Blue Cross Blue Shield Insurance Coverage for Alcohol Rehab

Learn more about Blue Cross Blue Shield insurance coverage for alcohol rehab, the types which may be covered and how to check your plan.

With 36 health insurance companies locally and independently operated throughout the United States, the Blue Cross Blue Shield (BCBS) Association is one of the largest insurance providers in the country.1 If BCBS is your insurance provider, some or all of your alcohol rehab and detox expenses will be covered, depending on the plan you have.

The Affordable Care Act requires health insurance providers like Blue Cross Blue Shield to provide coverage for mental health care and treatment for substance use disorder (including alcohol addiction); these are considered essential services, and the law mandates that treatment must be accessible to everyone who needs it.2

If you are searching for alcohol rehab and/or detox help for you or your loved one living with addiction, knowing what is covered by your insurance policy can provide peace of mind.

Does Blue Cross Blue Shield Cover Alcohol Treatment?

If Blue Cross Blue Shield is your insurance provider, your policy likely covers some or all of the costs for different types of alcohol treatment, including:3

  • Detox services: When some people stop drinking alcohol, they experience physiological and psychological symptoms of withdrawal. Detox services can help you withdraw from alcohol safely. Medical supervision is provided around the clock to ensure your comfort and safety.
  • Interim care: After alcohol detox, you may need interim care, which ensures you receive care until space opens up at an inpatient treatment center. This typically involves counseling and daily medication, if needed.
  • Inpatient or residential care: Inpatient residential facilities provide you with a place to live while you get sober and learn healthy coping mechanisms. Most rehab stays last anywhere from a month to a year, depending on your needs and the program/facility you are enrolled in.
  • Partial hospitalization programs (PHP): PHPs — sometimes called day treatment — allows you access treatment at the alcohol treatment facility during the day and sleep at home.
  • Intensive outpatient (IOP): Intensive outpatient programs involve attending alcohol treatment programs approximately 3 evenings a week. You live at home and go to work during the day, and are expected to attend treatment in the evenings.
  • Outpatient treatment: Outpatient treatment for is ideal for those who have completed residential/inpatient treatment and would like ongoing support in their sobriety.
  • Sober living home: Sober living homes are temporary living situations in a home or facility. These are for individuals who have completed inpatient treatment but are not yet ready to live independently.

Blue Cross Blue Shield Tiers and Coverage Plans

Blue Cross Blue Shield offers 3 or 4 tiers of individual and family plans so you can choose a plan that offers what you need based on your budget and how often you access healthcare. Bronze, silver, gold, and platinum plans give you an idea about your monthly payments and out-of-pocket costs, such as deductibles and co-pays. They break down as follows:4

  • Bronze plans offer lower monthly premiums but generally come with higher out-of-pocket costs in deductibles and co-pays. Once your deductible is reached, insurance covers approximately 60% of your healthcare costs.
  • Silver plans have higher monthly premiums but lower out-of-pocket costs than bronze. Once your deductible is reached, silver plans cover 70% of your healthcare costs.
  • Gold plans have higher monthly premiums but lower out-of-pocket costs. Once you reach your deductible, 80% of your healthcare costs are covered.
  • Platinum plans have the highest monthly premium but the lowest out-of-pocket costs. Approximately 90% of your healthcare expenses are covered — ideal for people who visit the doctor frequently or take ongoing prescription medications.

Where Is Blue Cross Blue Shield Accepted?

Thanks to Blue Cross Blue Shield’s widespread presence across the country, members can get coverage for alcohol rehab in all 50 states. A large number of doctors and healthcare facilities (including alcohol rehab facilities) throughout the United States accept BCBS.

Many alcohol treatment centers accept Blue Cross Blue Shield insurance. If you’re not sure if the rehab facility you’re interested in accepts your insurance, it’s a good idea to call the number on the back of your insurance card to find out. You can also call the rehab facility directly to ask if they accept your insurance.

