A Guide to ‌‌Blue Cross Blue Shield of Texas Opioid Addiction Rehab Coverage

BCBS of Texas: What Kind of Insurance Coverage Does It Offer for Opioid Rehab?

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Opioid rehab and substance abuse in general fall under the category of behavioral health services. As one of the essential health benefits this category also includes mental health disorders that often accompany substance abuse. State and federal laws require all commercial, state-regulated health plans to provide treatment for mental health and substance use disorder conditions. This includes the Blue Cross Blue Shield of Texas, as one of the major health insurance providers in the U.S.1, 2

According to data collected through the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS), Texas consistently ranked among the top 10 states regarding the total number of rehab facilities. Included facilities (431 in total) reported treating 35,474 clients for some type of substance abuse.3 According to National Institute on Drug Abuse (NIDA), there were 1,402 opioid-involved overdose deaths in 2018.4

Since BCBS of Texas is in-network with a large number of primary care physicians, specialists, hospitals, and other healthcare providers, it’s easy to find a local substance abuse treatment facility that can provide necessary services to its members. The Blue Cross Blue Shield of Texas coverage and benefits will, however, depend on the type of health plan you have.5

BCBS of Texas health insurance coverage for opioid rehab

What Opioid Rehab Services Does BCBS of Texas Insurance Cover?

Blue Cross Blue Shield of Texas offers a variety of health plans. Their prices and coverage levels vary, but all of them offer essential health benefits, including behavioral health services, substance abuse, and mental health disorder treatment. However, the treatment must be appropriate, medically necessary, evidence-based, and FDA-approved.2, 6

If the above conditions are met, BCBS of Texas typically covers:2

  • Evaluation and screenings to determine the severity of a substance abuse disorder, as well as any potential mental or physical health issues, as well as interventions addressing those issues.
  • Medically supervised detoxification, including pharmacotherapy to help with unpleasant, and sometimes even life-threatening opioid withdrawal symptoms.
  • Inpatient or residential treatment, both short-term and long-term, as necessary.
  • Flexible outpatient programs for opioid addiction treatment, as well as intensive outpatient treatment.
  • Behavioral therapies that usually involve individual psychotherapy sessions. Cognitive-behavioral therapy (CBT) and motivational interviewing are among the most commonly used ones.
  • Treatment for co-occurring disorders, as they can be both the underlying cause or a consequence of opioid abuse. SUDs and co-occurring mental or physical health issues need to be addressed simultaneously if diagnosed during the assessment.

Are There Some Aspects of Opioid Rehab BCBS of Texas Isn’t Likely to Cover?

Effective substance abuse treatment is individualized and tailored to each patient’s needs according to factors like their background, lifestyle, belief system, homelife, or support system, as well as many other personal characteristics.7

The type of treatment that might be best suited and most effective for a certain patient may involve approaches and services that are not considered medically necessary or scientifically proven. If this is the case, some parts of the treatment might have to be paid for by the patient.7

Some of those services can include:7

  • Various types of non-medical amenities that may include high-end accommodation, swimming pools, spas, saunas, or gyms.
  • Holistic approach activities and services like yoga, meditation, mindfulness exercises, or tai chi.
  • Recreation programs like pilates or nature and wilderness therapy.
  • Special food requirements, particular diet preferences, food delivery, professional chefs.
  • Private treatment services like massages, or personal training.
  • Alternative therapies that might include acupuncture, hypnosis, energy healing (reiki), or Chinese herbal therapy.

Opioid Rehab: What Determines the Cost?

The cost of opioid rehab can vary significantly depending on several factors. The most important one is the type of insurance plan you have and the coverage it provides. BCBS of Texas offers 8 Bronze, 7 Silver, and 5 Gold plans. They all vary by cost and coverage they provide. This is why Blue Cross Blue Shield of Texas may cover different percentages of your addiction treatment cost.8

The most important factors that are likely to influence the cost of opioid rehab include:9

  • The number and type of services included in your Blue Cross Blue Shield of Texas covered drug treatment program.
  • The intensity of provided services, regardless of the setting (inpatient or outpatient)
  • The duration of treatment which can be either long-term or short-term, and may involve a period of aftercare services.
  • The type of amenities a specific treatment center offers. Luxury ones with a wide selection of amenities are naturally more expensive.

