Paying for Inpatient Alcohol and Drug Rehab Centers With Blue Shield of California

Does Blue Shield of CA Cover Alcohol and Drug Rehab Centers in California?

About 19.4% of people in the U.S. have used illicit drugs at least once in their lifetime. If alcohol and tobacco are considered, this number goes up to 60.2% of US citizens older than 12. This leads to approximately 70,000 drug-related overdose deaths each year. In 2018, almost 19 million people aged 12 or older required treatment for their substance use disorder (SUD). However, less than 2% of people actually receive it.1

Out of those who wanted to get treatment but didn’t, most have listed lack of funds as the main reason why they never received therapy. Fortunately, most insurance providers, such as Medicaid, offer treatment for those struggling with SUD.2 

While about 21.3% of individuals who wanted to get treatment in 2011 had Medicaid insurance, 10.5% of individuals opted for private insurance, including a Blue Shield insurance policy.2

According to US law, all health insurance providers have to provide coverage for mental health and SUD treatment the same way as they would for any medical condition.3 As such, if you wondered whether Blue Shield insurance covers drug rehab in California, the answer is affirmative. 

To learn more about Blue Shield coverage in California insurance, you can get in touch with the rehab center you’re interested in and see whether they’re in-network and whether you’re covered. Another option is to call your insurance company for more info about your specific plan.4  In general, 56% of facilities in California accept private insurance, including Blue Shield, so you’ll likely be able to find a treatment center for you.5 

What Is Blue Shield of California? 

Blue Shield of California insurance is a non-profit health plan that is an independent member of the Blue Shield Association. It’s an affordable option for Californians to get access to the care they otherwise wouldn’t be able to pay for. 

Blue Shield was founded in 1939, and the California Medical Association House of Delegates voted for it. By 1940, more than 20,000 Californian residents have already signed up for the plan. The company became a co-founder of the National Association of Blue Shields Plans 6 years later, which was later renamed the Blue Shield Association and Blue Cross. 

By 1961, Blue Shield insurance already had more than a million subscribers. In the late 1980s, Blue Shield HMO was established in Sacramento, which helped the company join the health maintenance organization business. It was also the first health plan in CA that offered online benefits and connected members and doctors via the internet. 

Today, you can get Blue Shield California insurance coverage from 22 locations around the state, with the main headquarter being in Oakland. It has more than 4.5 million members and around 7,500 employees. Blue Shield California insurance healthcare plans include services such as: 

• Offering a possibility to talk to a registered nurse 24/7.
• A chance to get connected with a variety of doctors regarding numerous conditions. 
• Offering plans for individuals of different budgets.
• Access to professional medical advice from almost any location in the world.
• Various discount programs.
• Mental health and substance abuse treatment.

Types of Addiction Treatment covered by Blue Shield of California

There are several drug treatment programs in California that fall under the scope of Blue Shield California insurance coverage, as the company has a written agreement with the Mental Health Services Administration (MHSA). All require treatment to be medically necessary to be covered, so you’ll need to speak to a health professional who can confirm that you or your loved one are indeed struggling with SUD. If you’re eligible, you can get treatment at one of Blue Shield California substance abuse treatment facilities.

Some of the costs that are entirely or partially covered include the expenses of:

• Inpatient or residential rehab in California.
• Outpatient rehab therapy that helps people with mild SUD.
• Intensive outpatient programs (IOP).
• Partial hospitalization programs (PHP).
• Detox programs in California hospitals or treatment centers.

Does Blue Shield of California Cover Mental Health & Co-Occurring Disorder Treatment? 

It’s rather common for people with SUD to also struggle with co-occurring mental health disorders. In fact, about 9.2 million adults in the U.S. have not just SUD but also some co-occurring disorder. Most of these people get medication-assisted treatment (MAT).6

According to The Mental Health Parity and Addiction Equity Act (MHPAEA), insurance providers are required to provide coverage for not just substance abuse, but also mental health care and treatment. As such, both stand-alone drug rehab and treatment for co-occurring disorders fall under this mandate.3

This means that Blue Shield insurance substance abuse coverage is the same as coverage for Blue Shield California mental health and for any other medical hospital services. 

Does Blue Shield of California Insurance Cover Addiction Treatment Therapy? 

While the exact coverage amount entirely depends on your plan, most of the time Blue Shield of California insurance covers different types of addiction treatment therapy due to the regulations set by MHPAEA.3

As such, coinsurance and copayment amounts for treatment of addiction and co-occurring disorders are the same as coinsurance and copayment for any traditional medical expense. For example, if you need to get treatment at one of the Blue Shield inpatient drug rehab centers in California, you will copay the same amount as if you were going to get inpatient hospital care for a medical emergency. 

How Long Does Blue Shield of California Cover Inpatient Alcohol and Drug Rehab programs?

SUD is a relapsing disorder that can make an individual struggle even long after they have stopped using drugs. This is why effective treatment has to adhere to the individual’s needs. This also includes the length of the treatment.7 

For the treatment to be effective, it’s essential to stay in rehab for an adequate time frame. While there isn’t an appropriate treatment duration that will work for everyone, longer treatment options are usually more effective, no matter the individual needs of the patient. There are indications that at least 3 months of treatment are required to help individuals significantly reduce their substance abuse. Longer treatment times are even more successful.7

As there are various types of policies, as well as numerous types and lengths of rehab, the duration of your Blue Shield California insurance rehab coverage will depend on your specific plan. To get more information, you can call the number on your insurance card and see how long your Blue Shield rehab coverage can last.

What if my Blue Shield of California Insurance Does Not Cover an Inpatient Rehab Program?

