Blue Shield of California: Insurance Coverage for Opioid Rehab
The opioid epidemic is sweeping the nation, and California is no exception. Every year, over 2,400 people in California die from overdosing on various forms of opioids. In over 45% of cases, prescription opioids are the cause of death, followed by 36% of deaths involving synthetic opioids and 32.4% of deaths caused by heroin.1
Most people who want to get treatment for their substance use disorder (SUD) don’t receive the necessary care because they can’t afford it. Fortunately, most insurance providers offer coverage for those struggling with addiction.2
In 2011, over 21% of people who wanted treatment opted for Medicaid insurance, while a little over 10% opted for private insurance programs like Blue Shield California insurance coverage.2
All health insurance providers are required to provide coverage for mental health and substance use disorder treatment the same as they would for any other medical condition. Therefore, the implied answer to “Does Blue Shield cover drug rehab“, is yes.3 In fact, close to 56% of treatment centers in California accept Blue Shield and other private insurances.4
What Opioid Treatment Services Does Blue Shield of California Insurance Coverage Include?
Blue Shield California insurance coverage follows the same principles and limitations as medical and surgical benefits since mental health and addiction have to be considered equally important as physical health.5
When it comes to addiction treatment in California, Blue Shield may cover some or all of the following:6
- Screening and professional interventions. These evidence-based procedures help identify patients who abuse opioids at dangerous levels and are usually performed at the treatment centers.
- Detox. This is the first step in the drug rehabilitation program following the intake procedure. It ‘s the process of cleansing the body of all traces of opioids. Detox can be difficult and uncomfortable due to withdrawal symptoms, but it’s essential for overcoming addiction. It may take anywhere from a few days to over a week.
- Inpatient treatment. Inpatient treatment is a process in which a patient is admitted to a facility and monitored around the clock. This type of treatment is often reserved for people with severe opioid addiction who cannot safely overcome it on their own.
- Outpatient treatment. Outpatient treatment is a great option for those who don’t need intensive care but still need assistance with their addiction. It may be a more affordable option than inpatient treatment, and it allows patients to continue living at home while they receive treatment.
- Behavioral therapies. Behavioral therapies are designed to help people change their behaviors related to drug use. Behavioral therapies can help people learn how to resist cravings, deal with stress and emotions without using drugs, and set goals for their lives.
- Treatment for co-occurring disorders. People with a dual diagnosis of SUD and a mental health issue require a special type of treatment. Treating co-occurring disorders is most effective when both disorders are addressed simultaneously. Some common treatments for co-occurring disorders following initial assessment include medication, therapy, and self-help groups.
Blue Shield insurance coverage in California includes 22 locations across the state. The main headquarters is in Oakland, and the company employs more than 7,500 employees.7
Are There Services Blue Shield of California Won’t Cover?
While most standard treatment amenities are included in the Blue Shield of California insurance coverage, certain elements of treatment are considered non-essential and are not covered by insurance. These include:5
- Recreational activities
- Non-medical services
- Delivery services for food
- Private treatment amenities
- Alternative treatments
- Holistic health care
How Much Does Opioid Rehab Cost?
The cost of opioid rehab can vary depending on a number of factors, including:3
- The exect services included in the plan.
- The intensity and scope of treatment.
- How long a treatment program lasts.
- Whether additional amenities such as same-day admittance are included.
Depending on the treatment used to combat opioid addiction in various certified opioid treatment programs, the prices can range from $126 to $1176.50 per month or $6,552 to $14,112 on an annual level.8
How Much Is Opioid Rehab at Inpatient Facilities?
Inpatient opioid rehab, also known as residential treatment, involves admitting the patient full-time at a facility while participating in a recovery program. The costs of inpatient treatment are higher than those of outpatient programs since the patient has continuous access to medical care and caregivers 24/7 for the duration of their stay.6
Inpatient rehab programs offer a high level of care for people struggling with opioid addiction and other mental health disorders. The length and cost of inpatient rehab can vary depending on the level of care needed, ranging from 30 to 90 days or more. Inpatient rehab is often the best option for people who require a high level of care, have a severe addiction, or have relapsed.6
How Much Is Opioid Rehab at Ourpatient Facilities?
Outpatient rehab is a less restrictive and less expensive type of opioid treatment. It allows patients to stay and home and perform their daily activities while receiving adequate treatment. Treatment can consist of counseling, individual or group therapy, and support groups. Outpatient therapy aims to support patients in recovery while teaching them valuable skills and coping mechanisms.6 In the long run, outpatient treatment has proven both efficient and cost-effective.9
How Much Is Opioid Rehab in Opioid Partial Hospitalization Programs (PHP)?
Partial hospitalization programs (PHP) are a form of outpatient treatment in which a person receives daily treatment at a facility for a set number of hours each day. PHP can provide a person the level of care they need while still allowing them to live at home.10
The cost of a PHP depends on your specific needs and level of care. It may include meeting with your counselor daily in the treatment facility for 6 hours, access to hospital services and facilities, and various forms of behavioral and medication therapy.10
How Much Is Medication-Assisted Treatment (MAT)?
