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Blue Shield of California Insurance for Alcohol Rehab Near Me

On this page, you will learn about Blue Shield of California health insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
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Provider Overview

Can You Use Blue Shield of California Insurance Coverage for Alcohol Rehab?

The demand for SUD treatment is on the rise in the U.S. as there are about 14 million people in the states struggling with alcohol abuse. Many of those are children above the age of 12. Additionally, one-tenth of children live in a household where a parent has an alcohol abuse disorder.1

When looking at the damage substance use disorder (SUD) can cause, there are approximately 70,000 deaths due to substance-related causes each year. Additionally, about 60% of people use some type of addictive substance yearly.2 Despite this, no more than 2% of individuals get the treatment they require. While the reasons for this are many, the main cause is a lack of funds.2,3

Insurance is the main way of funding treatment. For example, about 21.% of individuals use Medicaid insurance for their SUD treatment, while 10.5% of struggling individuals choose private insurance, and residents of California can opt for Blue Shield rehab coverage.3

What Will the Blue Shield of California Healthcare Plans Cover for Alcohol Treatment?

Blue Shield of California belongs to the Blue Shield Association. This is a non-profit insurance provider that helps Californians cover their medical bills, including alcohol treatment.4 

As legally prescribed, health insurance companies must provide the same amount of coverage for behavioral health and substance abuse as they would for other medical issues. This means that you can get Blue Shield California mental health and substance abuse coverage, including coverage for alcohol abuse.5

The exact scope of coverage will depend on individuals’ treatment plans that are individualized and adjusted toward patients’ needs. The coverage might include, but is not limited to:6

While it’s challenging to find the exact number of facilities that accept Blue Shield, you can get treatment in 56% of facilities in CA with private insurance. This includes Blue Shield of California.7

What Isn’t Included in a Blue Shield of California Coverage for Alcohol Treatment?

Insurance companies won’t cover all the expenses of undergoing professional treatment for alcohol abuse. Not only will you be eligible for some copayments, coinsurance, and deductibles, but some non-medical services won’t be covered at all. This might include all non-medical amenities, food delivery, alternative therapies and holistic care, recreation programs, or private treatment services.5,8

How Expensive Is Alcohol Rehab?

There are many factors that affect the cost of rehab, such as:5,9

Medical professionals will determine the exact scope and intensity of your treatment after the initial assessment of your substance abuse issues and health.5

How Expensive Is Inpatient Alcohol Rehab?

If you have to go to inpatient treatment, you can expect to be placed in a controlled setting with 24/7 medical supervision. This is usually recommended for people struggling with a rather severe case of AUD, or people who have struggled with substance abuse for a long time.6 

Accommodation, length of stay, as well as other factors can make inpatient alcohol rehab rather expensive. However, Blue Shield coverage in California may help you reduce these costs by covering some aspects of treatment.6 Nonetheless, it’s advisable to consult with your insurance or treatment provide to determine the exact price and scope of coverage. You can also discuss your special requirements if you have any, such as professional treatment for partners struggling with alcohol use or same-day admittance into a rehab facility.

How Expensive Is Outpatient Alcohol Rehab?

Outpatient treatment includes various forms of therapies, but patients aren’t required to stay in a facility once the sessions are over. Individuals will likely be required to visit a counselor on a regular basis. These visits might be in a group or individual setting.6

As outpatient treatment doesn’t provide the same scope of care as inpatient treatment and it uses fewer resources, it will usually cost less than inpatient or partial hospitalization programs.6

How Expensive Are Alcohol Partial Hospitalization Programs (PHP)

Partial hospitalization programs (PHPs) combine some aspects of outpatient and inpatient treatment. They require patients to spend a lot of time within residential centers, but allow them to reside somewhere else, usually within their own home. In general, PHP is less expensive than inpatient tretment, but costlier than outpatient therapy.6

How Expensive Is Medication-Assisted Treatment (MAT)

Medication-assisted treatment includes using medications in combination with therapy. Medicines can be used to improve the outcomes of both outpatient and inpatient treatment. As this type of treatment can be used in various settings and it might include various differently priced medications, the cost of MAT can vary greatly.10

How Much Does Alcohol Addiction Actually Cost?