If you choose to get treatment at a residential facility that isn’t a licensed Blue Shield inpatient drug rehab in California, you can still get the required care. Even if you don’t have Blue Shield California insurance coverage for substance abuse treatment, there are several other payment options that you might be eligible for.3

Depending on the inpatient rehab center of your choice, you might be eligible for some financing or scholarship options. The facility might agree upon a sliding scale, or you might get some payment assistance.3 If we look at 1,311 treatment facilities in California, here are the payment options available for those without insurance:5

• 85.5% of facilities accept cash or self-payment.
• 4.2% accept Access to Recovery (ATR) vouchers.
• 10.5% can be paid with IHS/Tribal/Urban Funds. 
• 61.2% will agree on a sliding fee scale depending on your income.
• 46.6 offer free treatment for those who cannot afford to pay.

As addiction is a disease that affects brain function, it’s important to start treatment right away. It’s critical to enter rehab as soon as possible to ensure a successful recovery. If you push it down the road, the treatment might end up being more extensive and, as such, much more costly.3,5

Blue Shield of California In-Network vs. Out-of-Network Inpatient Rehab Centers

When looking at Blue Shield California insurance drug treatment programs some providers are listed as in-network, while others are out of network. Those terms might confuse people who are not familiar with how insurance coverage works. 

In-network treatment providers have a contract with the insurance company. They offer medical care to people who are enrolled in Blue Shield rehab coverage plans. They’re also known as network providers or participating providers. Providers who aren’t participating in Blue Shield California programs are known as out-of-network. 

The biggest difference between the two is the cost and whether your insurance plan offers out-of-network coverage. Most of the time, out-of-network inpatient drug rehabs in California don’t accept the approved coverage amount in-network Blue Shield rehab centers do. This means you’ll be the one responsible for paying the difference between your plan’s approved amount and the provider’s full charge. This process is known as balance billing.

To find out whether the desired rehab facility is in-network or out-of-network, you can call the Blue Shield California helpline and check this information with them.

How To Check Blue Shield of California Insurance Coverage for Alcohol and Drug Rehab?

There are several ways you can check whether you’re eligible to go to some of the in-network Blue Shield California Insurance rehabilitation centers. Calling their hotline is one of the first steps you can take. If the number isn’t accessible to you, or if you’d like to see what other benefits you have, you can also contact an American Addiction Centers helpline. There, you’ll get a chance to speak with an admission navigator who will verify your insurance and check what other payment options you might be eligible for.  

In California, there are more than 700 rehabs that accept private health insurance. Most of them are in-network with Blue Shield insurance.5 As Blue Shield of California has more than 4.5 million members, many people have their policy coverage for SUD treatment.

One of the treatment centers in California that might accept Blue Shield of California is Laguna Treatment Center.

Laguna Treatment Center

Laguna Treatment Center is a treatment facility located in Orange County, CA. In fact, it’s the first chemical dependency recovery hospital in the area. It focuses on treating people who require 24/7 care due to their medical condition and provides them with both MAT and various behavioral therapies. 

Some of the services Laguna Treatment Center provides are:

• Detoxification in the professional environment and help with withdrawal management. 
• Residential treatment with proper medication. 
• Aftercare planning and providing individuals with resources they might need to stay sober.

If you’re looking for an advanced Blue Shield California insurance drug treatment, this is certainly a facility you should consider.

What Rehab Centers Take Blue Shield of California Insurance?

American Addiction Centers (AAC) has various rehab facilities around the country that provide drug and alcohol addiction treatment. If you have a Blue Shield of California insurance plan, the following AAC facilities accept Blue Shield of California insurance for drug and alcohol addiction rehab.

• AdCare Rhode Island: With various facilities located in Rhode Island, AdCare provides innovative, quality, and cost-efficient addiction treatment. Its integrated system of care offers an inpatient treatment center in North Kingstown and a network of outpatient offices throughout Rhode Island. AdCare’s continuum of care includes detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, inpatient and outpatient services, and tele-health.
• Desert Hope Treatment Center: Located in Las Vegas, Nevada, Desert Hope provides individualized care programs as well as offering a full continuum of care including detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, and tele-health.
• Greenhouse Treatment Center: Located in Grand Prairie, Texas, Greenhouse offers individualized treatment plans and many levels of care including detox services, residential treatment, dual-diagnosis treatment, intensive outpatient services, outpatient services, and tele-health, all in a luxurious setting with high-end amenities.
• Laguna Treatment Center: Located in Orange County, California, Laguna is a chemical dependency recovery hospital that focuses on treating people who are medically compromised and need 24/7 oversight. Provided care includes detox services, residential treatment, dual-diagnosis treatment inpatient treatment, and intensive outpatient services.
• Oxford Treatment Center: Located in Etta, Mississippi, Oxford offers gender-specific rehab while offering an opportunity to connect with nature and try new activities. Provided care includes detox, residential treatment, dual-diagnosis treatment, inpatient and outpatient treatment, intensive outpatient services, and tele-health, all with individualized treatment programs.
• River Oaks Treatment Center: Located in Riverview, Florida, River Oaks treats substance use disorders through combining evidence-based therapies with world-class amenities. Provided care includes detox, residential treatment, behavioral disorder treatment, dual-diagnosis treatment, outpatient services, and tele-health, all with individualized treatment programs.
• Sunrise House Treatment Center: Located in Lafayette Township, New Jersey, Sunrise House provides treatment for people suffering from substance abuse from a medical and holistic standpoint. With various evidence-based therapeutic interventions, personalized care is provided through detox, residential treatment, dual-diagnosis treatment, and outpatient services.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are rehabs near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by Blue Shield of California insurance.

Frequently Asked Questions