Blue Cross Blue Shield Coverage for Opioid Drug Treatment

According to government statistics, over 760,000 Americans have lost their lives to drug overdose in the last 20 years. In 2018, two thirds of these fatal outcomes involved the use of opioids. Also, a 2019 survey showed that about 10.1 million Americans aged 12 or older misused opioids – 745,000 of them used heroin and 9.7 million of them misused prescription pain medication.¹

The Department of Health and Human Services declared an ongoing opioid crisis in 2017 and announced a strategy for controlling this alarming situation. Improving access to the prevention and treatment of opioid addiction is one of the essential principles included in the strategy.²

Blue Cross Blue Shield is an insurance company committed to improving the standards of treatment for opioid use disorders. While the extent of BCBS coverage varies based on each patient’s plan, members generally have access to quality addiction recovery services.³

What Extent of Opioid Rehab Does Blue Cross Blue Shield Insurance Cover?

Blue Cross Blue Shield provides substance abuse coverage, but the covered amount depends on different factors, like the location, type of treatment, and rehab facility. If it’s established that they are medically necessary, your BCBS insurance may cover different drug treatment programs nationwide, including:⁴

• Drug screenings.
• Withdrawal management, also known as detox.
• Stays at an inpatient facility.
• Outpatient rehab.
• Dual diagnosis and the treatment of co-occurring disorders.
• Sober living communities.

You can learn more about your policy and tier of coverage by dialing the phone number on the back of your insurance card and talking to a BCBS helpline representative.

What Does BCBS Not Cover for Opioid Rehab?

Although Blue Cross Blue Shield is dedicated to increasing members’ access to opioid rehab, there are certain aspects of treatment that your plan isn’t likely to cover, such as:⁴

• Non-medical care.
• Holistic treatment.
• Recreational activities.
• Food orders.
• Alternative therapy.

What Determines the Cost of Opioid Addiction Treatment?

The expenses associated with receiving opioid treatment differ based on several factors, including:⁵

• The services that are included in your treatment plan, including medication and behavioral therapies.
• The intensity of services, such as how many times a week you attend outpatient treatment.
• The duration of treatment, which ranges based on the patient’s condition and needs.
• The amenities that the facility provides.

Blue Cross Blue Shield insurance may cover some or all of the cost of your opioid addiction treatment. However, the level of coverage differs depending on the plan. You can check it by contacting the company.⁴

What Determines the Cost of Inpatient Opioid Treatment?

Being the highest-intensity form of treatment, inpatient services are usually recommended to patients that require extensive professional care and support. They stay at the facility 24/7 with treatment services at their constant disposal.⁶

Because it’s the most comprehensive and time-intensive level of care, the costs of residential treatment are typically higher than those of other treatment modalities.⁷ However, the exact price of your program depends on several factors, like the location of the facility and offered amenities. Blue Cross Blue Shield may cover a member’s inpatient drug treatment if it’s determined to be medically necessary.⁴

What Determines the Cost of Outpatient Rehab for Opioid Addiction?

Outpatient rehab is one of the options for the treatment of opioid misuse and addiction. It can have varying intensity and duration, based on the patient’s individual needs. With this type of program, the patient lives at home and receives treatment at a facility several times a week.⁶

They’re generally more affordable than inpatient treatment. Also, outpatient programs of higher intensity tend to cost more than less intensive ones. The precise cost of your BCBS-covered drug rehab can only be determined after you undergo your clinical assessment and get a recommended treatment plan at your facility.⁷

What Determines the Cost of PHP for Opioid Use?

Partial hospitalization programs (PHP) are similar to outpatient services because the patient doesn’t stay at the rehab center round the clock. However, they are more intensive because they often require patient participation every day of the week, for the larger portion of the day.⁶ This is also typically reflected in their price.⁷

To discover the specific price of your PHP treatment and whether your Blue Cross Blue Shield plan provides coverage for the substance abuse treatment you need, a medical professional first has to determine if this course of treatment is a medical necessity in your case.⁴

What Determines the Cost of MAT for Opioid Addiction?

Medication-assisted treatment (MAT) is a common form of treatment for opioid misuse, which has proven clinical effectiveness. It combines approved medication with behavioral therapies to reduce cravings and stabilize the patient’s brain chemistry.⁸ 1.27 million Americans are currently undergoing MAT.¹ This approach typically:⁸

• Increases patients’ survival rates.
• Makes it more probable for patients to stay in treatment.
• Improves patients’ chances of getting and keeping a job.
• Reduces patients’ opioid use and participation in crime.
• Helps pregnant patients have better birth outcomes.