If you go to a healthcare provider that doesn’t have a contract with BCBS of Texas, you will probably have to pay for the received treatment completely or partially. Out-of-network coverage will also depend on the type of health plan you have. Some services might not be covered at all, while others may be covered at a lower level.5

Inpatient Opioid Rehab: How Much Does It Cost?

Undrgoing treatment at an inpatient or residential facility means that the patient lives at the facility until they complete the rehabilitation program. The length of stay will determine the price of treatment. Inpatient treatment programs can significantly vary in length, depending on the severity of addiction and other factors like potential co-occurring mental health issues. Inpatient treatment can be short-term or long-term.9

Individuals with less severe addiction enroll in short-term treatment programs that usually last up to a month and begin with a period of medically monitored detoxification process that lasts up to a week. Long-term treatment programs can last 60 days, but sometimes 90 days of rehab are more effective for achieving lasting recovery. In most severe cases, particularly in the case of dual diagnosis and the need to treat mental health disorders simultaneously with opioid addiction, treatment may last for 6 months up to a year.10

Outpatient Opioid Rehab: How Much Does It Cost?

Even though outpatient treatment doesn’t require the patient to live at the facility, the duration and intensity of the program can vary significantly, as well as the number of services. These factors will determine the cost of treatment.11

Depending on each patient’s program, outpatient treatment may require daily visits to the facility while some patients may only attend meetings a few times per week. Outpatient programs can last a couple of months up to a year.11

Partial Hospitalization Programs (PHP): How Much Do They Cost?

Partial hospitalization treatment is a more intensive form of outpatient treatment. The patient doesn’t live at the treatment facility but they do spend significantly more time there. It also involves a higher level of care and more services.10

This type of treatment is generally appropriate for those patients whose withdrawal symptoms are mild to moderate. They also go through a psychosocial evaluation as well as any necessary medical intervention to achieve stabilization.10

Medication-Assisted Treatment (MAT): How Much Does It Cost?

Medication-assisted treatment (also called “maintenance treatment”) is an effective option for treating opioid addiction in some individuals. Treatment can also include psychosocial counseling, or co-occurring disorder treatment, if necessary.12

The cost of this type of treatment will depend on its duration as well as the tier of prescribed medication. Blue Cross Blue Shield of Texas drug coverage will depend on your plan and the tier a specific drug belongs to. You might need to pay a set amount out-of-pocket or a determined percentage of the medication cost.6

Pharmacotherapy used for opioid addiction usually involves methadone, buprenorphine, or naltrexone. This type of treatment is offered in 21.1% of TX outpatient rehab facilities. Buprenorphine with naloxone (Suboxone) is the most commonly used one, and it’s available in 23.4% of TX rehab facilities.3

Cost Comparison: Opioid Rehab vs. Opioid Addiction

A lot of people that suffer from opioid addiction, or any other type of substance abuse issues, don’t even attempt to get help. Several reasons deter afflicted individuals from seeking out treatment options. Aside from the stigma that is usually associated with addiction or the skepticism about the effectiveness of treatment, the most influential one is the seemingly high cost of rehab treatment.13, 14

However, the cost of active addiction is several times higher than the cost of treatment, for both the addicted individual and the society. The costs and loss of income that addiction produces result from:13, 15

  • Substance abuse itself, i.e. the cost of drugs someone is addicted to.
  • Lost income due to diminished work productivity, or losing a job.
  • Cost of various health problems and mental health issues that prolonged opioid use can cause.
  • Cost of emergency room visits and stays at a hospital in case of overdose.
  • Costs related to arrests for misdemeanors, or other criminal activity.

What Length of Opioid and Other Drug Rehab Does BCBS of Texas Cover?

The length of treatment is determined by a team of addiction experts. Since each person has different needs, personality traits, and most importantly, the severity of addiction, effective, high-quality treatment needs to be tailored according to those factors.10

Even though highly effective longer treatment programs raise your chances of achieving lasting recovery and result in fewer relapses, the Blue Cross Blue Shield of Texas will cover the duration of treatment according to the medical necessity and the type of your healthcare plan and tiers of coverage. This means that the type of treatment that might be most effective for you won’t be completely covered, and you might have to pay for some of the services out-of-pocket. If this is the case you can explore different payment options.2, 10

To find out what kind of rehab coverage and benefits your specific healthcare plan provides, contact Blue Cross Blue Shield of Texas to get the most accurate information about your plan, or read your insurance contract. This way you can make an informed decision about the type of facility and treatment you should choose.