The cost of medication-assisted treatment or MAT can vary depending on a variety of factors. Addiction coverage may be different depending on your insurance company and what type of plan you have. The price of MAT may also vary depending on the provider you go to for treatment: a doctor’s office or an inpatient facility.11
In general, the weekly MAT costs based on the treatment prescribed cost are:8
- $126 for methadone treatment.
- $115 for Suboxone/Buprenorphine treatment.
- $1,176.50 per month for Naltrexone treatment.
All treatment prices include medication, administration, therapy, counselor meetings, and related services.8
What About the Cost of Opioid Rehab vs. Opioid Addiction?
The cost of rehab can be a deterrent for some people when considering treatment for substance abuse, as only 18.5% of those who require treatment actually get it. However, Blue Shield of California insurance coverage may include some aspects of addiction treatment. The cost of treatment shouldn’t keep you from seeking help for your problems.6
Substance abuse can have a significant impact on your finances, as well as your health and quality of life. Treatment is an investment, but it’s one that can pay off, in the long run, considering opioid abuse can affect your quality of life, relationship, and mortality.6
The cost of substance abuse is significantly greater than the cost of treatment for substance abuse. Annual treatment for substance abuse costs an average of $1,583 per person, while the average cost of opioid abuse per year is roughly $11,487.12 Please note that this is an approximate figure and that treatment costs depend on the factors mentioned above.
The social and economic toll of illicit drug use in the United States is significant. In 2007, it cost the country an estimated $193 billion. This includes public health costs, crime costs, and lost productivity. Substance abuse treatment can offset these costs in the long run. On average, for every dollar spent on substance abuse treatment, $4 is saved in healthcare costs, while $7 is saved in law enforcement and criminal justice costs.12
What Opioid Treatment Length Does Blue Shield of California Cover?
There are no “one-size-fits-all” solutions when it comes to treatment length, as different patients will progress through their opioid addiction treatment at a different pace. However, good treatment outcomes are proportionate to the length of the treatment.13
Generally, participation in inpatient or outpatient treatment for less than 60 days is of limited effectiveness, and significantly longer treatment or participation in an aftercare program are required for long-term positive outcomes.13
There are many different types of policies and tiers of coverage, so the length of time that a person is covered by Blue Shield California insurance will depend on their specific plan and benefits included within.3,5
You can learn more about your Blue Shield insurance plan and what it entails through the information on your insurance card or by contacting the Blue Shield California helpline. If you are looking for information on whether your insurance will cover a specific facility within the American Addiction Centers network, admissions navigators can verify your insurance via a phone call.
Should I Choose Inpatient or Outpatient Treatment?
The inpatient facility may be more expensive but worth the investment. The setup of a residential program has staff living on-site and patients who can’t or won’t leave their rooms 24/7. This level of care ensures that each person receives all the treatment needed to overcome addiction and withdrawal symptoms, get a full night’s sleep, and be protected from environmental triggers (such as drug-using friends) that may interfere with their recovery.13
Recovering individuals looking for outpatient programs will have to negotiate time for medical appointments whereas those in residential facilities don’t need to spend any extra time away from treatment unless they want to take advantage of the onsite amenities offered.13
In general, inpatient treatment offers various benefits that improve the chances of long-term recovery including:13
- Better quality of care and easy and continuous access to essential tools and resources needed for recovery.
- A treatment-focused ecosystem, free of distractions and temptations.
- Support from both medical professionals and peers in recovery.
- A more focused and structured environment.
- Increased accountability.
How to Use Blue Shield California Insurance For Opioid Rehab?
If you are considering getting treatment and wondering how to use Blue Shield California insurance for opioid rehab, the process is the following:3
- Consult your doctor about your opioid addiction. They are likely to recommend an inpatient treatment program based on your assessment.
- Find a suitable treatment center through Blue Shield California helpline or via resources such as SAMHSA.
- Ask your insurer about coverage for substance abuse by calling the number on the back of your insurance card or visiting their website.
- Work with the chosen rehab center to determine coverage. You can reach out to AAC’s alcohol and drug rehab hotline to talk to their admissions navigators who can help you confirm your insurance benefits and verify your coverage with Blue Shield.
What Opioid Rehabs Accept Blue Shield of California Insurance?
Over 700 treatment centers in California alone accept private insurance policies and are in-network with Blue Shield insurance. Almost 4.5 million people in California are covered by Blue Shield of California‘s policies for SUD treatment.7
There are several ways you can see if you’re eligible for some of the in-network Blue Shield inpatient drug rehab centers in California or across the state. The first step to getting help is calling their hotline, but if that number isn’t accessible or if you would like to check what additional benefits or what other payment options are available, American Addiction Centers will verify your insurance and check what other payment options such as financing might work for you. When it comes to recognized AAC facilities, Laguna Treatment Hospital is one of the in-network Blue Shield California addiction treatment options available.
Laguna Treatment Hospital
Laguna Treatment Hospital is located in Orange County, CA. This treatment facility focuses on treating people who require continuous care due to the severity of their addiction. This local center employs MAT as well as different behavioral therapies.
The treatment center provides:
- A safe and professional medical detoxification.
- Residential rehab program with MAT assistance.
- Various aftercare tools and programs to ensure long-term recovery.