Blue Cross Blue Shield Rehab Coverage

Blue Cross Blue Shield (BCBS), the largest health insurer in almost every state in the U.S., including about 90% of doctors and hospitals, provides coverage to approximately 115 million Americans.

This extensive network means that one in three Americans, including about half of all federal employees, rely on BCBS for their health coverage. Coverage can vary with 36 separate companies under the BCBS umbrella, but knowing the basics can help you or your loved ones access the necessary care.

Blue Cross Blue Shield plans often include benefits for addiction treatment services, from inpatient rehab to outpatient programs and counseling. Keep reading to learn about the specifics of your BCBS rehab coverage.

Table Of Contents:

• Does Blue Cross Blue Shield Cover Drug Rehab?
• What Does Blue Cross Blue Shield Cover?
• Benefits of Blue Shield Insurance for Members
• How To Check Blue Cross Blue Shield Drug Rehab Coverage?
• Finding Rehabs That Accept Blue Cross Blue Shield
• Does Blue Cross Blue Shield Cover Rehab? – Bottom Line
• People Also Ask

Does Blue Cross Blue Shield Cover Drug Rehab?

Yes, Blue Cross Blue Shield (BCBS) covers drug rehab. The Affordable Care Act (ACA), commonly known as Obamacare, has significantly impacted addiction treatment coverage. Under the ACA, substance use disorder treatment is considered an essential health benefit.

This means that all health insurance plans, including those offered by BCBS, must cover addiction treatment services. Yet, the specifics of the drug rehab coverage can vary depending on the particular plan and state regulations. Still, generally, BCBS plans include benefits for a wide range of addiction treatment services.

What Does Blue Cross Blue Shield Cover?

As we mentioned, while most health insurance plans are required to offer some form of addiction treatment coverage, the extent of this coverage can differ significantly. You can expect your plan to cover essential addiction treatment benefits including, but not limited to, the following areas:

• Inpatient rehab: Residential addiction treatment programs with 24/7 medical supervision
• Outpatient rehab: Therapy sessions, counseling
• Drug Detox: Medical supervision during withdrawal
• Medication-assisted treatment (MAT): Prescription drugs for addiction treatment
• Partial hospitalization programs (PHP): Intensive outpatient treatment
• Intensive outpatient programs (IOP): Less intensive outpatient treatment
• Support groups: Group therapy sessions

Does Blue Cross Blue Shield Cover Methadone Treatment?

Methadone is a synthetic opioid used to treat opioid addiction. This treatment approach, known as methadone maintenance therapy, has been effective since the 1950s. Patients receive a daily dose of methadone, either as a liquid or pill, to alleviate withdrawal symptoms and reduce cravings for opioids.

Blue Cross Blue Shield rehab coverage typically covers addiction treatment with methadone. However, BCBS places methadone as tier 2 or “non-preferred” medication (higher cost than preferred generic drugs).

This coverage may be facilitated through the reimbursement process using the HCPCS code H0020, which specifically denotes “alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program).”

Does Blue Cross Blue Shield Cover Suboxone?

Suboxone, a medication combining buprenorphine and naloxone, is another primary treatment for opioid addiction. This medication-assisted treatment (MAT) approach significantly reduces the risk of fatal overdoses by nearly half. Additionally, MAT lowers the likelihood of nonfatal overdoses, which can have severe medical consequences.

Blue Cross Blue Shield (BCBS) considers Suboxone a tier 1 (lowest co-payment) or preferred medication, but plans often don’t cover it directly. Instead, most plans cover generic alternatives that can perform the same function. BCBS drug rehab plans may also have dispensing limits on the quantity of covered medication per prescription or in a given period.

If a doctor prescribes more medication than the limit, Blue Cross Blue Shield suboxone coverage may not be covered, and the patient may be responsible for the full cost of the prescription.

Does Blue Cross Blue Shield Cover Alcohol Rehab?

Yes, alcohol rehab is also part of Blue Cross drug rehab coverage. However, remember that the specifics of your coverage will depend on:

• Your specific plan: Different BCBS plans have varying levels of coverage.
• State regulations: Coverage can differ by state.
• Type of rehab: Inpatient, outpatient, or detox programs may have different coverage levels.

Does Blue Cross Cover Therapy?

Yes, Blue Shield rehab coverage typically covers therapy services as part of their commitment to mental health services. However, the amount of coverage you receive depends on the type of insurance plan you have and your state.

Coverage details can include the number of sessions covered, types of therapy covered, copays or coinsurance amounts, and the network of providers. For example, some plans may cover medications to treat mental health, but others might require prior authorization before covering certain tests and medications.

Commonly covered addiction therapies include:

• Cognitive-behavioral therapy (CBT)
• Motivational enhancement therapy (MET)
• Motivational interviewing counseling (MIT)

Does Blue Cross Blue Shield Cover Drug Test?

