Blue Cross Blue Shield Detox & Rehab Benefits Guide
Blue Cross Blue Shield (BCBS) is a private insurance company that services members across the United States and Puerto Rico. The system covers more than 107 million people within its 36 independently owned and locally operated companies.1 If you are struggling with drug or alcohol addiction and are considering drug rehabilitation or detoxification services, this page will help inform you about using your insurance plan to access these services.
You may be wondering how Blue Cross Blue Shield insurance works and how to access drug rehab coverage or receive treatment at a Blue Cross Blue Shield alcohol rehab center. Navigating the world of health insurance can feel intimidating, but it is important to gather as much information about your coverage options as possible if you are considering entering drug or alcohol treatment.
Many alcohol and drug rehabilitation centers across the U.S. accept Blue Cross Blue Shield. It is your job to make sure that your Blue Cross Blue Shield plan is accepted by the rehab provider.
Types of Blue Cross Blue Shield Plans
Blue Cross Blue Shield offers several plans to help ensure you receive the benefits specific to your healthcare needs. It is important to note that plans vary from state to state. Insurance options are available to employers, individuals, and families.
With the Basic plan, you must use an in-network provider and you must receive a pre-authorization.4 You will most likely have a co-pay for substance abuse services under the basic plan. Coverage for an individual is roughly $35 a week. You can learn more about the FEP basic plan here.
The FEP Blue Focus Plan is the least expensive option; you can expect to pay around $26 a week for individual coverage.5 A stipulation with this plan is that services and providers must be in-network. There are no co-pays for inpatient mental health or substance abuse services; however, you are required to pay a percentage of services received. For outpatient substance abuse and mental health services, you can expect to pay a $10 co-pay. To learn more about the FEP Blue Focus Plan, visit the FEP Blue Focus benefit page.
For individuals, families, and employees, Blue Cross Blue Shield offers several plans including Bronze, Silver, Gold, and in some states, Platinum. Things to consider when picking a plan include out-of-pocket costs (including co-pays) and whether your provider is in-network or out-of-network. Bronze plans have the lowest monthly costs and the highest out-of-pocket costs; they cover about 60% of the total cost of services.6 The Silver plan has higher monthly costs than Bronze, with roughly 70% of services covered. 6 Where the Platinum plan is available, it has the highest monthly cost with the lowest out-of-pocket costs for services (90%).
Consider whether a preferred provider organization (PPO) or a health maintenance organization (HMO) is right for you; each option has its own advantages. A PPO allows you to receive services from any healthcare professional, whether or not they are in the provider network.7(blue box) You do not need a referral. However, it is important to understand that some services may not be covered by an out-of-network provider. This is also true for alcohol and drug rehabilitation services, so make sure that your services are covered under your plan.
With an HMO you pick a primary care physician who coordinates all other medical services for you.7 You can expect to need a referral for specialized services. Blue Cross Blue Shield has created an interactive tool to help you determine whether a PPO or HMO is right for you, based on your specific healthcare needs. Click here to determine your best choice.
Blue Cross Blue Shield & Medicare
Blue Cross Blue Shield has Medicare supplemental insurance plans for individuals age 65 and older. Medicare is a federally funded health insurance plan for people 65 and older. BCBS offers supplemental Medicare plans to help reduce the cost of healthcare for people who qualify for Medicare.2
The Federal Employee Plan (FEP) provides services to federal employees, retirees, active military, and veterans. Under the FEP you can choose from among 3 different plans: Standard, Basic, and FEP Blue Focus. With the Standard plan, you can use in-network or out-of-network providers, and, depending on your plan, you can expect to pay a co-pay for inpatient mental health or substance abuse services.3 It is the most expensive plan, with weekly payments around $59 for an individual plan. Pre-certification is required for inpatient hospital services. Visit the standard FEP plan to learn more.
How to Check Your BCBS Benefits
How do I check my Blue Cross Blue Shield coverage? To check your insurance benefits, you can call the number on the back of your insurance card and speak to an insurance representative. You can also obtain information by going to the login page. Here you will find information about your specific plans, including coverage, in-network providers, co-pays, and deductibles. You can also verify what services are covered and which rehabilitation providers accept your plan.
Do BCBS Plans Cover Detox & Rehab?
Blue Cross Blue Shield rehab coverage varies from state to state, so it is important to verify your coverage before receiving substance abuse treatment. Blue Cross Blue Shield rehab insurance covers a variety of substance abuse and mental health services. The following mental health and substance abuse services are generally covered:
- Psychiatric evaluations
- Inpatient mental and behavioral health treatment
- Substance use disorder treatment
- Specialized therapeutic services
- Psychotherapy and counseling
Substance use disorder treatment refers to a broad range of services including detoxification, inpatient rehabilitation, outpatient therapy, and case management services. Detoxification, often the first of many steps on the road to recovery from drugs and alcohol, is composed of a set of medical interventions designed to aid in the safe withdrawal from alcohol and drugs.8 It can be dangerous and often involves medication use under the supervision of medical professionals. Your Blue Cross Blue Shield therapy coverage may cover detox services that help make a withdrawal from substances as comfortable and safe as possible.
Given that detox and rehab are costly, it is important to understand what services are covered under your specific plan. Also, consider whether your substance abuse treatment requires a pre-authorization and if the program is within the approved provider network. These two factors are important in ensuring that you maximize your insurance coverage and pay the least amount of out-of-pocket expenses for treatment.
- Blue Cross Blue Shield. (n.d.). The Blue Cross Blue Shield system.
- Blue Cross Blue Shield. (n.d.). Blue Cross Blue Shield Medicare.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 standard options benefits chart.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 basic options benefit chart.
- Blue Cross Blue Shield Federal Employee Program. (n.d.). 2020 FEP blue focus benefits chart.
- Blue Cross Blue Shield Blue Care Network of Michigan. (n.d.). What’s the difference between bronze, gold and silver plans?
- Blue Cross Blue Shield Blue Care Network of Michigan. (n.d.). HMO vs. PPO: Which one is right for you?
- U.S. National Library of Medicine. (n.d.). Detoxification and substance abuse treatment.