Does BCBS of Illinois Coverage Apply to Alcohol Rehab?
Illinois is a state with a considerable number of substance abuse treatment facilities. When it comes to the total number of rehab centers, it ranked 3rd during the period from 2007 to 2017. It had also been ranked as 3rd or 4th, during the same period, regarding the total number of clients in rehab. The 2017 National Survey of Substance Abuse Treatment Services (N-SSATS) reported 770 rehab facilities in Illinois, with 44,265 clients in treatment, 80.1% of which were treated in private for-profit facilities.1
Speaking of alcohol abuse in particular, 500 Illinois rehab facilities treated 8,441 clients suffering from alcohol abuse disorder only (85.5%), while 544 facilities treated 15,811 clients battling both alcohol and drug abuse. Considering that SUDs often co-occur with mental health issues, it’s important to note that 42% of clients had a dual diagnosis and were treated in 478 Illinois facilities providing dual diagnosis treatment.1
Healthcare industry reforms and implementation of parity laws had incentivized private health insurance companies to address substance abuse and SUD-related disorders in a more effective manner and in various healthcare settings.2
Therefore, all healthcare plans, including those of BCBS of Illinois, are required by law to provide nationwide coverage for mental health and substance abuse disorders. This was made possible by the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. This law requires that the same level of benefits be provided for SUDs and mental health disorders as for medical and surgical care.3
What Kind of Coverage Does BCBS of Illinois Insurance Provide for Alcohol Treatment Programs?
BCBS of Illinois insurance coverage for alcohol abuse treatment, as outlined in MHPAEA, belongs to the category of mental health and substance use disorder services. As such, it represents one of the essential health benefits.4
State-regulated health plans and insurance providers are required to cover medically necessary treatment of mental health conditions and SUDs in various settings, including inpatient and outpatient treatment. When the necessary services are unavailable in-network, BCBS of Illinois should provide coverage for medically necessary treatment out-of-network.5
BCBS of Illinois is an independent licensee of the Blue Cross and Blue Shield Association. All of their health plans cover essential benefits and services, including mental health, substance abuse, and prescription drugs. However, to get the cost of your treatment covered, you need to request services within your plan’s network or group of providers. If you get out-of-network services, you will have to pay for most or all of the received treatment.5
BCBS of Illinois works with a wide selection of in-network physicians and hospitals to provide alcohol rehab coverage for:5
- Screenings, evaluations, and interventions.
- Medically monitored detoxification and management of withdrawal symptoms.
- Inpatient treatment in alcohol rehab centers nationwide.
- Outpatient treatment, including intensive outpatient treatment.
- Various types of behavioral therapies.
- Dual diagnosis treatment of co-occurring mental health disorders.
What Elements of Alcohol Treatment are Not Covered by the BCBS of Illinois?
Alcohol abuse treatment involves personally tailored plans and approaches designed to fit each patient’s needs. Even though some additional elements and services may be essential to some people, they might not be covered by BCBS of Illinois healthcare plans. Services that are not considered medically necessary, evidence-based, FDA-approved, or those provided out of network, won’t be covered by the health plan benefits:5, 6, 7, 8
- Services that provide holistic care.
- Non-medical amenities.
- Alternative treatment methods.
- Programs for recreation.
- Services provided in a private setting.
- Delivery of food.
What’s the Cost of Alcohol Addiction Treatment?
Alcohol abuse treatment, like SUD treatment in general, encompasses a wide range of options and levels of care, so the cost of rehab can also vary significantly. When you decide to start looking for the right kind of treatment for yourself or a loved one, the first step is making sure that you go to a primary care physician and substance abuse treatment facility that is in-network with BCBS of Illinois. Those healthcare providers have contracts with your insurance provider, so staying within the network will ensure that the health plan you have will keep your costs down to a minimum.9
Opting for an out-of-network doctor is likely to leave you without full coverage and you’ll end up paying more for the required services or even paying the full cost. If your BCBS health plan is HMO (Health Maintenance Organization), you have access to doctors and hospitals that form your HMO provider network. Your primary care doctor can refer you to an addiction specialist within your network.10 HMO health plan is designed to provide personalized care coordinated by your primary care doctor, who is familiar with your health history, any additional issues, medication, lifestyle, or family’s health history.9
It’s also possible to get low-cost or freetreatment through a government program, (like Medicaid, for example) based on your income and family size.10 When it comes to the cost of alcohol rehab, several factors influence the final cost of addiction treatment:11
- The type and number of services.