Blue Cross and Blue Shield companies have a national designation program called Blue Distinction Center for Substance Use Treatment and Recovery.5 The program recognizes nationally accredited treatment facilities that accept BCBS and use evidence-based, patient-focused care. Blue Cross Blue Shield offers a provider finder on their website. If you’d like to find a rehab center that accepts BCBS insurance, use the handy search tool on their website.

Does BCBS Cover Out-of-Network Care?

An in-network treatment facility is one with an agreement with Blue Cross Blue Shield to offer care for members at a lower rate than other providers. When you choose an in-network facility, it typically means lower out-of-pocket expenses for you.

Out-of-network facilities do not have an arrangement with BCBS, so your alcohol rehab costs may not be covered. If you choose an out-of-network facility, you will likely pay more for services yourself; in some cases, you must pay all associated costs.

Try to choose an in-network provider for your alcohol treatment whenever possible to keep your costs lower.

BCBS does cover rehab costs for some out-of-network facilities in special circumstances. For example, you may be a veteran in need of care at a veteran-specific facility, or you might live in a rural area with no local treatment facilities in-network. In these cases, it typically requires a pre-authorization from your healthcare provider before insurance coverage kicks in.

Does BCBS Cover Co-Occurring Mental Health Conditions?

The Mental Health Parity and Addiction Equity Act is a law enacted to ensure that everyone who wants access to addiction and mental health treatment can get the care they need. All healthcare insurance providers, including Blue Cross Blue Shield, must cover these services to some degree.6

Although BCBS may not cover all alcohol addiction treatment, it does cover many addiction treatment services. What is covered and the amount covered depends on your specific plan. Before you enter treatment, it’s a good idea to understand:

  • What your plan requires for accessing services.
  • Which services are covered under your plan.
  • How much you will pay out-of-pocket.
  • How much your insurance plan pays.

Taking care of your mental health is just as important as caring for your physical health. Just as you wouldn’t wait to get treatment for a broken bone, you shouldn’t put alcohol treatment on the back burner for a later time.

How to Check What Blue Cross Blue Shield Covers

Insurance coverage for drug and alcohol addiction treatment varies plan by plan, so it’s important to check with BCBS to determine what your specific policy will cover and how much you will be personally responsible for paying out-of-pocket.

There are a few ways to check which rehab and detox services will be covered by your Blue Cross Blue Shield insurance plan:

  • Blue Cross Blue Shield member portal. Log in to your account on the website to learn more about your policy and what is covered.
  • Blue Cross Blue Shield customer service. Call the number on the back of your insurance card to speak with a customer service representative. They can walk you through the details of your policy so you understand exactly what is covered.
  • Call the alcohol treatment center. Call the alcohol rehab facility you are considering and speak with an admissions specialist. They can check your benefits with you while you’re on the phone.

How to Pay for What Insurance Doesn’t Cover

No matter what insurance policy you have, you will likely have some out-of-pocket expenses for your alcohol addiction treatment. If you’re not sure how you will finance rehab, there are a few options that can ensure you get the help you need. Don’t wait for your finances to be in order — what’s most important is to get treatment as soon as you are ready and able.

Some options for paying for alcohol treatment include:

  • Payment plans. Most rehab facilities offer payment plans so you can pay over time, in affordable installments.
  • Sliding scale. Some alcohol rehab facilities offer sliding scale fees based on your income.
  • Grants and scholarships. The Substance Abuse and Mental Health Services Administration offers grants for individuals who meet the requirements. Many individual treatment facilities also provide grants and scholarships.
  • Use personal savings and/or credit cards.
  • Crowdfunding — websites like Gofundme allow you to ask for financial support from family and friends to help pay the costs of rehab.

Don’t let money hold you back from seeking treatment. If your insurance doesn’t provide coverage, there are ways to help pay your out-of-pocket expenses so you can focus on what matters most: getting and staying sober.

Verifying Your Blue Cross Blue Shield Coverage

Once you’ve found an alcohol treatment facility that meets your needs, it’s time to verify your insurance. Call the number on the back of your insurance card to determine what is required before you enter treatment (pre-authorization forms, for example), or call the rehab facility directly. Representatives can check your insurance for you while you’re on the phone.

 

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