Alcohol abuse made the U.S. economy lose 249 billion dollars in 2010 alone. If divided by the number of people living in the states, this means that these costs are $807 per person.11

Additionally, a person abusing alcohol will likely be less productive in the workplace, which will lead to an income loss. Their healthcare expenses will increase, as there are many health issues related to alcohol abuse. Some individuals might also face some legal expenses, as well.11

Alcohol addiction changes the way the brain works and it can cause permanent damage. The more you delay your treatment, the more likely you are to require longer and more extensive care. Therefore, it’s much more affordable to start treatment right away.5,7

How Long Does the Blue Shield of California Insurance Coverage Last?

If you plan to undergo treatment at a Blue Shield California in-network or out-of-network facility, you’re probably wondering how many days of treatment will your insurance cover. 

According to the principles of effective treatment, a person needs to stay in treatment for as long as a medical professional estimates is needed. Longer treatment has shown to be more successful, reducing chances of relapse.12 In general, a person should stay in treatment for 3 months or longer.12

As for how long your Blue Shield California insurance coverage will last, you need to check this with your insurance or treatment provider. A good place to start is to call a local Blue Shield California helpline or a hotline for idnividuals dealing with alcohol abuse

What Is Better: Blue Shield-Covered Inpatient or Outpatient Alcohol Rehab in California

While both outpatient and inpatient rehab facilities offer significant benefits to recovering individuals, there are important differences between the two.6

  • Inpatient programs allow a person to undergo intensive treatment while staying in a focused, professional environment. 
  • Outpatient programs allow a person to stay in a comfortable, home setting they’re used to.

Determining which type of treatment is right for you will depend on your particular situation. However, there are some advantages to inpatient treatment. Most importantly, it seems that inpatient treatment for alcohol abuse can have better outcome rates.6,12

This is because inpatient treatment can offer people much more than just high-quality care with constant supervision. It also helps by providing an excellent treatment ecosystem and an environment without external distractions. At the same time, it connects patients with groups of people that have been through similar struggles, while also helping them take greater accountability for their own actions.6

How Can I Start Using My Policy Under Blue Shield Coverage of California?

If you’d like to use your Blue Shield of California insurance coverage for alcohol detox and treatment nationwide, you need to follow a protocol most insurance providers have in place. One of the first steps is acquiring a medical referral and providing it to your insurance and treatment provider. Without a referral, you’re unlikely to get coverage for treatment that will help you recover from aclohol addiction.13

To get a referral, as well as other necessary documentation, you should revise your insurance policy. Various plans and insurance companies may have different requirements. Most will ask you to go to your primary care provider for a referral. Others might allow you to schedule an appointment by contacting a behavioral healthcare provider.13

Once you get a referral, your provider will point to some in-network Blue Shield of California treatment providers.

How to Locate an In-Network Blue Shield of California Treatment Facility?

When looking for local treatment facilities that accept Blue Shield insurance, you can start by calling a number on your Blue Shield membership card. You can also call a free hotline for alcohol abuse. This is a great option if you have any questions about confidentiality regulations in your state and about available private-pay facilities in your area.

Another option is to contact American Addiction Centers (AAC) and speak to a trained dispatcher that can answer your questions. While talking to an admission navigator, you can ask what payment options are available to you. They will also help you verify your insurance coverage for treatment and let you know where you can find some of the best treatment facilities in California, such as the recognized Laguna Treatment Hospital.

Laguna Treatment Hospital

Laguna Treatment Hospital helps individuals get treatment for SUD by providing them with expert care. The facility focuses on helping people detox from alcohol and providing them with research-based treatment. Treatment programs are individualized, so each patient can get the help they personally require. 

Laguna Treatment Hospital is in-network with all major insurance carriers that offer coverage for substance abuse treatment. This includes Blue Shield of California insurance.

