Does Federal BCBS Insurance Include Opioid Rehab Coverage?

Edited by: Editorial Staff
Last updated on June 10, 2022

Prescription opioids are a mostly safe way to attain pain relief, provided that they’re used for brief periods of time and in accordance with health care provider guidelines. That being said, there’s still some possibility of opioid misuse and eventual addiction.1

Apart from illegal substances like heroin, opioids also include powerful prescription painkillers such as tramadol, hydrocodone, percodan, oxycodone, fentanyl, and codeine. Since both substance abuse and opioid misuse can be exceedingly harmful to the affected individual, the importance of making treatment readily available can’t be overstated.1

Under the Affordable Care Act, all insurance plans that are available in the Marketplace have to cover the 10 crucial health benefits, which include substance use and mental health disorders.2 Opioid addiction treatment is therefore a crucial component of every Marketplace plan.2

Treatment-seeking individuals who have Federal BCBS (Blue Cross Blue Shield) Insurance coverage for addiction treatment can choose from a number of drug rehab centers nationwide that accept this kind of insurance for substance use and mental health disorder treatment, which includes opioid addiction.3

Insurers will generally cover a greater portion of the cost of treatment if your rehab center of choice is in network with them. However, some insurance carriers who offer Federal BCBS insurance will refuse to provide out-of-network rehab center coverage. In these cases, you will have to explore other payment options.3

Federal BCBS insurance drug treatment programs and rehabilitation

What Is Covered Under Federal BCBS Opioid Rehab Nationwide Insurance?

The Mental Health Parity and Addiction Act (MHPAEA) requires health insurance providers to cover for any mental health services necessary, including opioid addiction rehab, in the same way that they would cover medical/surgical benefits. Nearly all Federal BCBS healthcare plans therefore include a certain level of coverage for mental health problems.4

What exactly is covered under your Federal BCBS substance abuse coverage will depend on the specifics of your policy. Most policies cover the following:5,6

What Types of Opioid Treatment Are Not Covered Under Federal BCBS?

Different Federal BCBS Insurance healthcare plans and state legislatures can vary widely in what they cover and how they approach addiction treatment.7 Although all drug treatment programs are customized to fit the patient’s specific needs and situation, there are some types of treatment that are unlikely to be covered by Federal BCBS Insurance. These include:8

  • Food delivery
  • Non-medical amenities
  • Alternative therapies
  • Holistic care
  • Recreation programs
  • Private treatment

How Much Does Opioid Rehab Usually Cost?

The cost of substance addiction treatment is calculated based on numerous variables, including the specific policy an individual has and their preferred rehabilitation plan. Specialized plans such as opioid rehab for veterans, substance use treatment programs for couples, or custom programs at luxury rehab centers may be subject to reduced or increased coverage. Other factors that determine cost include:7

  • Whether it’s an inpatient or outpatient program
  • Facility type
  • Duration of treatment
  • Which medication is used for detox and treatment
  • The state the facility is located in
  • Which treatment provider the patient has opted for

What Is the Cost of Inpatient Opioid Addiction Treatment?

Inpatient substance use disorder treatment programs are designed to shield patients who battle severe or chronic opioid misuse disorders by physically and mentally separating them from exterior triggers and challenges that could aggravate their condition. This is achieved via an extended stay at a drug rehab facility. Due to its intense 24/7 nature, inpatient treatment tends to be costlier than outpatient programs.6

People who are unable to cover these costs can still receive the care they need at rehab centers that offer treatment for free or at an affordable price. These centers are funded by various organizations, including government grants, charitable donations, and private endowments.9

How Much Does Outpatient Opioid Rehab Cost?

While opioid addiction is a severe issue that usually requires intense long-term treatment in order to minimize the risk of relapse and maximize the possibility of long-term recovery, Federal BCBS Insurance healthcare plans may also include specialized outpatient opioid addiction treatment programs. However, this is usually reserved for milder cases, patients who have obligations they’re unable to delay or avoid, and patients who are unable to cover the cost of inpatient treatment.6

Federal BCBS Insurance may also cover intensive outpatient programs (IOP), which allow patients who don’t require constant monitoring to receive intensive treatment without putting their daily lives on hold. Even so, these patients are typically required to visit a Federal BCBS substance rehabilitation center 3-4 times per week.10

What Is the Cost of Partial Hospitalization Programs (PHP) for Opioid Treatment?

Also known as day treatments, PHPs tend to have a similar level of intensity as inpatient programs. However, they tend to cost less because patients aren’t obligated to spend the night at a rehab facility, making them the preferred option for individuals who are unable to afford the cost of inpatient programs.11

A PHP normally takes time during the day and includes 20+ hours of opioid addiction and mental health treatment per week. It may also include scheduled family meetings, various kinds of medical services, and treatment of co-occurring disorders.11

How Much Does Medication-Assisted Opioid Treatment Cost?

