Blue Cross Blue Shield Drug And Alcohol Rehab Insurance Coverage

BCBS is one of the largest medical insurance providers in the nation, and has many plans to help coverage for addiction and substance abuse treatment. Which types of behavioral health services your Blue Cross Blue Shield policy covers for substance abuse treatment depends on your individual plan.

BCBS Insurance Coverage For Addiction Treatment

Blue Cross Blue Shield (BCBS) insurance offers healthcare coverage to millions of Americans every year. Essential health benefits under BCBS of Massachusetts plans include coverage for addiction treatment (alcohol and drug rehab).

The amount of coverage and covered drug and alcohol addiction treatment services vary by plan. Health insurance companies like BCBS generally cover some portion of the cost of inpatient treatment, outpatient treatment, medications, and more.

Spring Hill Recovery Center is in-network with BCBS of Massachusetts insurance.

If you are looking for behavioral health services and planning to pay with insurance, it may help to understand:

  • what’s covered by your Blue Cross Blue Shield plan
  • what your out-of-pocket expenses will be
  • how to verify your insurance before heading to treatment

Blue Cross Blue Shield Insurance Coverage For Massachusetts Drug And Alcohol Rehab

Your amount of coverage for drug and alcohol treatment will vary according to your Blue Cross Blue Shield insurance plan. Blue Cross Blue Shield Association groups coverage into metal tiers, including Bronze, Silver, and Gold. Platinum plans, with the highest level of coverage, may also be offered in some states.

All private health insurance plans, like those offered through Blue Cross Blue Shield, are required through the Affordable Care Act (ACA) to provide different coverage levels for each tier.

The coverage amount can vary by plan as well. In general, Blue Cross Blue Shield insurance coverage by plan is as follows:

  • BCBS Bronze plans: about 60 percent
  • BCBS Silver plans: about 70 percent
  • BCBS Gold plans: about 80 percent

Depending on your plan and when in the year you seek treatment, you may also have a deductible to meet before drug rehab coverage kicks in. Other costs not covered by BCBS policies can include copayments and any treatments not outlined by your health plan benefits.

Using Blue Cross Blue Shield Insurance To Pay For Addiction Treatment

Addiction treatment can be highly effective at helping addicted individuals seek lasting recovery, which means it is worth the price you pay for treatment. Without insurance, the price of drug rehab can be costly.

Using your BCBS insurance to pay for addiction treatment can make the overall cost far more affordable to you. However, there are a few things you may want to know and steps you may need to take to ensure you get the most out of your coverage.

Do I Have To Stay In-Network To Use My BCBS Insurance For Massachusetts Drug Rehab?

Most BCBS insurance plans fall into one of two categories: preferred provider organization (PPO) or health maintenance organization (HMO) plans. Both HMO and PPO plans operate on a network of treatment providers.

Which type of plan you have will affect the variety of treatment providers you can access. Yet Blue Cross Blue Shield is one of the most widely accepted insurance carriers among alcohol and drug treatment centers.

In some cases, your BCBS insurance plan may offer reduced coverage for out of network providers, which helps if you find a health care provider that works for you but which doesn’t accept your plan.

What Will Be My Out-Of-Pocket Costs For Rehab?

Out-of-pocket costs for alcohol and drug rehab typically include meeting deductibles, copayments, and paying for any costs not covered by your Blue Cross Blue Shield plan. Deductible amounts are determined according to your plan.

Knowing your deductible amount and whether you have fulfilled it when you are trying to enter a Massachusetts rehab program can be important. If you haven’t met your deductible, you may have to pay for some portion of the treatment before coverage begins.

If your copayment amounts are high, you may have other options to cover these expenses. Some rehab facilities offer private scholarships to cover the remaining costs of treatment, like copays, for patients who qualify.

There are also many private pay options, such as using savings, applying for other grants or scholarships, or payment plans such as sliding-fee scales.

How Do I Find A Massachusetts Rehab Center That Accepts BCBS?

Because BCBS is in-network with many rehab centers across the United States, it likely won’t be difficult to find drug and alcohol rehab that accepts your plan. To begin this process, you can talk to a BCBS insurance adjuster or one of our treatment representatives to get started.

Does BCBS Cover Massachusetts Inpatient/Residential Rehab?

