A Guide to Blue Shield of California Alcohol Addiction Rehab Insurance Coverage

Does Blue Shield of California Have Insurance Plans That Cover Alcohol Rehab?

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Blue Shield of California is a nonprofit health plan. It is an independent member of the Blue Shield Association, founded in San Francisco in 1939. BS of California provides healthcare coverage for its 4.5 million members through 22 locations across the state. It offers affordable healthcare as a part of the national Blue Network. Since about one-third of Americans have the Blue card, this enables them to have coverage across the U.S.1

Blue Shield of California healthcare plans include a wide range of mental health benefits. This means that you can get the necessary help for alcohol addiction and any potential accompanying mental health issues, like depression or anxiety.2

Under the requirements of the Affordable Care Act (ACA) the same level of coverage has to be provided for behavioral services as for other medical conditions. However, the exact coverage and benefits will depend on each patient’s plan. Blue Shield of California offers a range of HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans.3

BS of California offers healthcare plans for different budgets so members can choose the coverage and cost that fits their needs.3 Most plans provide comprehensive benefits and access to wide CA healthcare provider networks.2, 4

Blue Shield alcohol rehab coverage California

What Services of Alcohol Addiction Treatment Does Blue Shield of California Insurance Cover?

Blue Shield of CA provides different levels of insurance coverage for alcohol rehab and all the accompanying services if they are determined to be medically necessary, appropriate for the specific case, and evidence-based.5 The services that are included in all plans are:6, 7

  • Screenings and assessment for substance abuse, or any physical or mental health issues, as well as interventions and 24/7 registered nurse help.
  • Medically supervised detox programs with withdrawal management and nursing care, including medication to alleviate severe, or even life-threatening withdrawal symptoms.
  • Inpatient or residential treatment, including short-term and long-term programs.
  • Outpatient and intensive outpatient treatment programs.
  • Behavioral therapies, most commonly cognitive-behavioral therapy (CBT) or motivational interviewing (MI).
  • Treatment for co-occurring disorders since alcohol addiction, as well as other substance abuse disorders, are frequently accompanied by mental health issues, which need to be addressed concurrently to achieve effective treatment and lasting results.

What Elements of Alcohol Treatment Programs in California Blue Shield Doesn’t Cover?

Substance abuse treatment programs, alcohol addiction ones included, are designed to accommodate the specific needs of each individual. Since each patient is different, the most effective treatment in each particular case may involve approaches and services that don’t satisfy the medical necessity criterion. Even though they can be quite beneficial and effective for patients, some are not evidence-based or FDA-approved.8, 9

Elements and services that might not be covered by insurance include:8

  • Non-medical amenities, swimming pools, saunas, spas, gyms.
  • Holistic care services, yoga, mindfulness techniques, meditation, or tai chi.
  • Recreation programs or nature/wilderness therapy.
  • Particular diet requirements like organic meals or food delivery.
  • Private treatment services like massages, or personal training.
  • Alternative therapies like acupuncture, chiropractic services, hypnotherapy, or Chinese herbal medication.

What Does Alcohol Rehab Typically Cost?

The cost of your alcohol addiction treatment will primarily depend on the coverage your plan provides for the recovery program you need. Blue Shield of California offers addiction treatment coverage that varies depending on whether the patient has a health maintenance organization (HMO) plan or a preferred provider organization (PPO) plan.9

The HMO plans limit coverage to physicians and treatment centers located in a specific area, while PPO plans provide more flexibility and allow members to choose doctors and treatment centers that could be out-of-network. This type of plan is naturally more expensive.9

Other factors that influence the price of your alcohol addiction treatment include:10

  • Both the number and type of services that your Blue Shield of California covered rehab program includes.
  • The intensity of received services, regardless of the setting in which they’re provided (inpatient or outpatient).
  • The duration of treatment in both inpatient and outpatient programs can vary significantly in length.
  • The choice of amenities that a certain rehab center offers – high-end, luxurious ones are usually not included in most plans since they’re not considered to be medically necessary.

Alcohol Rehab: What’s the Cost of Inpatient Treatment?