Medication-assisted treatments (MATs) address substance use disorders (SUDs) through a combination of behavioral interventions and medications. The medications that have been approved by the U.S. Food & Drug Administration (FDA) for use in MAT are naltrexone, methadone, and buprenorphine. Due to the chronic nature of opioid addiction, the need for continuing MAT should be subject to periodic evaluation.12

Your copays, deductibles, monthly premiums, and out-of-pocket expenses for your opioid treatment and rehabilitation program can vary based on the Federal BCBS drug addiction treatment coverage you have.12

The Cost of Opioid Addiction Treatment vs the Cost of Opioid Addiction

It’s difficult to exaggerate the financial burden substance use disorders place on the American people. In 2013 alone, more than $78 billion was spent on prescription opioid use disorders and overdoses in the United States. Just 3.6% of this sum ($2.8 billion) was spent on treating patients.12 There’s a pressing need for care delivery systems, policymakers, and healthcare plans to increase capacity and make outpatient treatment for opioid abuse as widely available as possible.13,14

On a personal level, failing to seek treatment for SUDs can lead to life-threatening overdoses and long-term health problems. If you’re struggling with opioid use disorders, or you suspect a loved one may be, it’s advised that you seek treatment as soon as possible regardless of what it may cost in the short term, as the cost of addressing long-term health issues caused by prolonged opioid abuse can be far greater.15

What Length of Opioid Abuse Treatment Does Federal BCBS Insurance Cover?

The length of opioid rehab and the benefits you’re entitled to are determined by the Federal BCBS drug coverage plan you have and the state you’re seeking treatment in. Since opioid abuse is a chronic disorder, many patients will need a comprehensive detox program and long-term care in order to safely manage withdrawal and limit the possibility of a relapse.6

Federal BCBS Insurance offers various levels of coverage for inpatient drug rehab nationwide. Depending on the specifics of your Federal BCBS healthcare plan, you may have significant coverage and benefits for opioid abuse treatment. You can verify your coverage for addiction treatment by reaching out to your insurance carrier or rehab center directly.15

Choosing Between Federal BCBS Outpatient vs Inpatient Opioid Abuse Rehab Facilities

When deciding between outpatient and inpatient treatment, it’s generally recommended to follow the advice of your medical professional. The optimal type of treatment will also be determined during the intake assessment at your opioid rehab center of choosing.16

Outpatient programs include group and individual counseling, as well as treatment for both opioid use disorder and co-occurring mental health issues.16 They’re the go-to option for patients who:17

  • Are unable to commit to inpatient programs due to work responsibilities.
  • Have a loving and supportive home environment that can aid in recovery.
  • Are committed to attending and following the treatment procedures.
  • Are suffering from a mild substance use disorder.

Inpatient opioid rehab programs are far more thorough and include prolonged stays at specialized treatment facilities. They can range from short but intensive 3-10 day detox programs and 28-30 days opioid addiction treatment programs, to extended hospitalizations that include long-term post-treatment support.16 They tend to be the recommended option for patients who:17

  • Require a more focused environment and increased accountability.
  • Are struggling in their day-to-day life and are unable to function without assistance.
  • Have experienced a relapse after completing less-intensive rehab programs.
  • Are battling severe or long-term substance abuse issues.
  • Are at a higher risk of withdrawal or relapse.

How To Use Federal BCBS Coverage for Opioid Addiction Treatment?

To use your Federal BCBS insurance coverage to access a drug treatment program, you will first need to consult with a medical professional. They will determine whether rehab is right for you and recommend a suitable substance abuse program that will address your SUD and any co-occurring disorders based on your needs and situation.

You will then get in touch with your preferred Federal BCBS substance abuse treatment providers to explore available coverage options and learn more about the specifics of your treatment. If you would like to ask further questions in total confidentiality, or you or your loved one are in need of emergency same-day admittance, don’t hesitate to call the opioid addiction helpline.18

How To Find Opioid Addiction Treatment Programs That Accept Federal BCBS Insurance

American Addiction Centers (AAC) is a nationwide network of drug and alcohol rehab facilities that can help you or your loved one find effective treatment for your substance use disorder and any co-occurring mental health issues.

To learn how we can assist you, call our free helpline and discuss your issue in total privacy. Whether you call our Florida-specific substance abuse helpline, our alcohol abuse-specific helpline, or our general SUD help helpline, our helpful and knowledgeable admissions navigators will be able to provide expert guidance. They will verify if opioid addiction rehab is covered under your insurance and to what extent, assess your particular benefits, and offer a tailored treatment recommendation, all in a single call.AAC rehab facilities are located across the United States and are in-network with Federal BCBS Insurance. Our team will help you collect all of the required data on your policy and guide you through all stages of the admission process in order to ensure you receive the right treatment for your particular situation and maximize the chance of long-term recovery.

 

 

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