Getting to the bottom of what Blue Cross Blue Shield will cover when it comes to substance abuse treatment can be tricky. Different states have different parameters for what must be covered by insurance and in what amount, plus they offer a range of policies that vary from state to state as well.
Consider, for example, Blue Shield of California. They offer at least 14 insurance policies that cover substance abuse treatment. However, each plan will pay different amounts for different types of treatment for varying lengths of time. Some variables across policies include:
- Outpatient services
- Partial hospitalization
- Physician benefits
- Hospital benefits
Depending upon the venue, the specific treatment recommended, and the professional recommending that service, your co-pay and out-of-pocket costs will vary significantly. However, Blue Cross Blue Shield does guarantee that substance abuse treatment services co-payments and coinsurance amounts will be “the same as that for comparable medical services.” There are also no annual limits on the number of “medically necessary services” that will be covered.
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.
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
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.
Further Reading About Will Blue Cross Blue Shield Pay for Rehab?
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton