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Blue Shield of CaliforniaUnderstanding precisely what Blue Cross Blue Shield covers regarding substance abuse treatment can be difficult. Various states have different parameters regarding what must be covered by health insurance and in which amount. They also offer a range of policies that differ from state to state.

Take Blue Cross Blue Shield of California, for example. They offer 14 insurance policies that include substance abuse treatment coverage. However, each plan covers different amounts for different forms of treatment and for different lengths of time. 

If your variables across health insurance policies include:

  • Co-payments
  • Hospital benefits
  • Outpatient treatment
  • Partial hospitalization program
  • Physician benefits

Depending on the rehab center and specific treatment needed, the co-payment and out-of-pocket costs will differ significantly. However, Blue Cross Blue Shield does guarantee that substance abuse treatment copayments and coinsurance costs will reflect similar medical services. Also, there are no limits on the amount of medically necessary services covered.

Blue Cross Blue Shield is a mix of multiple separate providers, but collectively it’s one of the nation’s biggest health insurance companies.

Blue Cross Blue Shield health insurance covers some of the cost associated with:

Blue Cross Blue Shield is a global healthcare provider covering over 106 million people across the nation, operating 36 local independently owned and operated community-based companies. In California, the Blue Cross Blue Shield providers are Anthem Blue Cross and Blue Shield of California.

Blue Cross Blue Shield is one of the most comprehensive insurance companies in the U.S., with over 95% of doctors and hospitals contracted, making it the top healthcare provider nationwide. 

Blue Cross Blue Shield offers many different policies and insurance coverage for its members.

Does Blue Cross Blue Shield Cover Rehab Expenses?

Health insurance was once thought of as a luxury for the rich. People with low paying jobs and small budgets usually didn’t have extra money to pay for expensive health insurance plans.

This drove people to not receive treatment unless it was a life-threatening situation. Any other issues were ignored. That also meant substance abuse remained untreated. For people without health insurance, seeking out rehab for a substance addiction was too expensive to consider.

Luckily, that is not the case today since the passing of the Affordable Care Act. In 2014, the only 13% of Americans were not covered with health insurance. Today, more U.S. citizens than ever are covered by health insurance.

Two of the most common forms of health insurance plans are HMO and PPO. Every individual insurance policy does cover a portion of substance abuse and mental health treatment. Listed below are differences between HMO and PPO plans:

Health Maintenance Organization (HMO): This plan allows clients to choose their primary care physician and use them for most of their medical needs. This allows the client to maintain their relationship with their doctor who knows their health history. When looking into a specialist or physician outside of the network, referrals are required by your primary care doctor. 

HMO plans have small or no deductibles, and the coverage is typically less than PPO plans. HMO coverage benefits are when clients like to remain with their specialists and healthcare providers while still paying in-network premiums.

Preferred Provider Organization (PPO): This plan allows clients to see their healthcare provider even out of network without requiring a referral. PPO plans usually come with a higher deductible than HMO plans. One benefit of PPO plans is the ability to see a specialist or other healthcare provider outside of your network claim without a referral from your primary care physician.

Does Blue Cross Blue Shield Cover Mental Health Disorders?

As part of the Affordable Care Act, health insurance plans are also required to provide the same amount of care for mental health disorders as they do for physical health issues. This means that plans which allow podiatrist visits for $20 must also allow psychologist visits at the same price. The care and value must be equivalent.

It has been stated that these parity laws pertain to several programs, including plans provided by employers, people requiring healthcare changes, and people coming through the Children’s Health Insurance Program (CHIP) and Medicaid.

Parity laws don’t specifically say which forms of mental health disorders a plan must cover, but the rules are similar to those seen in addiction treatment. If the plan provides care for mental health disorders, it usually won’t stipulate covering some diseases like addiction and mental health. Tapping into that would require a lot of time and paperwork. Therefore, the plan covers everything.

Regardless, this should be addressed with your plan administrator. But usually, mental health is covered by all health insurance plans.

