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Blue Cross Blue Shield Rehab and Therapy Coverage

Last Updated: July 14, 2022

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

Blue Cross Blue Shield insurance encompasses 36 separate companies and 105 million insured in the US, resulting in one in three Americans having some sort of health coverage through the company. It means that millions of people count on Blue Cross Blue Shield drug rehab coverage every year, including about half of all federal employees. Anyone insured under the BCBS banner must understand addiction treatment coverage of Blue Cross Blue Shield rehab facilities.

What Is BCBS?

BCBS Association owns 36 insurance companies across the United States. More than 106 million people rely on it to access their health insurance. In addition, the company provides some form of insurance in every state of the US.

BCBS offers individual, group, and family plans that fall into four categories: bronze, silver, gold, and platinum. Bronze plans have the highest deductibles and copays but the lowest premiums. On the other hand, platinum plans offer low deductibles and copays, but the members have to pay higher monthly premiums.

Health insurance form.

Blue Cross Blue Shield Rehab Coverage

Every insurance company is obligated to cover addiction treatment at least partially. Therefore, BCBS will also cover addiction rehab treatment and appropriate care for its members. However, the specifics of this coverage will vary depending on which company under the BCBS banner a person has coverage with. In addition, the level of coverage will depend on each individual plan. To find out what a particular program covers, call your insurance provider directly to know all the information and details.

Most Policies Will Cover the Following Types of Drug and Alcohol Rehab:

If someone depends on BCBS health insurance for drug rehabilitation care, they should check with their company to determine what types of rehab center it will cover.

Does It Cover Inpatient Rehabilitation?

The simple answer is yes, Blue Cross Blue Shield drug rehab coverage includes inpatient drug rehab. The more nuanced answer is that the insurance coverage extends to inpatient rehab center treatment for most people they insure, but there are restrictions in most cases.

For example, a large percentage of those insured by BCBS have an HMO. Therefore, these individuals can only expect their inpatient substance abuse rehabilitation to be covered if they select one contracted with their HMO.

Assuming that someone has a policy that covers substance abuse rehab and they select an in-network provider, BCBS should help with the cost of treatment. However, that does not mean they will pay for it in full. Whether someone has COBRA or individual insurance or another product, they should expect to pay some of the cost out of pocket.

Patient paying to the doctor.

In other words, while having BCBS coverage can make rehab more affordable, it does not mean it will be free to anyone with their insurance coverage.

Does BCBS Cover Outpatient Drug Rehab?

Just like with inpatient coverage, Blue Cross Blue Shield alcohol rehab policies will cover outpatient rehabilitation in most cases. However, there are limits, and a big one is that users will generally need to opt for an in-network provider. If someone has BCBS coverage for outpatient rehab and selects an in-network provider, they should expect to pay for part of their treatment.

While this does mean that the individual will be paying for part of their rehabilitation, having this coverage makes it more affordable at an approved Blue Cross Blue Shield drug rehab center.

BCBS Substance Abuse Coverage Policy

Researching BCBS insurance for rehab is tricky because there are so many variables at play. Each of their 36 companies uses slightly different language in their policies, and each company’s policies are divided into multiple tiers.

In Most Cases, These Are as Follows:

  • Bronze
  • Silver
  • Gold
  • Platinum

Policy Plans

What each of these tiers covers will depend on the state the policy was issued in, the level of care being sought, and even the financial status of the insured in some cases. Below is a glance at what might be covered for each tier with inpatient and outpatient rehab center.

PLAN INPATIENT REHAB OUTPATIENT REHAB
BRONZE The insured must meet the deductible for in-network providers. Out-of-network providers are not covered. The insured must meet the deductible for in-network providers. Out-of-network providers are not covered.
SILVER A coinsurance percentage is charged in addition to the plan’s deductible for in-network services. Out-of-network is not covered. A coinsurance percentage is charged in addition to the plan’s deductible for in-network services. Out-of-network is not covered.
GOLD After reaching the deductible, coinsurance percentage is required, but this is usually smaller than that of the silver tier. Out-of-network services are not covered. After reaching the deductible, coinsurance percentage is required. Out-of-network services are not covered.
PLATINUM In-network has a copay per day or a coinsurance percentage the insured must pay. Out-of-network providers may be covered with a higher deductible or coinsurance percentage. Varying copays or coinsurance percentages are charged for anything in-network. Out-of-network providers may be covered with a higher deductible or coinsurance percentage.

To find out the specifics of their plan, insured individuals should contact their provider.

