BlueCross Blue Shield does cover treatment for substance abuse. However, the coverage depends on your policy and plan; it varies depending on your location and your plan. This means some programs may have a significant out-of-pocket expense, while others may be covered entirely. The best way to know is to call BCBS directly and ask what your coverage is. 

BlueCross BlueShield for Drug and Alcohol Rehab

BCBS insurance companies cover nearly 105 million people nationwide. That means BCBS covers almost 1 in 3 people! Each policy varies, each providing a range of benefits for drug and alcohol rehab. 

Universal BCBS includes coverage for some of the costs of the following addiction programs.

The BlueCross BlueShield Association owns 36 health insurance companies. These companies are independently owned and operated and located across the country and make up the Blue System. BCBS covers more than half of federal employees as part of their Federal Employee Program. 

BlueCross BlueShield Plan Options for Addiction

The individual and family plans from BCBS fall into 3 or 4 categories. These categories depend on the state in which you live. These plans include bronze plans, silver plans, gold plans, and platinum plans.

Bronze plans will have the lowest costs, while platinum plans cost more monthly. The platinum plan is not available in all states. BCBS recommends the bronze plan for people who are healthy and do not go to the doctor much. The bronze plan may have low monthly costs, but the deductible is high. 

BlueCross BlueShield tiered plan coverage is as follows:

  • Bronze plan – This plan covers approximately 60% of medical costs. The bronze plan has a low monthly payment and a high deductible. 
  • Silver plan – This plan covers about 70% of medical expenses. The silver plan has a little higher monthly payment with a slightly lower deductible. 
  • Gold plan – The gold plan covers around 80% of medical costs. The gold plan has a higher monthly fee and a low deductible. 
  • Platinum plan – The platinum plan covers approximately 90% of medical expenses. The platinum plan has the highest monthly payment but has the lowest deductible.

It is vital to talk with your BCBS representative to get a clear explanation of what your BCBS policy covers.

Tools and Resources for Addiction Prevention with a BlueCross BlueShield Policy

BlueCross BlueShield understands to risks of addiction. They offer different tools to help identify addiction issues and resources for individuals to find help for their addiction. Recently, BCBS created a prescription pain medication safety program. This program can help people at risk of addiction reduce the chance of addiction. This program was designed specifically for opioids like Percocet and Vicodin.

OneHealth is a mobile platform that provides members and their families with 24/7 support. BCBS has loaded this application with the tools and resources needed to recover from addiction and build a healthy life. Included in these tools and resources are:

Blue Distinction Centers for Substance Use Treatment and Recovery

BlueCross BlueShield companies developed a national program, Blue Distinction Center for Substance Use Treatment and Recovery. This program recognizes nationally accredited treatment centers that improve outcomes with evidence-based and patient-centered care. 

Blue Cross Blue Shield Provider Finder

BCBS provider directory allows you to search for a provider by name or type of provider. To locate a provider in your network, you will need your policy information. This information will be available on your member ID card. 

Will My BlueCross BlueShield Policy Help Pay for Rehab?

BlueCross BlueShield offers partial coverage of addiction rehab. Coverage depends on your policy type and the state in which you live. A person in one state may be covered while a person in a neighboring state may be denied. 

Understanding your coverage through BCBS can be complicated. The best way to get a clear explanation of your coverage is to call BCBS. North Jersey Recovery Center representatives can also help you receive the full benefits you are entitled too.

BlueCross BlueShield offers coverage for substance abuse treatment in some form. Most plans cover medical detox treatment if it is deemed necessary. Medical detox is essential for those suffering from alcohol addiction, opiate addiction, and benzodiazepine addiction. Detoxing from these substances is extremely dangerous and should only be done under medical supervision. 

How To Know If The Provider Is Covered

The type of program and the provider you choose for addiction treatment also affects BCBS coverage. If your plan is an HMO (Health Maintenance Organization) plan, then you are only covered at HMO-contracted centers. If your plan is a PPO (Preferred Provider Organization) plan, then you have the potion to see a range of providers. This includes out-of-network providers, but at a higher out-of-pocket expense. 

Each plan is unique. For this reason, it is vital to speak to your insurance representative to get the specific details of your policy. Addiction treatment centers can be costly. The cost of treatment is a significant factor in which facility a person chooses. Your BCBS representative will help you find the best treatment for the least amount of out-of-pocket expense. 

BlueCross BlueShield Detox Coverage

In many situations, those seeking addiction treatment must first go through medical detox. Not all individuals who battle addiction need medical detox. Detoxing from substances such as alcohol or opioids can be dangerous and require medical detox. If medical detox is necessary, It is vital to know BCBS’s policy on medical detox. 