Most Blue Cross Blue Shield insurance plans cover some portion of the costs of inpatient rehab programs (also called residential treatment). Your amount of coverage will depend on your individual plan, with Bronze plans typically covering the least amount of treatment costs overall and Gold covering the highest amount.

Inpatient treatment programs for substance abuse range in format and length, but can last from two weeks to 90 days or longer, with the first few days spent in detoxification. Residential rehab treatment may include detox, dual diagnosis treatment, therapy, counseling, and more.

How long your BCBS plan will pay for residential rehab may depend on you—most insurance providers require clinical evaluations to show medical necessity for treatment (prior authorization).

Inpatient rehab programs often perform medical assessments throughout treatment to determine recovery progress. If a BCBS policyholder continues to show the need for drug and alcohol addiction treatment after completing an inpatient treatment program, then a longer residential rehab stay may be approved for coverage.

Is Medical Detox Covered By Blue Cross Blue Shield?

Drug and alcohol detox is often the first step in substance abuse treatment for many individuals. Because detox can be so important for alcohol and drug treatment, it is usually covered by Blue Cross and Blue Shield insurance plans.

Many rehab centers, including those that accept Blue Cross Blue Shield, offer a medical detox program as part of inpatient treatment.

Does Blue Cross Blue Shield Cover Outpatient Treatment?

Unlike inpatient treatment, outpatient treatment for addiction does not require an overnight stay at a rehab center. Many forms of outpatient rehab programs are covered by a Blue Cross and Blue Shield insurance policy. Coverage will differ by the rehab program and your individual plan.

Your BCBS insurance provider may require precertification for outpatient treatment, a physician referral, or a clinical assessment showing the need for treatment before covering the cost of your rehab program.

Is Partial Hospitalization Covered Through BCBS?

Partial hospitalization programs (PHP) can be covered by Blue Cross Blue Shield policies. These intensive day treatment programs are useful for newly recovering individuals or patients who cannot enter inpatient treatment.

Is Massachusetts Intensive Outpatient Treatment Covered Through BCBS?

Blue Cross Blue Shield health plans may cover the cost of intensive outpatient programs (IOP) as well, which are similar to PHPs in structure and intensity. Intensive outpatient programs may be offered by drug and alcohol rehab centers for individuals who are in their early days of recovery.

Does Blue Cross Blue Shield Cover Sober Living?

Sober living costs can be covered by Blue Cross Blue Shield insurance policies if the transitional living facility pairs sober living with a form of outpatient treatment. However, whether sober living is considered treatment for substance use disorders (rather than a form of housing) may vary according to where you live.

Does Blue Cross Blue Shield Cover Medication-Assisted Treatment?

Medication-assisted treatment (MAT) programs are often covered by BCBS, as these programs are highly effective in helping individuals addicted to opioids, alcohol, and other substances safely quit the use of the drugs.

Are Methadone Costs Covered By BCBS?

Methadone costs may be covered by Blue Cross Blue Shield plans for those with opioid use disorders. Which type of medication you take can affect your amount of coverage, such as the daily methadone pill or monthly methadone injection.

Will Massachusetts BCBS Cover Suboxone Therapy?

Blue Cross Blue Shield may cover the cost of Suboxone as well, another medication used in MAT programs. Suboxone therapy is often part of a long-term recovery plan which includes counseling and therapy as well. Your Blue Cross Blue Shield pharmacy benefits will likely include specific coverage information for each prescription.

Verifying Your Massachusetts Blue Cross Blue Shield Insurance Coverage

When you’re ready to look for addiction treatment for you or a loved one, the first thing to do is verify your insurance coverage.

This will tell you what types of addiction treatment will be covered by your Massachusetts BCBS plan and at what rate. You will also want to begin vetting treatment centers to find rehab programs that meet your needs.

To make this process easier, Spring Hill Recovery Center can help. We can look at your insurance policy and help you understand which forms of drug and alcohol treatment qualify for coverage through your BCBS plan.

If you are in the northeast U.S. region, we can help you find the rehab treatment program that’s right for you.

We offer rehab programs for residents of New England states, including:

Learn more about Spring Hill Recovery, our inpatient treatment facility, the programs we offer, and how we can help you explore addiction treatment options by contacting our helpline today.

Written by Spring Hill Editorial Team

Published on: July 31, 2020

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This page does not provide medical advice.

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