The cost of MAT varies based on factors like the facility and the included services. To find out the exact cost of MAT and if your Blue Cross Blue Shield insurance offers coverage for this form of treatment, you need to undergo a clinical assessment and see if it’s a suitable course of action for you.⁴

Is the Cost of Opioid Rehab Higher Than the Cost of Opioid Addiction?

Opioid misuse is extremely burdensome for both the individual and the society at large. If it’s left untreated, it contributes to grave societal and personal problems, which have their financial consequences. These issues include:⁹

• Higher crime rates and longer prison sentences.
• Newborns who are born opioid-dependent.
• Easier transmission of infections.
• Opioid overdose.
• Getting injured while intoxicated.
• Losing income.

The costs of treatment are considerably lower than the expenses associated with continued drug use. The USA loses $600 billion due to the effects of substance abuse every year and providing wide access to suitable treatment could reduce these losses. As a member of Blue Cross Blue Shield, you can easily access evidence-based detox and other drug treatment programs nationwide.⁵

What Length of Treatment for Opioid Use Will Blue Cross Blue Shield Cover?

In a number of cases, long-term rehab programs are connected to better outcomes. In general, treatment services that last for at least 90 days increase the likelihood of complete recovery. For example, patients who follow their treatment plan for 6 months or more will probably experience significant improvements and continue a drug-free lifestyle.¹⁰

While this is a general recommendation, every treatment-seeker receives their tailored treatment plan and its duration is determined after considering their needs. Some patients benefit from short-term treatment programs, such as a 28 or 30-day long drug rehab program or a 60-day stay at a rehab facility. The severity of the patient’s addiction and potential co-occurring disorders are some of the factors that can influence it. Residential treatment can be followed by weekend rehab as a part of continuum of care.¹⁰

If a certain treatment length is determined to be medically necessary, you can use your Blue Cross Blue Shield insurance at one of the rehabilitation centers in their network to significantly reduce your out-of-pocket expenses.⁴

Do I Need BCBS-Covered Inpatient or Outpatient Opioid Rehab?

Typically, the treatment of opioid misuse starts with a medically supervised detox, which can be as short as a 7 or 10-day program at the detox facility. Detox minimizes the uncomfortable side effects of stopping opioid use. Once the patient’s system is clear of the drug, they can move onto other levels of care. Outpatient treatment can be an adequate rehab option for people who have a solid support network at home and don’t require high-intensity care.¹⁰

However, a stay at a residential facility may be more effective than outpatient services if the patient needs intensive treatment because it offers:¹⁰

• 24/7 supervision of trained staff.
• Safe, drug-free setting.
• Support of other individuals who are undergoing treatment.
• Enhanced focus on recovery.
• Greater accountability.

How Do I Use Blue Cross Blue Shield Insurance for Opioid Treatment?

There are certain steps to take before you use your Blue Cross Blue Shield insurance coverage:⁴

• Consult your doctor, share your concerns, and receive treatment recommendations.
• Find a treatment facility in a location that suits you.
• Contact the rehab center to verify your insurance coverage. Some treatment facilities run their own helplines that offer helpful, accurate information on opioid addiction.
• Make arrangements for your stay at the facility and go through the admissions process with the guidance of the center’s trained admissions team.

If you aren’t sure if you require drug treatment, you can complete a short substance abuse self-assessment and determine could be a solution for you.

How to Find Opioid Rehab Centers In-Network With BCBS

If you’re looking for a reputable treatment center in your area where you or a loved one can enter an evidence-based rehab program, a facility run by the American Addiction Centers may be the right choice. You can browse their treatment centers that are located across the country to find the highest standard of care. Also, treatment-seeking individuals can call their heroin hotline to inquire about the specifics of opioid rehab.Blue Cross Blue Shield members can check their insurance coverage and what facilities are in their carrier’s network by contacting them directly. To find treatment centers that are in their carrier’s network, you can use their provider directory. Choosing an in-network BCBS rehabilitation center means that a larger portion of the price will be covered by your insurance and you likely won’t have to look for other payment options.¹¹