Empire Blue Cross Blue Shield Drug & Alcohol Rehab Coverage

Empire Blue Cross Blue Shield New York: Rehabs & Detox Centers in NY That Take BCBS

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Does Empire BCBS of New York Insurance Cover Inpatient Alcohol and Drug Rehab Centers?

The fourth-largest state by population, New York is home to more than 19.8 million people.1 It’s estimated that 12% of the state population age 12 and older has a substance use disorder, which equates to 1.9 million New Yorkers.2 If you or a loved one is struggling with addiction in New York, you’re not alone. Getting treatment is one of the best ways to overcome addiction, but it often comes with a high price tag, which can be a burden for many.

Fortunately, if you have health insurance, like an Empire BCBS of New York plan, you may be able to use your health plan to help fully or partially cover the cost of treatment. Empire BCBS of New York may help to cover all or some of the cost of inpatient alcohol and drug rehab centers in and around New York, and potentially throughout the country.

To verify your benefits, call the number on the back of your insurance card and speak to a representative, or reach out to the leading addiction company, American Addiction Centers (AAC), for assistance. AAC has various ways to help you check your benefits and learn more about rehabs, including a confidential helpline, a chat function on their site, and a form that you can use to check your own benefits. Reach out today to learn more.

How to Find Empire BCBS of New York Covered Inpatient Drug Treatment Centers in New York?

There are a handful of different ways that you can go about finding an Empire BCBS of New York-covered inpatient drug treatment centers in and around New York state. First, you can call the number on the back of your insurance card to work with an Empire BCBS representative to verify your coverage and identify covered facilities near you.

Another way to do this is to work with American Addiction Centers. Admissions navigators can work with you over the phone via AAC’s helpline. Here, a real person will answer the phone and speak with you. They can help verify your insurance coverage for you right while you’re on the phone, and help you locate a nearby rehab facility that may be a luxury facility or have same-day admittance. AAC has various facilities around the country, which provide top-notch, industry-leading care to attendees.

AAC also works with many different insurers, which means that you may be able to use Empire BCBS of New York plans to help offset some of the costs associated with rehab. It’s unknown how many people go into rehab every year financed through BCBS of New York, but Empire BCBS of New York provides health care coverage to nearly 5 million members.3

What Is Empire BCBS of New York?

Empire BCBS of New York is the largest health insurer in the state of New York, and it has been serving New Yorkers for 80 years.3 There are nearly 5 million people covered by an Empire BCBS of New York plan, and over 38,000 New York businesses, small employers, and unions turn to Empire BCBS of New York to offer health insurance to employees or other members.3

Empire BCBS of New York is a subsidiary of the Blue Cross and Blue Shield Association, which is a national federation of 34 community-based, independent, and locally operated BCBS companies.3 “About Blue Cross Blue Shield Association” Collectively, all of the BCBS companies across the country provide health care coverage to 1 in 3 Americans. 3 “About Blue Cross Blue Shield Association”

Empire BCBS of New York provides health insurance plans from various insurance markets, including individual and family plans, Medicare plans, Medicaid plans, and plans for small businesses and normal employers.4, “Our Plans” Because there is a multitude of different plans available in each of these markets, all of which come with their own network of covered providers, it’s impossible to cite how many rehab centers are in-network with BCBS of New York. The best way to check your coverage to find a covered network provider is to call the number on your insurance card or call the AAC helpline.

How Much Does Empire BCBS of New York Cover (Addiction Treatment)?

How much your Empire BCBS of New York covers addiction treatment will depend upon your specific health insurance plan, as coverage details will vary. Networks and cost-sharing requirements of your specific plan may limit where you can seek care or may include rules on how long care is to be covered. Please check your coverage details before seeking care unless it is an emergency.

Despite the variance in coverage details, there are a handful of common addiction treatment methods that may be covered by an insurer like Empire BCBS of New York. Some of these common treatments in which some or all the costs may be covered, include:

  • Inpatient or residential rehab. An inpatient or residential rehab program generally involves a patient remaining at the facility around the clock for the duration of their treatment (could be days, weeks, or months), where they receive 24/7 medical supervision.5, Pg. 8, “What types of treatment programs are available?” Para 2, 6, pg. 8, para 1
  • Outpatient rehab or therapy. An outpatient rehab or therapy program generally involves a patient traveling to a facility once or twice a week to receive the care they need, but they return home after the treatment session is completed. In other words, no overnight stay is involved with an outpatient program.5, Pg. 10, Para 2
  • Intensive outpatient programs. An intensive outpatient program is a more rigorous and structured version of a traditional outpatient program that involves patients attending a minimum number of hours of treatment each week but not staying overnight at a facility. 5, Pg. 10, Para 3
  • Partial hospitalization programs. A partial hospitalization program, also known as a day program, typically involves a patient attending sessions at a facility for between 4 and 8 hours daily but returning home each night. Patients generally attend multiple sessions per week.5, Pg. 10, Para 1

Remember, just because these are common treatments for addiction and substance use doesn’t mean that your plan is guaranteed to cover all or some of the cost of these treatments. What’s more, these treatment methods may not be recommended for your unique situation. Work with your health care provider to determine the course of treatment that’s right for you.

Does Empire Blue Cross Blue Shield of New York Provides Coverage for Inpatient Mental Health Facilities?

