically for certain population groups, such as:

• Faith-based treatment approaches for Christians.
• Luxury amenities that help with stress relief so patients can focus on recovery.
• Rehab programs for couples who are battling addiction together.
• Gender-specific treatment programs for women.
• Flexible schedule executive programs for professionals.
• Weekend rehab as a form of aftercare.

Getting Guidance About Alcohol Addiction

If you’re still unsure about the severity of your addiction and don’t feel ready for a visit to your PCP or for enrolling in a rehab program, there are free and confidential addiction hotlinees in Texas you can call to get accurate information about alcohol addiction in general, or advice about helping a loved one. Experienced alcohol addiction helpline advisors can assess your situation and suggest appropriate next steps.