BCBS Insurance Coverage for Addiction Treatment

Blue Cross Blue Shield (BCBS) companies cover 110 million members in the United States and have more doctors and hospitals under contract nationwide than any other insurer.¹ Blue Cross Blue Shield Massachusetts alone has nearly 3 million members.²

This article will discuss how you can use Blue Cross Blue Shield to cover your addiction treatment.

Does Blue Cross Blue Shield Cover Drug and Alcohol Rehab?

Yes, most BCBS plans will provide substance use disorder treatment coverage. If the plan was purchased on the marketplace, the Affordable Care Act (ACA) requires this essential health benefit be covered. The passage of the ACA also mandated that companies can no longer refuse to provide coverage to individuals with preexisting conditions and that behavioral health coverage cannot be more restrictive than medical health coverage.”³

If you have health insurance coverage, it is very likely that you will be covered for addiction treatment. However, the amount you pay out-of-pocket that treatment will vary greatly depending on your specific plan and the facility you choose.

You can easily verify your BCBS health insurance coverage and see if you’re covered for treatment with AdCare by filling out an .

Addiction Treatment Centers that Accept Blue Cross Blue Shield Insurance

With most Blue Cross Blue Shield plans, you’ll have to—or it will be much more cost-effective to—opt for addiction treatment with rehabs that are in the Blue Cross Blue Shield network. Fortunately, AdCare, which has several facilities in Massachusetts and Rhode Island, is considered in-network with BCBS.

In most cases, BCBS will need to provide authorization of treatment services before the facility you choose may begin treating you. Staff at a treatment facility may reach out to BCBS to get this preauthorization on your behalf.⁴

Types of Addiction Treatment Covered by Blue Cross Blue Shield

There are several forms of addiction treatment provided by AdCare that may be covered by your Blue Cross Blue Shield plan. These include:⁵

• Medical detox: The management of withdrawal symptoms with medications and the support of medical staff.
• Inpatient treatment: Intensive live-in rehab fully focused on changing destructive habits and introducing healthy structure and recovery-sustaining habits.
• Outpatient care: Treatment that contains many elements of inpatient rehab, such as group and individual therapy, but allows the freedom to live at home.
• Telehealth therapy: Treatment provided via phone or computer for those unable to attend treatment in person.
• Medication-assisted treatment (MAT): The use of maintenance medications (e.g., methadone, Suboxone, or naltrexone) for addiction to opioids used in combination with behavioral therapies. MAT medications such as acamprosate or disulfiram may also be used for the treatment of alcohol addiction.

The appropriate setting and length of treatment will vary based on an individual’s needs. However, every setting typically involves a combination of various evidence-based therapies.⁶

How Much Does Rehab Cost with BCBS Insurance Coverage?

This will depend significantly on a patient’s specific Blue Cross Blue Shield (BCBS) insurance plan, the facility where they are treated, and the type of care they receive. Factors that determine treatment cost include the following:

• Annual deductible. This is the amount you must pay before health insurer begins paying for treatment.⁷
• Co-insurance rate. This is the percentage of the fees for a covered service you will be responsible for while the insurer covers the rest.⁸
• Co-payment. This is an amount you must pay for a covered service (e.g., a doctor visit or therapy session) after you’ve met your deductible.⁹
• Out-of-pocket maximum. This is the maximum amount you would be required to pay for health services within a plan year. After this, the insurance company will cover 100% of the remaining costs for covered services.¹⁰

Even with insurance, cost still may be a barrier to treatment.¹¹ However, there are several ways that make paying for treatment more affordable, including financing and loans. Some facilities may also offer sliding scales (adjusted rates based on income) and flexible payment plans.

How Do I Use Blue Cross Blue Shield Insurance for Rehab?

The first step in using Blue Cross Blue Shield insurance to pay for rehab is finding a rehab facility that is within the BCBS network. You can use our online benefits verification tool to see whether your insurance plan covers treatment at AdCare.

Make sure you get your prior authorization before starting treatment as not doing so may void your coverage in certain instances. For questions about coverage and treatment options, you can call to speak to an admissions navigator immediately at .

Benefits of BCBS Insurance Coverage in the Northeast

Addiction and substance misuse is a serious problem in the New England area, as the following statistics will confirm:

• New Hampshire, Massachusetts, Connecticut, Rhode Island, Maine, and Vermont respectively place 3^rd, 5^th, 6^th, 8^th, 10^th, and 11^th highest in states with the highest opioid-involved overdose deaths per 100,000 people.¹²
• Alcohol misuse is also high in New England, with Vermont leading the USA in the having the highest percentage of people that drink heavily (9.4%) according to data compiled by the Centers of Disease Control and Prevention (CDC) in 2019.¹³
• Vermont also has the highest percentage of people 12 years old or older that used illicit drugs within the past month (21.13%), according to the 2019 National Survey of Drug Use and Health (NSDUH).¹⁴