Navigating the complexities of insurance coverage can be difficult and stressful, particularly if you have a mental health condition or conditions for which you need care. In 2020, about 52.9 million adults in the U.S. age 18 and older had any type of mental illness, and about 46.2% of them received mental health services for mental illness.7 “Prevalence of Any Mental Illness (AMI)” “Mental Health Services – AMI”

Of those living with mental illness, 1 in 3 also experience substance abuse, and 1 in 2 with severe mental illness also experience substance abuse.8 “How Common is a Dual Diagnosis” Of those with a substance use disorder, one in three are also experiencing alcohol use disorder while 1 in 2 are also experiencing drug use disorder, and may also experience a mental illness.8 “How common is a dual diagnosis”

If someone is experiencing both a substance use disorder and mental illness, it is called a co-occurring disorder or a dual diagnosis. Because the two are often interconnected, a common method of treatment for co-occurring disorders is integrated intervention, which is when care for a mental illness and substance use disorder are received concurrently.8 “How is dual diagnosis treated?

You may be wondering whether Empire BCBS of New York provides coverage for mental health facilities and treatments. The short answer is yes. Under the Affordable Care Act, mental and behavioral health services are considered an essential health benefit, which means your health plan must provide coverage in some capacity for these services.9

Specifically, your Empire BCBS of New York drug rehab coverage must include coverage in some capacity for inpatient mental and behavioral health services, behavioral health treatment, and substance use disorder treatment.10 What this means for you is that your Empire BCBS plan must provide some type of coverage for co-occurring disorder treatment and stand-alone heroin rehab.

Does Empire Blue Cross Blue Shield of New York Cover Addiction Treatment Therapies?

All BCBS plans, including those that apply to New York state, must cover addiction treatment therapies in some capacity under the ACA.9 The Blue Cross Blue Shield Association has a Substance Use Resource Center, which helps to connect members with local substance use resources. It also details the types of addiction treatment therapies that may be available:11 “What types of treatment are available”

  • Withdrawal Management (also known as detoxification)—This process involves a patient “detoxing” and removing substances such as drugs or alcohol from their body. It is done in a managed environment to help mitigate some of the side effects of withdrawal.
  • Outpatient Care—With outpatient care, patients attend appointments at a facility, but return to their homes after each session.
  • Inpatient Care—With inpatient care, patients are admitted to a facility and stay there for days or weeks, receiving 24/7 care.
  • Residential Care—Similar to inpatient care, residential care involves patients staying at a facility to receive treatment, but the stay ranges from months to a full year.
  • Medication-Assisted Treatment—This involves the administration of FDA-approved medications to help a patient manage their withdrawal and recovery.

Be sure to review your Empire BCBS of New York plan details to find out coverage details for the above treatment methods before seeking care whenever possible.

How Long Does Empire BCBS of New York Insurance Cover Alcohol and Drug Rehab Programs?

How long your Empire BCBS of New York insurance covers alcohol and drug rehab programs varies based on the plan you have and where you seek care. It’s recommended that you review your plan’s details prior to seeking care unless it’s an emergency to help avoid surprise medical bills. Despite the coverage details of your plan, staying in treatment for an appropriate length of time is essential to your overall recovery.12

Research indicates that treatments should last at least 3 months can help stop or reduce drug use and improve outcomes.12, bullet 5 Be sure to talk about adequate treatment lengths with your mental health provider.

What if My Empire BCBS of New York Policy Does Not Cover an Inpatient Drug Rehab Program?

It’s possible that your Empire BCBS of New York policy will not fully or partially cover the cost of your inpatient drug rehab program or any aspect of your treatment. If this is the case, you may be responsible for paying for the costs of care out-of-pocket.

Many rehab facilities have alternative payment options, such as financing opportunities or scholarship opportunities. Be sure to ask the rehab facility whether any of these options may be available to you. Regardless, it’s important to remember that getting the treatment you need right now is critical rather than pushing it down the road.

Empire BCBS of New York In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

Choosing an in-network provider versus an out-of-network provider can greatly affect the overall cost of your care. Certain BCBS plans only cover services from in-network providers, and you could be responsible for paying for all of the charges if you use an out-of-network provider.13 “Understanding your health plan and network” An in-network provider (like a doctor, hospital, pharmacy, lab, or urgent care center) is one that is contracted with your BCBS plan to provide health care services at lower rates.13 “In network provider” In-network providers generally also file your health care claims and can help you request preapprovals or pre-authorizations if they are needed. 13 “In network provider”

By contrast, out-of-network providers are not contracted with your plan and can charge you whatever amount their practice sets, which is usually higher than what in-network providers can charge you. 13 “Out-of-network providers” If your plan doesn’t allow for any coverage of out-of-network providers, you will be responsible for paying for all the health care costs on your own.

To check whether a provider is in or out of your plan’s network, call the number on the back of your insurance card. You can also usually work with the provider directly, as they can help determine whether your insurance is accepted at their facility.

How to Verify Empire BCBS of New York Insurance Coverage of Drug Rehab Centers?

If you’re ready to take the next step in getting care at a New York drug rehab center, but don’t know where to find a covered facility, don’t worry. American Addiction Centers is here to help you verify your insurance coverage for you. You can call our helpline and speak to a real person who can check your benefits for you right while you’re on the phone.

Because there are so many different types of plans and coverages, it’s impossible to know exactly how many people go into rehab every year financed through Empire BCBS of New York. AAC works with a variety of insurance companies and also has treatment centers around the country where you can receive top-notch, quality care. Don’t wait any longer to get the care you need. Call AAC today to get started.

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