How to Read Your Insurance Provider Card
  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
  1. National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help.
  2. National Center for Drug Abuse Statistics. Drug Abuse Statistics
  3. Substance Abuse and Mental Health Services Administration. (2011). Health Insurance Status of Adult Substance Abuse Treatment Admissions Aged 26 or Older: 2011.
  4. Blue Shield of California. About Blue Shield.
  5. Find Paying for Treatment.
  6. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.
  7. Substance Abuse and Mental Health Services Administration. (2018). National Survey of Substance Abuse Treatment Services (N-SSATS): 2017. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  8. Blue Shield of California. Health Plans.
  9. Substance Abuse and Mental Health Services Administration. (2014). What is Substance Abuse Treatment? A Booklet for Families.
  10. National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help.
  11. Centers for Disease Control and Prevention. (2019). Excessive Drinking is Draining the U.S. Economy.
  12. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
  13. Department of Managed Health Care. Behavioral Health Care.
  14. Blue Shield of California. Individuals with Health Conditions.
  15. Office of the Legislative Counsel. (2010). Compilation of Patient Protection and Affordable Care Act.
  16. Out-of-Pocket Costs.
  17. Kuria, M. W., Ndetei, D. M., Obot, I. S., Khasakhala, L. I., Bagaka, B. M., Mbugua, M. N., & Kamau, J. (2012). The Association between Alcohol Dependence and Depression before and after Treatment for Alcohol Dependence. ISRN Psychiatry, 2012, 482802. 
  18. National Institute on Alcohol Abuse and Alcoholism. What Types of Alcohol Treatment Are Available?

Check Your Policy Coverage

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Frequently asked questions

Can I Get Alcohol Rehab Without Blue Shield of California Insurance in CA?
Even if you’re not eligible for Blue Shield of California rehab coverage, there are other financing options you might apply for. For example, about 8% of facilities will accept Access to Recovery (ATR) vouchers and 8% more will accept Tribal, HIS, or Urban funds.7 Also, about 90% of treatment facilities will accept self-payment, which means you can get the money in a way that works for you. This might include various payment plans, loans, or even borrowing from family and friends.7
Should I Choose Residential Alcohol Rehab Over IOP?
Residential alcohol rehab allows you to get professional treatment in a controlled setting, under medical supervision. On the other hand, intensive outpatient treatment (IOP) gives offers a greater level of care than regular outpatient treatment, but it won’t remove you from triggering situations.6 While it’s impossible to tell which one is right for you without a professional assessment, there are indications that you may experience a better outcome if you go to a residential facility.6
Is Alcohol Addiction Considered a Pre-Existing Condition?
Some treatment plans might have limited options for pre-existing conditions. Before the Affordable Care Act (ACA), there were some coverage limitations for pre-existing conditions, including addiction. However, ACA states that alcohol addiction can no longer be considered a pre-existing condition when it comes to insurance, making Blue Shield of California-covered addiction treatment much more accessible.14,15
What Are Some Out-of-Pocket Expenses for Alcohol Rehab Treatment?
Out-of-pocket costs refer to expenses not covered by your insurance. This can include coinsurance, copayments, and deductibles, as well as any costs that your Blue Shield of California insurance plan doesn’t cover. The precise out-of-pocket costs will depend on your plan and treatment, so this is something you should check with your insurance provider.16
Does Blue Shield Alcohol Rehab in California Work for Depression?
Individuals struggling with alcohol use can also struggle with depression and major depressive disorder. In fact, depression is one of the most common co-occurring disorders in people with alcohol use disorder (AUD), as about 63.8% of people with AUD struggle with depression.17 For treatment to be successful, it should focus on treatment for both addiction and mental health issues. Most Blue Shield of California-covered rehabilitation centers will also treat depression and any other mental health issue that might be in correlation with AUD. Contact your insurance and treatment providers to find out more.6
Is Alcohol Rehab the Only Option?
Alcohol addiction is a relapsing condition that requires professional treatment. Otherwise, your health might be at risk. However, there are more options than just going to rehab. For example, you might contact Alcoholics Anonymous (AA) and enroll in their 12-step programs. Also, there are a few ways to get therapy via phone or video chats.18 However, the most successful form of treatment is inpatient therapy, and it has shown positive outcomes even in people struggling with a severe alcohol addiction. Finally, it’s important to emphasize that you should make this decision in consultation with a medical professional.6

Guides for other health insurance providers

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