HCSC Insurance Coverage for Drug & Alcohol Rehab

If you have an HCSC insurance plan and are struggling with addiction, you may be wondering whether you can use your plan to cover alcohol or drug rehab. Generally speaking, health insurance plans in the United States are required to provide some level of coverage for mental health and substance use services under the Affordable Care Act.¹ However, how each health insurer covers these services will vary by insurer, specific plan, and location.

Due to the nuances in how each plan and policy handles covering health services, including drug or alcohol rehab, checking your insurance benefits before receiving care whenever possible is recommended. There are a variety of ways in which you can verify your benefits. You can call the number on the back of your insurance card or log in to the online member portal to view your summary of benefits and coverage.

You can also call a rehab center directly and ask them to help you verify your benefits and coverage. Finally, you can call the American Addiction Centers (AAC) helpline to work with a real person who can help you check your benefits right while you’re on the phone.

How does HCSC Insurance rehab coverage work?

The rehab coverage afforded to you through your HCSC plan varies based on your specific plan. You may be limited to seeing a provider that works with HCSC, which is referred to as an in-network provider, and you may be required to get prior authorization for your rehab care before getting care for HCSC to agree to cover the costs.

You may also need to pay various cost-sharing elements when obtaining care, such as a copayment at the point-of-service, deductible, or coinsurance. Every plan is different, and these may or may not apply to you.

AAC can help you learn more about your HCSC insurance rehab coverage and cost-sharing details. Call our helpline today to get the help you need in learning more about your health plan and coverage details, including how the authorization process and coverage work.

What is HCSC Health Insurance?

Health Care Service Corporation (HCSC) was founded in 1936 and is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA) and a Mutual Legal Reserve Company.^{2, para 2, para 1}HCSC operates the BCBS plans offered in Montana, New Mexico, Oklahoma, Texas, and Illinois.^{2, para 1} Collectively, it is the largest customer-owned health insurance company in the United States.^{2 para 1}

Across the 5 states in which it offers health insurance plans, HCSC serves almost 17 million lives.^{2 para 2} These covered members have access to about 326,145 physicians and other providers and 9,260 facilities within the plan networks, with Illinois and Texas boasting the largest plan networks.^{3 “Networks and Services” and “Stats by State”}

What’s more, in 2021, HCSC processed an average of 873,000 health insurance claims every single day and paid out 89.6% of those claims within 14 days.^{3 “Customer and Member Focus”} HCSC is a large healthcare insurer, and if you live in 1 of the 5 states in which it provides plans, you may have a variety of different plans available to you.

Types of HCSC Health Insurance Plans

HCSC operates in 5 different states in the United States. In each state, there may be different types of plans offered through HCSC and the BCSBA. This means that there are innumerable plan types and designs, including plans with Medicare or Medicaid, that may be available to you. Please work with your local BCBS or HCSC plan representative to learn what types of plans may be available to you or how the different types of plans work.

Treatment types covered by HCSC Insurance

The types of addiction treatment that will be covered by your HCSC insurance plan will vary depending on the plan you have, where you seek care, and where you’re located. There are many different plans available across all 5 states in which HCSC operates, meaning there are many different scenarios regarding plan coverage surrounding addiction treatment. Your specific policy may fully or partially cover the following treatments, depending on its design:

• Inpatient or residential rehab. Some patients may be recommended to enroll in an inpatient or residential treatment program, where they will remain, living at the facility, for the duration of the care. Here, patients will have round-the-clock medically supervised care, which may include detox.^{4, Pg 8, “What types of treatment programs are available?”}
• Outpatient rehab or therapy. Outpatient rehab or therapy programs typically involve a patient attending 1 or 2 sessions a week at a facility, but they return home after their session is complete. There is no overnight stay.^{4, Pg 10, Para 2}
• Intensive outpatient programs (IOP). With this type of addiction treatment program, a patient attends a minimum number of hours of treatment, usually 9 hours a week. It offers more structure than a typical outpatient program, but less structure than inpatient care.^{4, Pg 10, Para 3}
• Partial hospitalization programs (PHP). With this type of addiction treatment program, which is colloquially referred to as a day program, a patient goes to a facility for 4–8 hours a day, returning home when their daily sessions are done. Care typically includes multiple days a week.^{4, Pg 10, Para 1}

Be sure to check with your HCSC plan representative or an AAC representative to learn whether your health insurance plan covers the above treatments. Additionally, work with an AAC plan representative to connect with a provider who can best recommend a course of treatment for you. No 2 patients are the same, and what may work for a peer may not work for you.