The cost of inpatient rehab will primarily depend on the length of stay at the facility. Inpatient or residential programs can be short-term or long-term. Short-term stays last for about a month and include a detoxification process that usually lasts up to a week. Longer programs can last 60 days or in the case of a more comprehensive approach up to 90 days. More severe alcohol addiction may warrant an even longer stay of 6 months, up to a year, particularly when accompanied by co-occurring mental health disorders.11, 12

Alcohol Rehab: What’s the Cost of Outpatient Treatment?

Outpatient rehab programs don’t require living at the treatment facility. They involve a determined number of hours of therapy per week. This helps patients to adhere to the program and enables monitoring of their progress. In cases of more severe addiction, intensive outpatient programs are also available and naturally cost more.11

Alcohol Rehab: What’s the Cost of PHP?

Partial hospitalization programs (PHP) also don’t require live-in treatment but are more intensive than outpatient programs. They are sometimes called ‘day treatment’ programs and involve several hours of intensive treatment per day. They can last for a couple of months and usually start with 20 hours of treatment per week.13

Alcohol Rehab: What’s the Cost of MAT?

The cost of medication-assisted treatment (MAT) will depend on the type and tier of the prescribed medication. Blue Shield of California will only cover medication that is FDA approved. When it comes to alcohol addiction there are three medications in use, and the most prescribed one is naloxone in oral tablet form.14, 15

When it comes to drug coverage, Blue Shield of California has established a collaboration with Civica Rx to provide low-cost generic medications outside of the hospital setting.1 Since alcohol addiction is a chronic disease it’s important that the prescribed medications are taken regularly and studies show that high medication costs can lead to patients rationing their prescriptions.9

Cost of Treatment vs. the Cost of Alcohol Addiction

A significant percentage of people suffering from alcohol or drug addiction never get appropriate treatment for several reasons, the most common one being financial concerns. Rehab is often viewed as a cost-prohibitive luxury and many think that they couldn’t afford to pay for it.16

However, in comparison to rehab costs, the cost of active addiction is much higher for both the individual and society. The factors that make addiction more expensive in the long-term include:17, 18

  • The cost of active substance abuse, meaning the cost of alcohol itself.
  • Loss of income due to diminished work productivity, or neglecting work responsibilities that might lead to job loss.
  • Cost of treating various health problems that can arise from prolonged alcohol use.
  • Cost of alcohol-related criminal charges, DUIs, violence, crime.
  • Cost of ER visits for alcohol poisoning.
  • Various mental health issues, anxiety, depression, and even suicide.
  • Domestic violence, child endangerment or neglect.

What Length of Alcohol Rehab Do Blue Shield of California Policies Cover?

The length of alcohol abuse treatment is individually tailored to each patient’s needs. Blue Shield of California healthcare plans will cover the length of treatment that is determined to be appropriate and medically necessary for each case. The programs are designed by a team of substance abuse specialists in collaboration with your primary care physician, or other specialists in case of any physical or mental health issues.8

Sometimes the type of treatment program that may be the most beneficial for you might not be fully covered by your health plan, and you may have to decide to pay for the rest out-of-pocket. Longer treatments are more effective, as they produce longer-lasting results and lower the chance of relapse.8, 19

The best way to be sure what kind of insurance coverage your Blue Shield of California plan provides for alcohol rehab is to reach out to them by calling the Blue Shield of California helpline or by looking up information on their website or in your insurance contract.

Should I Use Blue Shield of California to Undergo Inpatient or Outpatient Alcohol Treatment?

This decision is a particularly important one and should be made according to the assessment and recommendation from both your primary care physician and a team of substance abuse specialists. However, some factors can influence your choice between inpatient and outpatient treatment programs. For example, your decision may depend on whether you’re able to put aside professional and family responsibilities during the treatment, or if you have a healthy support system at home or a stressful and enabling environment that may trigger a relapse.20

When it comes to your preferences, you can make an informed decision by considering some of these factors:13

