BCBS of Colorado Coverage for Drug and Alcohol Rehab Centers

Does BCBS of COLORADO Insurance Cover Inpatient Alcohol and Drug Rehab Centers?

The state of Colorado, which is home to 5,812,069 people, has seen an increase in substance use disorders and drug overdoses since 2015.^1,2 Deaths due to drug overdose in Colorado increased from 16.8 per 100,000 people in 2015 to 26.0 per 100,000 in 2020.^{2 “substance use and related deaths”} In 2020 alone, there were 987 opioid overdose deaths in Colorado, which attributed to 65.3% of all drug overdoses in the state.^{2 “substance use and related deaths”} Beyond opioid-related addiction and deaths, Coloradoans exhibited dependence on alcohol and other illicit drugs.

From 2018 to 2019, 8.8% of adults reported having past-year alcohol use disorder and 5.0% reported having past-year illicit drug use disorder.^{2 “substance use and related deaths”} In Colorado, adults’ dependence on alcohol is higher than the U.S.’s reported average of 5.7% of the adult population reporting past-year alcohol use disorder. ^{2 “substance use and related deaths”}

From 2018 to 2019, approximately 9.4% of the state of Colorado’s adult population reported having an unmet need for mental health treatment. This includes a need for counseling or mental health or substance use treatment, but they are not receiving care. ^{2 “Unmet Need and Barriers to Care”} Of those who reported this unmet need, 41.8% said they didn’t receive the care needed because of the cost.^{2, Unmet Need and Barriers to Care}

One way that you can potentially offset the cost of getting the care you need for mental health or substance use disorder, or both, is to use your health insurance. Many companies, such as BCBS of Colorado, will provide coverage in some capacity for the costs of inpatient alcohol and drug rehab center treatment. Coverage will vary based on your specific plan’s details, which is why it’s important to verify your benefits before seeking care whenever possible.

To check your benefits, call the number on the back of your insurance card. Or you can reach out to American Addiction Centers (AAC) through different channels, such as the confidential helpline or online chat function. AAC staff can work with you on the phone to help you learn more about your BCBS of CO plan.

How to Find BCBS Of COLORADO-Covered Inpatient Drug Treatment Centers in CO?

If you have a BCBS of Colorado plan, you may be wondering how to find a BCBS of Colorado-covered inpatient drug treatment center in CO. The good news is that because BCBS of Colorado is a large company that serves many markets, there are many plans available.³ As such, it’s impossible to say how many people use their BCBS of Colorado insurance to finance rehab every year. Rehab coverage will depend largely upon the plan you have and where you seek care.

To figure out whether there are nearby facilities that are covered under your plan, you’ll need to learn more about your health insurance plan. You can do this in a number of ways. First, you can call the number on the back of your Blue Cross Blue Shield Colorado health plan card. You’ll then be able to speak with a representative who can help explain your benefits and coverage to you over the phone, and potentially help you locate nearby covered facilities.

Another option is to work with rehab centers directly. AAC has many facilities across the country, which all provide industry-leading rehab and addiction treatment. AAC staff are trained to help you every step of the way. You can call the AAC helpline and speak to a person who can check your benefits right while you’re on the phone. They can even help you find AAC-accredited facilities near you in Colorado, or see whether your insurance will cover treatment at AAC facilities in nearby states, like the Oxford Treatment Center in Mississippi, the Desert Hope Treatment Center in Nevada, or the Greenhouse Treatment Center in Texas.

What is BCBS of COLORADO?

BCBS of Colorado isn’t just one type of health plan. Rather, the term is used to refer to the plans offered by Anthem Blue Cross Blue Shield in Colorado. For over 80 years, Anthem Blue Cross and Blue Shield and its subsidiary company, HMO Colorado, Inc., have provided health insurance solutions to Coloradoans.⁴ Anthem, Inc., one of the largest insurers in the country, is the parent company of BlueCross Blue Shield.⁴ Across the country and through Anthem’s various affiliated companies, 1 in 8 Americans—or 118 million people—are covered by one of Anthem’s health plans.⁵

In Colorado, Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc.⁶ Anthem BlueCross BlueShield offers different types of plans, like family and individual plans and in and out of the Marketplace. Specifically, these plans work through Connect for Health Colorado.⁴ There are multiple plan types and networks, which makes it hard to know, for sure, how many drug rehab centers are in-network with BCBS of Colorado plans in Colorado.

How Much Does BCBS of COLORADO Cover (Addiction Treatment)?

What’s covered under your BCBS of Colorado plan will be determined by your specific plan. Additionally, where you seek care, and whether it’s in your plan’s network will also play a role in determining coverage details. It’s recommended that you check your insurance coverage details prior to seeking care whenever possible.