Does HCSC Insurance cover mental health treatment along with drug abuse?

The ACA mandates that almost all health plans in the United States provide some level of coverage for mental health and substance use treatment coverage.¹ What this means for you if you have an HCSC health insurance plan is that it must provide coverage in some capacity. Consequently, your HCSC insurance plan must provide full or partial coverage for mental health treatment along with drug abuse, but their approach to coverage can vary.

Call AAC today to work with an admissions navigator to talk through your situation. They can help connect you to a local provider who can evaluate your condition, whether it be a stand-alone drug or alcohol addiction or dual diagnosis. A dual diagnosis is a clinical term for when someone has both a mental illness and substance use disorder.^{5, para 2} Those who have either a mental illness or substance use disorder are twice as likely to develop the other in their lifetime.^{6 “Does one cause the other?”}

At AAC, we recommend that patients with a co-occurring disorder, another term for dual diagnosis, are treated wholistically, with both conditions being addressed at once. As such, we will help you find providers nearby who prioritize integrated treatment.

How long does HCSC Insurance cover rehab? (Inpatient/Residential)

Every HCSC Insurance plan will have different benefits and coverage when it comes to how long it will cover rehab, including inpatient, residential, and outpatient services. What’s more, how long you should remain in rehab for your circumstance is uniquely personal. Determining how long you should remain in treatment is something that should be worked out between you and your mental health provider.

It’s important to note that how long your provider recommends you should be in treatment and how long your HCSC plan may cover treatment may not match up. With that being said, AAC is here to be your mental health care advocate, working with insurance providers on a patient’s behalf to recommend complete coverage for the full suite of health services that they need. AAC is your advocate in getting the care you need and maximizing your health insurance benefits to keep your health care costs as low as possible.

• Writer note: This is not available: Discuss the duration of the treatment financed by HCSC Insurance (generally)

What if my HCSC Insurance policy does not cover rehab?

If your HCSC insurance policy doesn’t fully or partially cover rehab or rehab-associated costs, you may be responsible for paying those costs out of pocket. However, there may be options available to use where insurance isn’t your primary source of financing. Some of these payment options may include:

• Payment plans—Ask the rehab facility you’re attending whether they offer any special financing or payment plan options. Be sure to ask whether this option is available to you.
• Family support—Consider asking your family if they would be willing to help you finance your rehab program. Depending on your relationship, you could approach this as asking for the gift of financing or potentially asking for a loan from your family to finance your treatment.
• Only detox-related packages (AAC’s facilities)—If you’re attending an AAC facility, be sure to ask about detox-only packages. This may help you get immediate, acute care while keeping costs low.
• Crowdsourcing—You may be able to turn to crowdsourcing platforms to share your story and ask for donations from peers or strangers to help finance your rehab treatment.

Remember, it is critical to get the treatment you need right now rather than kicking it down the road. AAC is here to go above and beyond to help you get into treatment and help you figure out financing options if your insurance doesn’t fully or partially cover your treatment costs. Getting care should be of the utmost importance and should not be pushed down the road.

What is the difference between HCSC In-network and Out-of-network rehab centers?

Depending on the type of health plan that you have through HCSC, you may be limited to seeing in-network providers for the maximum amount of coverage. The term “in-network” is used to refer to a provider, physician, or facility that is under contract with your HCSC plan.^{7 “In-Network”}

As a result of this contractual agreement, care received at in-network providers tends to be covered at a higher benefit level than by out-of-network providers. ^{7 “In-Network”} There may or may not be a difference in the level of care provided during treatment. AAC can help you locate quality treatment facilities nearby, regardless of network status. Call AAC today to get started.