  • The quality of care. Most CA inpatient programs are licensed by the Department of Health Care Services (DHCS)21. You should look for local, state, or federal accreditations and licensing, like from the California Department of Public Health, for example. The Joint Commission and CARF accreditations are also a sign of high-quality programs.
  • A particular treatment ecosystem is created by a sober environment and structured activities that help patients stay on track. The sense of community and companionship among patients can help them move towards the goal together. People are also more open to rehab programs when they are surrounded by others going through a similar experience.
  • Support groups can also be quite beneficial to recovery since patients that participate in these groups often show a more favorable attitude toward treatment, which helps them maintain sobriety. Support from peers can help them acknowledge that they are not the only ones struggling with addiction and that others are going through a similar experience. An inpatient setting can also provide family or marital counseling.
  • Inpatient programs provide a more focused environment through a structured approach and activities that help a patient keep the goal in mind and stick to the treatment. Daily individual or group therapy sessions can help them get to the underlying causes of their addiction.
  • Accountability is more of a personal trait, but it becomes particularly evident in inpatient treatment when your progress is being evaluated and monitored daily. The presence of your peers also makes patients take responsibility for their actions and progress.

Blue Shield Insurance: How to Use My Policy to Cover Alcohol Rehab in California?

Your policy will determine the coverage for the medical services you need, as well as the doctors and hospitals you can use for those services. It also determines how much you need to pay for the healthcare you receive. To get the maximum substance abuse coverage you need to stay within the Blue Shield of California network.22

In-network providers are those that have a contract and work with Blue Shield of California. By using in-network doctors and hospitals, you can keep your costs lower.22 You might be better off choosing a PPO health plan (instead of HMO) as it allows you to see any provider in the PPO network without a referral. Members can also use non-network providers if they’re willing to pay a higher share of the cost.4, 23

The process of starting alcohol addiction treatment consists of these standard steps:5, 7

  • First, you consult your primary care physician for an assessment and referral if necessary, depending on your plan.
  • Finding a suitable rehab program that is in-network with Blue Shield of California. Your PCP can recommend some local rehab centers or send you to a specialist for an assessment and guidance.
  • Determine your ability to use insurance by checking your insurance contract or by reaching out to BS of California to get accurate information about the approved amount Blue Shield will pay for your treatment.
  • Your chosen substance abuse treatment facility will work with Blue Shield of California to determine coverage for your treatment.

Alcohol Treatment Centers Covered by Blue Shield of California: How to Find Them?

You can, of course, reach out to Blue Shield of California for the most accurate information about what your insurance plan covers. Consult your benefits booklet or call the Blue Shield of California helpline and ask about the details of your behavioral health program.

If you’re not ready for dealing with ‘official’ institutions just yet or are simply unable to determine the severity of your alcohol abuse issues, you can call a 24-hour alcohol addiction hotline. This is a completely confidential and free way to learn about addiction and rehab in general, whether you’re calling for yourself or trying to help a loved one. Trained addiction hotline advisors can direct you to local rehab centers in California, and you can find out how insurance works before starting the process with your provider.24

As one of the leading substance abuse treatment providers in the U.S., American Addiction Centers (AAC) is in-network with Blue Shield of California. You can check your benefits by filling out an online form or calling the AAC helpline. One of AAC’s admission navigators will answer your call and verify your coverage right away if you have your card with you.

What Else Can AAC Do for Me?

AAC insurance navigators can also present you with available insurance and payment options. You can get detailed guidance through each step of the admissions process, starting from intake and assessment to treatment planning. They can also help you with same-day admission options in case you feel the need to start with treatment immediately.

AAC is a nationwide network of renowned rehab centers, so California residents will naturally have local options. One of the leading rehab centers with a high-quality program is the Laguna Treatment Hospital in California.

This was the first chemical dependency recovery hospital in Orange County. It particularly focuses on medically compromised patients and provides 24/7 oversight, with medication-assisted treatment (MAT) when necessary, as well as evidence-based behavioral therapies after the detoxification process.

Are There Some Special Programs?

American Addiction Centers, following SUD treatment best practice, aims to accommodate different types of population groups that might need a specific environment or approach to get the most out of their rehab. This is why AAC among other options offers:

High-end, luxury centers provide a stress-free environment so patients can thoroughly focus on recovery.

 

 

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