Drug testing is often a crucial component of addiction recovery programs and ongoing monitoring. To initiate coverage, individuals typically need to disclose their substance use history to their insurance provider.

Subsequent testing is usually limited to the disclosed substances or those identified through further assessments. While BCBS generally covers drug testing, limitations apply. Most plans cap testing at 20 tests per calendar year unless specific approval is obtained. Covered tests include initial screening, confirmatory tests, and daily multi-drug screenings. Exemptions exist for emergency room visits, surgeries, and post-hospitalization periods.

Benefits of Blue Shield Insurance for Members

The BCBS insurance coverage may also include other benefits that can support drug rehabilitation, including:

• Preventive care for check-ups, screenings, and vaccinations.
• Online tools and resources to find providers and understand your coverage.
• Wellness programs to support healthy lifestyle choices (i.e., fitness programs and nutrition counseling)
• Member discounts for exclusive savings on healthcare products, services, and other items.
• Telehealth services for remote access to healthcare providers for consultations and treatments.
• Maternity and newborn care for prenatal care, delivery, and postnatal services.

How To Check Blue Cross Blue Shield Drug Rehab Coverage?

Researching Blue Cross Blue Shield (BCBS) insurance for rehab can be challenging due to the many variables involved. Each of BCBS’s 36 companies uses slightly different language in their policies, and each company’s policies are divided into multiple tiers.

Here’s how you can check your specific BCBS coverage for rehab:

• Use the customer service telephone number on your member card’s reverse side.
• Speak directly with a representative who can provide detailed information about your coverage.
• Enter your 3-letter member ID number into the Company Finder on the Blue Cross Blue Shield website.
• Access specific details about your plan, including coverage options and estimates for the drug rehab costs.
• Log into your BCBS account on their website to get detailed information about your coverage

Knowing your plan tier can also help to understand your rehab coverage. The following chart provides a general overview of potential coverage for rehab across different plan tiers:

Finding Rehabs That Accept Blue Cross Blue Shield

Individuals seeking drug rehab should first verify their insurance coverage. To do this, locate your insurance card, carrier, and policy number. Contact the insurance company directly to understand your benefits, including coverage for rehab services, deductibles, copays, and any required pre-authorization procedures.

• Ask for a list of in-network rehab facilities that accept your insurance.
• Choose a rehab facility that suits your preferences and needs, and filter using “BCBS near me”
• Call rehab facilities you’re interested in to inquire about their acceptance of Blue Cross Blue Shield.

Does Blue Cross Blue Shield Cover Rehab? – Bottom Line

While Blue Cross Blue Shield generally covers rehab services, the extent of coverage varies significantly based on individual plans, state regulations, and the specific type of treatment required. BCBS offers a range of plans, from basic to premium, each providing different levels of coverage for inpatient and outpatient rehab, detoxification, counseling, medication-assisted treatment, and aftercare services.

To make the most of your BCBS rehab coverage, contact BCBS customer service, use the Company Finder tool on their website, or consult a treatment provider for detailed information.

People Also Ask

Does Blue Cross cover drug rehab?

Blue Cross Blue Shield covers drug rehab, including inpatient and outpatient services, detoxification, and counseling, but specifics depend on your plan and location.

Does insurance cover methadone?

Yes, most insurance plans, including Blue Cross Blue Shield, cover methadone as part of medication-assisted treatment for opioid addiction.

Does Blue Cross Blue Shield cover sober living?

Coverage for sober living varies by plan; some Blue Cross Blue Shield plans may cover it, but you should check your specific policy details.

Page Sources

1. Hall, M. A., & Conover, C. J. (2003). The Impact of Blue Cross Conversions on Accessibility, Affordability, and the Public Interest. The Milbank Quarterly, 81(4), 509-542. https://doi.org/10.1046/j.0887-378X.2003.00293.x
2. Substance Abuse and the Affordable Care Act. The White House. https://obamawhitehouse.archives.gov/ondcp/healthcare
3. World Health Organization. (2009). Methadone maintenance treatment. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK310658/
4. Blue Cross and Blue Shield July 2024 Multi Tier Basic Drug List. https://www.bcbstx.com/docs/rx-drugs/drug-lists/tx/rx-list-multi-bas-tx-2024.pdf
5. Grinspoon, P., MD. (2021, October 7). 5 myths about using Suboxone to treat opiate addiction. Harvard Health. https://www.health.harvard.edu/blog/5-myths-about-using-suboxone-to-treat-opiate-addiction-2018032014496
6. BlueCross BlueShield of Illinois, Documentation Guidelines for Urine Drug Testing. 2018. https://www.bcbsil.com/pdf/claims/udt_documentation_guidelines.pdf