Some BlueCross BlueShield policies cover inpatient detox or outpatient detox. But, only a portion of the costs will be covered. Again, your coverage through BCBS depends on your policy and the facility you would like to attend. If your policy is an HMO plan and you choose an HMO-contracted center, you may be covered. If you have a PPO plan, then you have more facilities to choose from. 

BlueCross BlueShield goes above and beyond other insurance companies by being a little more flexible on detox and treatment options. It can be easier to find an addiction treatment facility and detox center when covered by BCBS. The easiest way to find a treatment or detox center with the least amount of out-of-pocket expense is to call BCBS. You can also contact us here at North Jersey Recovery Center, and we can help you with all the details. 

Inpatient Treatment Coverage With BlueCross BlueShield

Again, your BlueCross BlueShield coverage depends on your policy and the state in which you live. Each state has its own rules and regulations regarding insurance coverage. Inpatient treatment coverage also depends on the facility and its location.

For example, a person covered by BCBS receives treatment for substance abuse at a hospital, and another person also covered by BCBS gets treatment at a residential facility. The coverage for the services received will differ between both individuals. 

It is essential to know if you need pre-authorization before entering a treatment facility. Some plans through BCBS require pre-authorization. BCBS coverage does not depend on the type of addiction a person is battling. This means your policy through BCBS will cover the same amount whether you are addicted to alcohol or painkillers. 

Costs and Services of Inpatient Treatment BlueCross BlueShield Covers

Inpatient programs offer medically supervised detox and 24/7 support at the highest level of care. Some definitions of standard health insurance terms can help you understand your policy better. These terms include some of the following:

Premium: A premium is a monthly payment made to the insurance company to maintain coverage. Sometimes, an employer will cover a part of this payment. 

Coinsurance: Coinsurance is a cost-sharing service. These services cover healthcare and prescription medications. 

Deductible: A deductible is an amount a person pays before insurance starts to cover more of the bill. 

Out-of-pocket Maximum: Out-of-pocket maximum is the maximum amount of money a person will have to pay per year. Once the yearly maximum is met, then insurance covers 100%. 

Bronze Plan: Bronze plans have a minimum monthly payment and only covers in-network providers.

Silver Plan: Silver plans have a little higher monthly payment but they cover a little higher percentage of medical bills.

Gold Plan: Gold plans have high monthly payments but offer a higher percentage of coverage. People with gold plans can usually use in-network and out-of-network providers.

Platinum Plan: Platinum plans are not offered in every state. Platinum plans cover 90% of all healthcare needs. The high percentage of coverage also has a high monthly payment for coverage. 

Does BlueCross BlueShield Cover Mental Health Treatment?

For individuals who battle mental health disorders, BlueCross BlueShield can help cover the costs of treatment. Mental and behavioral health disorders are common in people who suffer addiction issues.

When a person suffers from both addiction and mental health disorders, it is called a dual-diagnosis. For someone who suffers from co-occurring disorders, it is vital to treat both issues. Your BCBS representative can help you discover the best options for treatment that fit into your budget. 

Insurance plans should not offer different coverage for mental health disorders than it does for a physical injury. So no matter what mental and behavioral disorders you are experiencing, insurance should offer some coverage for the costs of your care. 

Common mental and behavioral disorders include:

BlueCross BlueShield provides coverage for addiction as well as mental and behavioral health disorders. Again, coverage is based on your policy and the state in which you live. 

North Jersey Recovery Center Helps You Understand BCBS Benefits

At North Jersey Recovery Center, we understand that the specifics of insurance coverage can be confusing. Some of the benefits of being a BCBS policyholder and enlisting us to help include:

  • We do a thorough review of your BlueCross BlueShield insurance policy.
  • We determine what percentage of your BCBS policy covers treatment.
  • BlueCross BlueShield is accepted at many facilities in the U.S.; we will help find the best programs for you. 

It is vital to understand your options when choosing a treatment facility. The choice you make will help determine the success of recovery. Our caring and professional staff members are waiting to answer all your questions. Contact us today and get all your addiction treatment and recovery questions answered.

Reviewed for Medical & Clinical Accuracy by Laura Riley

Medical Reviewer

Laura comes to NJRC with 23 years of vast clinical experience in hospital, residential, outpatient, and community outreach settings where she has worked, supervised clinical teams, and volunteered. She has provided substance abuse and mental health counseling, clinical coordination, and advocacy to individuals, families and groups, and specializes in co-occurring disorders for both adults and adolescents.