Blue Cross Blue Shield Policies Regarding Rehab Coverage

When using Blue Cross Blue Shield insurance to enroll in rehab, the first step is to contact your insurance provider. Sometimes rehab services require preauthorization to be covered. The preauthorization process can be done over the phone or by filling out paperwork. Most Blue Cross Blue Shield plans do not require referrals to see the specialist of choice, just a verification for services rendered.

Depending on which plan, coverage for rehab can vary. For example, some plans might require a copayment for office and outpatient appointments. There will be a copayment needed, which is a set amount paid upfront for treatment services.

Insurance plans will also have a deductible amount, coinsurance rates, and annual fees. The deductible will be the amount that must be reached before the coverage starts, or the coinsurance amount of the policyholder’s rate must be paid out-of-pocket. For example, a coinsurance rate of 20% means Blue Cross Blue Shield covers 80% of the person’s treatment services responsible for the remaining 20%. The maximum out-of-pocket amount is a cap on the number of medical expenses a policyholder pays out in a year. From there, Blue Cross Blue Shield covers the rest at 100% after this amount is obtained. Generally, the higher the level, the lower the deductible and the higher the monthly premiums.

Blue Cross Blue Shield plans are all very different; but insurance plans like the gold 80 HMO Trio will cover mental health, behavioral health, and distribution treatment services. These include:

  • Hospital treatment
  • Inpatient treatment
  • Office visits
  • Outpatient treatment
  • Partial day treatment
  • Psychological testing
  • Residential treatment

Verification will be required prior to enrolling in the program offered through a Blue Cross Blue Shield in-network provider. Outpatient and inpatient treatment services will usually include relapse prevention skills training, educational programs, therapy, medical and mental health care, support groups, detox services, and medication management. Blue Cross Blue Shield representatives can direct their members to contracted providers and rehab clinics to optimize their insurance coverage in paying for services before they enroll.

Medical Necessity

One of the roadblocks in obtaining precise information regarding what is not covered by Blue Cross Blue Shield is the medical necessity issue. The therapist or physician who determines that residential treatment is necessary might need to provide an addiction diagnosis to the insurance provider, proving it is a medical necessity.

Unfortunately, physical dependence and withdrawal symptoms are usually not enough proof that residential treatment is a medical necessity. The increased risk of relapse during outpatient treatment will not guarantee approval for inpatient treatment. In some instances, clients will need to prove that outpatient treatment won’t work for their situation, or they might be required to utilize it first if they want their insurance to cover the cost.

Clients are also urged to get pre-authorization for the therapy services needed before they begin treatment to guarantee that their insurance company covers them.

Covering Additional Rehab Costs

Even in the best-case scenario, most health insurance policies do not cover the entire cost of detox and residential treatment. Clients and their families will be responsible for coming up with the remainder of the bill. Although this may sound overwhelming, especially when someone involved is suffering from addiction, it could be a life-saving decision.

Many people side stop using health insurance to solely cover the cost of addiction treatment because it delays the admissions to rehab or because the effort doesn’t equate the time put in. Instead, people will utilize various resources to cover treatment costs by using options that include:

  • Financing the cost
  • Receiving a loan from loved ones 
  • Personal savings
  • Fund me account

Regardless of whether you have health insurance, these options can help to cover the cost of treatment, allowing families to concentrate on helping their loved ones to heal. 

Get Help Today

Do not hesitate to inquire into substance abuse treatment any longer. At New Directions For Women, our admissions specialists are here to ensure that you receive all of the financial help you are entitled to with your Blue Cross Blue Shield of California coverage plan. 

New Directions For Women is in-network with Blue Cross Blue Shield of California. Therefore, we will work collectively to make substance abuse treatment coverage possible and convenient. Our treatment team understands the importance of catering to the client’s treatment while budgeting simultaneously.

If you or a loved one requires a rehab but is still uncertain you can afford it, contact us today for a free consultation. Our admissions specialists will answer any of your questions by getting you the answers you seek regarding your Blue Cross Blue Shield of California addiction treatment coverage options.

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