Blue Cross Blue Shield Substance Abuse Rehab Insurance Coverage

Your Blue Cross Blue Shield therapy coverage and benefits are based on the type of plan you have. You can check underneath or call the phone number on the back of your card to verify your Blue Cross Blue Shield mental health coverage.

If you need addiction treatment and have BCBS health insurance, you will likely have coverage and benefits for the substance use disorder treatment that you need. While the coverage may vary from one state to another, you are likely to find a substantial portion of your alcohol and drug rehab costs will be covered.

Blue Cross Blue Shield offers numerous plans with various levels of benefits and coverage. If you are going to receive inpatient treatment, your addiction treatment coverage will typically cover costs beyond those met by your deductible (the amount you pay out-of-pocket before coverage starts). You typically also have a co-pay, which is a percentage of the overall cost of treatment. Most co-pays range from 10% to 20% of treatment costs.

The co-pay and deductible will vary based on your level of coverage through your Blue Cross Blue Shield health insurance plan. Federal BlueCross BlueShield, for example, offers a plan where you pay $350 per addiction treatment admission and no further co-pays.²

Benefits for your Blue Cross Blue Shield health plan for outpatient rehab will also vary based on your level of coverage. If you have a Bronze, Silver, Gold, or Platinum plan, you will pay 60%, 70%, 80%, or 90% of the costs, respectively.

If you are a Federal employee, you will pay a certain percentage based on which Federal Blue Cross Blue Shield plan you have chosen.

Blue Cross Blue Shield has individual, family, and Medicare plans which means coverage will vary.⁷ Still, your insurance plan should cover at least some of the cost of rehab for drug or alcohol use.

Blue Cross Blue Shield may cover several types of addiction treatment, including:

• Intensive outpatient programs (IOP): During an IOP, you will attend therapy sessions several hours a day, several days a week with sessions conducted by a licensed therapist.
• Partial hospitalization programs (PHP): During a PHP, you will stay in a hospital environment for much of the day but return home at night.
• Aftercare: Once you complete an inpatient or outpatient program, aftercare gives you the support you need to maintain sobriety.

Your Blue Shield of California plan will determine the level of coverage you’ll receive for addiction treatment. Although you may be responsible for paying certain out-of-pocket expenses like copays and deductibles, you can take solace in knowing that your insurance plan will provide partial, if not full coverage for addiction to substances such as alcohol, heroin, and prescription drugs.

The short answer is yes, Blue Cross Blue Shield does cover rehab treatment for substance abuse. The type of treatment however does depend on the coverage levels of your insurance policy.

You can check your plan’s specific healthcare benefits and coverage by going online here.

You can also call and check with BCBS directly by calling the number on the back of your health insurance card. Blue Cross Blue Shield also offers an online resource center for members who are seeking information regarding options for substance abuse treatment.⁵

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act to ensure coverage of treatment for mental health care and addiction. This includes treatment for co-occurring disorders—a term used to describe when someone has a mental health diagnosis (e.g., anxiety, depression, PTSD) along with substance use disorder. The extent to which addiction and mental health treatment are covered and for how long depends on your insurance plan.

Blue Cross  Blue Shield can help coordinate care for you when you access treatment. If you are a BCBS member and need to access mental health care and addiction treatment, take comfort in knowing your insurance provider is committed to caring for members with mental health conditions. Most treatment facilities offer co-occurring disorder treatments for people who have mental health conditions and addiction to drugs and alcohol.

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Does Blue Cross Blue Shield Cover Addiction Treatment Therapy?

Yes, Blue Cross Blue Shield (BCBS) provides coverage for substance abuse treatment at least to an extent, as stipulated under the Affordable Care Act.¹ Depending on your plan, different portions of the cost of treatment will be covered. Patients can check the details of their plan by contacting Blue Cross Blue Shield using the phone number on their health insurance card. Alternatively, they can call their chosen rehab center’s helpline to verify their insurance.⁷

BCBS has also set up their own substance abuse resource center as well as assembled a directory of SUD treatment providers to help treatment seekers find research-based support.^8,9

Does Blue Cross Blue Shield Cover the Cost Of Sober Living?

For patients who need support during their transition from inpatient treatment, Blue Cross Blue Shield offers coverage for ancillary services, including stays in sober living houses.¹⁵ You can call Blue Cross Blue Shield to request support and check your insurance coverage.¹⁵

What Behavioral Health Treatments Does Blue Cross Blue Shield Cover?

Under the Mental Health Parity and Addiction Equity Act, mental health care and SUD treatment has to be covered by insurance as much as any surgical or medical care.¹⁰ This encompasses counseling and psychotherapy for co-occurring mental health disorders, such as depression or anxiety, which coexist with a substance use disorder. The exact scope of coverage for behavioral health treatment varies based on your health plan.¹³

Does Blue Cross Blue Shield Cover Medication-Assisted Treatment?

Yes, BCBS can cover your medication-assisted treatment at least in part. The level of coverage will differ according to your plan, which you can check by contacting your provider.⁷ Public health insurance Medicaid, which is provided through a Blue Cross Blue Shield program, has to cover it.^11,12

Does Blue Cross Blue Shield Cover Prescription Drugs Abuse Treatment?

Blue Cross Blue Shield covers different levels of care for a variety of substance use disorders, which may include treatment of prescription drug abuse. Coverage is based on several factors, such as your plan and different legal policies.¹⁷ You can check your benefits by contacting the provider directly or by getting in touch with a rehab facility.

Does Blue Cross Blue Shield Cover Suboxone Treatment?

Since suboxone (buprenorphine) has been approved by the FDA as a treatment option for opioid use disorder, most rehab facilities make it available and your BCBS plan may cover it.¹³

Does Blue Cross Blue Shield Cover Couples Therapy for Addicted Couples?

Your BCBS benefits plan may cover different psychotherapeutic approaches, including individual, group, family, and couples therapy. However, this depends on your coverage tier. You can verify your insurance by reaching out to Blue Cross Blue Shield or a treatment provider.¹⁴

What Should I Do if Blue Cross Blue Shield Won’t Cover the Total Cost of Rehab?

Even if Blue Cross Blue Shield doesn’t cover the entire cost of treatment, this should not deter you from seeking support as there may still be other available options. Many rehab centers provide payment plans that can help patients cover their treatment expenses.¹⁶ For example, they may offer sliding scale payment or another form of financial aid.¹⁶