Will Blue Cross Blue Shield Pay for Rehab?

Medically Necessary

One of the hiccups in getting straightforward information about what is and is not covered by Blue Cross Blue Shield is the issue of “medical necessity.” The physician or therapist who determines that drug or alcohol rehab is necessary may need to provide proof to the insurance provider that it is, in fact, a medical necessity.

Unfortunately, physical dependence and withdrawal symptoms may not be enough proof that, for example, inpatient care is medically required. The increased chance of relapse if treatment occurs on an outpatient basis will not necessarily translate into a guaranteed approval for inpatient rehab. In some cases, patients may need to prove that outpatient services were ineffective or else utilize these services first if they want insurance to help pay the bill.

Patients are encouraged to get preauthorization for the treatment services they need before beginning treatment in order to ensure that they have the coverage they expect before incurring a bill.

Networks

Within the Anthem Blue Cross Blue Shield network, for example, there are a host of psychiatrists, therapists, medical professionals, and mental health professionals who all offer substance abuse treatment. They may not be specialists but they provide treatment for drug and alcohol addiction and are within the network; therefore, it may be easier for consumers under this coverage to get more of the cost paid for by insurance if they use these specific providers. To determine the specific amounts of coverage provided for services given by network providers versus providers outside the network, consumers are encouraged to call their confidential helpline for that and other information.

After Health Insurance: The Options for Payment

Even in the best of circumstances, most health insurance policies will not cover the entire cost of inpatient addiction treatment. Patients and their families will be tasked with coming up with the remainder of the bill. Though this may sound overwhelming, especially when in the midst of the crisis of active addiction, it’s certainly possible.

In fact, many people sidestep the use of health insurance to cover the cost of treatment entirely because it can delay entry into rehab and/or because the effort is not worth the final payout. Instead they pull from various resources in order to cover the cost of care, using options like:

• Personal and family savings
• Loans from family or friends
• Financing

These options, with or without health insurance, can help cover the cost of treatment and allow families to focus on helping their addicted loved one to heal. Contact us today to learn more about connecting your family member with the treatment they need to overcome addiction and begin a new healthy life in recovery.