Blue Cross Blue Shield Therapy Coverage

Most BCBS plans will cover therapy. However, members might need to meet some requirements before the coverage starts. Call the number on your insurance card to know the peculiarities of Blue Cross Blue Shield therapy coverage under your plan.

The Affordable Care Act made it mandatory for providers to cover therapy for mental health and addiction treatment therapy.

If It Is Deemed Medically Necessary, Addiction Therapy Covered by Blue Cross Includes:

Holistic care, like acupuncture or art therapy, may not be covered. However, it is dependent on the plan.

Finding Rehabs that Accept Blue Cross Blue Shield

Anyone who needs drug rehab and has insurance should verify their coverage. To do this, they need to determine who their specific carrier is and their policy ID number. With this information, they should call the company and determine what their benefits are and how to use them.

Doctor giving an insurance card to the patient.

The company will also assist them in finding rehabs that accept Blue Cross Blue Shield. Depending on the plan, the company may require the rehab center to be in-network only or may allow out-of-network providers. In any case, they will assist in finding a suitable Blue Cross Blue Shield drug rehab nearby.

Addiction Treatment Medications Covered

Drug rehabilitation often requires the use of medications to help people detox and stay clean. BCBS rehab coverage does extend to medications. However, whether or not a specific medicine is covered can vary.

Commonly Covered Addiction Medications

Pharmaceutical use is covered under Blue Cross Blue Shield alcohol rehab policies. However, they can limit the medications they cover and refuse coverage under certain circumstances. The most commonly covered rehabilitation drugs are Suboxone, Zubsolv, and Buprenorphine/Naloxone.

However, for BCBS to Cover Them, the Insured Must Meet the Following Criteria:

  • They are actively being treated for addiction to opioids
  • Their prescribing physician has the correct training and all appropriate DEA waivers
  • They have signed an informed consent document
  • They are at least being offered behavioral health treatment and psychosocial support
  • Their prescribing physician has certified a preferred pharmacy chain

If these criteria are met, the insurance policies will cover drug rehab treatment with these medications.

Methadone Treatment Coverage

Addiction treatment with methadone is covered by BCBS health insurance through the process of reimbursement. It is coded as H0020: “Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program).”

In Addition to Providing Coverage of the Medication Itself, It Also Covers the Following:

  • Associated physician services
  • Associated nursing services
  • Pre-assessment
  • Post-assessment
  • Cost of administration, including automated equipment
  • Toxicology of lab fees
  • Patient care monitors
  • Security costs
  • Patient education
  • Primary care provider referrals
  • Emergency services
  • Crisis management
  • Special services for pregnant women
  • TB risk assessment
  • Associated transcription and data entry
  • Coordination of care

Although BCBS insurance plans for addiction cover methadone, the need for it must be well documented for the company to extend coverage.

Drug Testing Policy During Treatment

For many individuals, being drug tested regularly is part of the addiction rehabilitation program and maintenance after active rehabilitation has ceased. Getting this covered begins by adding the insured’s drug of use to their profile. Once it’s added, it sets the scope for testing, as it will be limited to those drugs or any substances that have been identified as drugs of use in subsequent evaluations.

BCBS health insurance does cover testing. However, drug testing coverage is limited to 20 tests per calendar year unless the insured seeks special approval.

Items That Are Covered Include the Following:

  • Presumptive and definitive (qualitative or quantitative) drug testing methods after a drug has been detected through a screening or presumptive test if a provider has submitted a written request
  • A single multi-drug screening per day
  • Restrictions are waived during emergency room visits, ambulatory surgery, and after inpatient admission

Ultimately, users should have access to any testing they authentically need through Blue Cross Blue Shield rehab coverage.

Verify Coverage Through BCBS And Begin Treatment

If someone has BCBS insurance, addiction treatment is covered in most circumstances. Anyone with this coverage and a substance use disorder should verify their coverage. It can be done by contacting the insurance provider. Once they do, they can find a Blue Cross Blue Shield rehab center within their network and begin their journey toward recovery.

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Page Sources

  1. National Library of Medicine, HCPCS (HCPCS - Healthcare Common Procedure Coding System) - Synopsis. https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/HCPCS/index.html
  2. BlueCross BlueShield of Illinois, Documentation Guidelines for Urine Drug Testing. 2018. https://www.bcbsil.com/pdf/claims/udt_documentation_guidelines.pdf

Published on: October 2nd, 2019

Updated on: July 14th, 2022

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.