Although coverage details may vary, there are a few common treatment methods for addiction that may be recommended to you by your provider. Some of these treatment methods may include:

• Inpatient or residential rehab. A residential or inpatient rehab treatment program is a structured program meaning a patient comes and stays at a facility 24/7 to receive round-the-clock medical care and supervision for the duration of their treatment.^{7, Pg 8, “What types of treatment programs are available?” Para 2, 8, pg 8, para 1}
• Outpatient rehab or therapy. An outpatient rehab program, which typically involves therapy, is a less structured type of care. A patient travels to the facility 1 or 2 times a week for their treatment and then returns home after it’s completed.^{7, Pg 10, Para 2}
• Intensive outpatient programs. An IOP is more structured and rigorous than the standard outpatient program, as it involves a patient attending a minimum number of hours of treatment each week.^{7, Pg 10, Para 3}
• Partial hospitalization programs. A PHP is a type of rehab program that is a less intensive version of inpatient rehab. It’s also commonly referred to as a day program, as patients are required to attend a program for 4–8 hours each day, multiple days per week, but they aren’t required to stay overnight.^{7, Pg 10, Para 1}

Although these are common treatment paths for addiction treatment, they may not be the right fit for you. Please follow the guidance of your provider when determining the best course of recovery for yourself.

Does Blue Cross Blue Shield of COLORADO Provide Coverage for Inpatient Mental Health Treatment Facilities?

Under the Affordable Care Act, which is a federal law, all services deemed to be essential health benefits (EHBs) must be covered in some capacity under U.S. health insurance plans.⁹ Mental health and substance use services are considered to be 1 of the 10 EHBs, meaning that almost all health plans, including your BCBS of Colorado plan, must provide some level of coverage for mental health facilities.¹⁰ Specifically, plans must cover costs at some level for inpatient mental health and behavioral health services, treatment for substance use disorder, and behavioral health treatment.¹⁰

This mandate allows those who need to receive care for stand-alone heroin rehab or for a co-occurring disorder can use their insurance to cover at least some of the costs. A co-occurring disorder is when someone has both a mental illness and substance use disorder simultaneously.¹¹ Researchers believe that about half of those with a mental illness will experience a substance use disorder in their lifetime, and vice versa.¹¹ Getting integrated treatment is often the recommended approach, as this allows for the treatment of both conditions at once.

How Long Does BCBS Of COLORADO Insurance Cover Alcohol and Drug Rehab programs?

The length of time that BCBS of Colorado Insurance will cover alcohol and drug rehab programs will vary based on your specific health insurance plan, as well as where you receive care. Whether the chosen rehab center or facility is an in-network provider will likely affect how your insurance plan covers the costs you incur during treatment.

To check what your insurance plan may cover, be sure to call the number on the back of your insurance card and speak with a representative who can walk you through what your BCBS of Colorado insurance covers. Despite the variance in coverage details, it’s important to note that remaining in rehab for an adequate amount of time is crucial to having a successful outcome. Experts point to research that shows that to help stop or reduce drug use and improve outcomes overall, treatments should last at least 3 months.^{8, bullet 5}

What if My BCBS Of COLORADO Policy Does Not Cover an Inpatient Drug Rehab Program?

Depending on the treatment you receive, the BCBS of Colorado policy you have, and where you receive care, it’s possible that your health coverage won’t fully or partially cover the cost of inpatient drug rehab programs. If this is the case, you will likely be responsible for paying the uncovered costs out-of-pocket.

Fortunately, there may be ways to offset the burden of paying for care on your own. First, you can ask the rehab facility if they have payment options available, which could include special financing opportunities or potential discounts for paying in cash. This could include setting up a payment plan or opening a health care credit card. Some rehab facilities may have scholarship opportunities that you can apply for to help offset the costs of care, too.

Though it may be scary to think about paying for treatment on your own, you should not let this deter you from getting the help you need. It’s critical to get the care you need now rather than pushing it down the road.

BCBS of COLORADO In Network vs. Out of Network Inpatient Rehab Centers

Choosing an in-network provider instead of an out-of-network provider can help you keep your health care costs as low as possible. Certain health plans offered by BCBS of Colorado may be set up to cover costs incurred from in-network providers only, which means that if you visit an out-of-network provider, you may not receive any coverage from insurance.¹²

An in-network provider is one that is contracted with your insurance plan to provide care to you at lower rates.¹² Out-of-network providers are not contracted with your insurance plan, and thus, can charge whatever their fees are currently. Choosing an in-network provider is generally more cost-effective.

To find nearby inpatient drug rehab centers that are within your plan’s network, call the number on the back of your card, use the BCBS of Colorado care finder, or call the AAC helpline to speak to a real person who can help locate a nearby facility.