Should I Go With Inpatient or Outpatient Treatment for Opioid Addiction?

Even though your healthcare is ultimately your choice, deciding between an inpatient or outpatient drug rehab program is something you should get professional advice on. A team of addiction experts and your primary care physician need to perform an assessment to determine the severity of your addiction and evaluate you for potential co-occurring mental health disorders that often accompany all types of substance abuse conditions.16

However, when it comes to your preferences, there are several factors that you should consider when deciding between inpatient and outpatient rehab:10, 11, 16

  • The quality of care is best determined by looking for licensing by federal, state, or local agencies. The Joint Commission and CARF accreditations are a sign of high-quality substance abuse providers.
  • A specific treatment ecosystem is created in a stable and structured inpatient setting, as well as fellowship among patients going through a similar experience.
  • Support groups are an important part of every treatment, both inpatient and outpatient, as they provide a sense of community and mutual understanding among patients. Family and marital counseling sessions are also helpful, as well as 12-step facilitation offered by many rehab centers.
  • A more focused environment is achieved through individual and group counseling and psychotherapy. Special activities help patients commit fully to recovery. Most facilities have characteristic rules and expectations for patients and their families to help them get the most out of treatment.
  • Accountability for personal choices and commitment to treatment ultimately depends on each individual but an inpatient environment can help patients stay on track and avoid potential triggers, or enabling environment and people.

How to Use BCBS of Texas Insurance for Opioid Rehab?

The process of finding an appropriate rehab facility that will be covered by the insurance plan you have begins with your primary health physician (PCP). So first of all, make sure to go to a doctor who is in-network with BCBS of Texas and follow their advice. The whole process consists of several steps:2, 5

  • Consulting your doctor for an evaluation and referral to an addiction specialist, or a mental health specialist in case of co-occurring disorders.
  • Finding a suitable addiction treatment program and facility. You can do your own research or get a suggestion from your PCP. It is also a good idea to contact BCBS of Texas so they can recommend in-network rehabilitation centers that they can provide maximum substance abuse treatment coverage for.
  • Determining if your insurance will cover the necessary treatment. In some cases, you or your doctor might need to get approval from BCBS of Texas before you can start your addiction treatment or be admitted into a substance abuse treatment center.
  • A collaboration between your chosen substance abuse treatment provider and BCBS of Texas to determine coverage for the appropriate recovery program.

What Facilities Accept Coverage From BCBS of Texas Insurance?

Since Blue Cross Blue Shield of Texas works with a wide selection of primary care physicians, specialists, hospitals, labs, and other facilities, finding an in-network opioid rehab center shouldn’t be difficult. You can call the BCBS of Texas helpline for guidance.

One of the top-rated substance abuse treatment providers that are in-network with BCBS of Texas is the American Addiction Centers (AAC). This is a nationwide network of advanced rehab facilities that can offer a full continuum of care for diverse addiction issues including dual diagnosis patients.

You can verify your insurance by reaching out to the AAC. Call the AAC hotline and speak to one of the admission navigators who can check your coverage while you’re on the phone and explain payment options in case your insurance doesn’t cover the full cost of treatment. You can also submit an online form on the AAC website to verify your benefits.

Admission navigators can answer any questions about intake and evaluation, explain all the steps of the admission process and treatment, and provide you with general information about opioid addiction treatment. They can also help you with same-day admission if you’re experiencing an acute crisis and feel you need to start with treatments right away. You should also know that 49.9% of TX rehab facilities offer interim services when immediate admission is not possible.3

Even though AAC has leading treatment centers across the U.S., most people prefer staying close to home. One of the best local treatment facilities in Texas is a Greenhouse Treatment Center. This luxury facility provides a full continuum of care and specialized programs, specifically tailored to each patient’s needs.

Additional Options and Services

Certain population groups may prefer programs adjusted to specific demographic groups. Some of those options, available at AAC rehab facilities, include:

General Guidance About Opioid Abuse and Treatment Options

A lot of people might not feel ready to open up to their doctors or are unsure about the severity of their addiction. This is why free, 24-hour opioid addiction hotlines are available for any information you might need. Compassionate and trained helpline advisors can evaluate your situation and give you accurate information about heroin use and addiction, and explain your options regarding health insurance coverage for rehab. They can also recommend the next steps you should consider and refer you to local rehab centers.17

 

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