- Treatment intensity.
- Level of care.
- The duration of the necessary treatment program.
- The type of amenities in your rehab facility.
How Much Is Inpatient Alcohol Abuse Rehab?
Inpatient or residential alcohol abuse treatment is considered to be the most effective option, particularly when it comes to individuals with more severe addiction, and those with diagnosed co-occurring mental health disorders. Dual diagnosis requires a more intensive level of care, including psychotherapy, behavioral therapies, and individual and/or group counseling. Inpatient treatment provides a safe and supportive treatment environment, away from the stress and triggers of everyday life, or potentially less-than-ideal friend or family relationships and interactions.12
Residential or inpatient rehab programs offer structured, intensive care and monitoring, safe housing, and medical attention. Short-term treatment usually lasts up to a month. It consists of safe, medically monitored detoxification and initial counseling to prepare the patient for treatment in an outpatient, community-based setting.13
Long-term inpatient treatment is generally the most expensive treatment program because the patient lives at a rehab center for a month to a full year. The amenities and the level of comfort vary between different rehab centers, as well as the quality of care, number of activities, the potential availability of holistic approaches, or specific nutrition preferences. All these elements are considered additional benefits that are not medically necessary, and most plans don’t provide coverage for them.12
How Much Is Outpatient Alcohol Abuse Rehab?
Outpatient alcohol treatment programs are less expensive than inpatient ones, but the cost will vary depending on the intensity of treatment and the number of visits to a rehab center. Patients usually continue to outpatient treatment after the completion of detoxification and inpatient treatment. They may also skip the inpatient program altogether if their addiction is not as severe, or if their life circumstances don’t allow for a long absence from work or family obligations.13
Outpatient treatment includes regularly scheduled visits to the treatment facility for meetings with addiction therapy specialists, usually for a few hours per week. These programs can involve individual and/or group counseling, that usually involves behavioral therapy sessions.13
How Much Are Partial Hospitalization Programs (PHP) for Alcohol Abuse?
Partial hospitalization programs are usually covered by the BCBS of Illinois if they are medically necessary. However, some additional costs are not covered by an insurance plan, like transportation, meals, or any particular services that might be recommended as part of a comprehensive individually tailored recovery plan.14
The severity of each patient’s addiction will determine the intensity and duration of treatment, and the level of care. The PHP treatment usually lasts about a month or two, starting with a minimum of 20 hours of treatment per week.14
How Much Is Medication-Assisted Treatment (MAT)?
BCBS of Illinois, like other major health insurance providers, offers health plans that cover medically necessary medication-assisted treatment. Taking the prescribed medication regularly is essential, due to the chronic nature of SUDs. Prescription drug coverage depends on each person’s plan. Sometimes there’s a fixed copay that the patient must add to the covered amount, or they have to pay a certain percentage of the medication cost.5
These out-of-pocket costs are calculated based on the member payment tier of a specific medication, and your plan benefits. In any case, to keep them to a minimum, make sure to use an in-network pharmacy to fill your prescriptions.15, 16 Sometimes a pre-approval request from your doctor is necessary, so that the prescription gets authorized for coverage.15
Additionally, the medication covered by BCBS of Illinois has to be FDA-approved for treating alcohol abuse disorder. Currently, there are three approved medications for alcohol addiction treatment. Naltrexone is the most commonly prescribed one.13
Is the Cost of Alcohold Addiction Higher Than Alcohol Rehab?
When comparing the cost of active alcohol addiction with the cost of treatment, two perspectives should be taken into account. One is the cost of addiction to an individual and the other is the cost to communities and society in general since SUDs are detrimental to the well-being of both.17
Substance abuse-related costs to society are estimated to be about $442 billion each year, and, aside from healthcare costs, they also include productivity loss and criminal justice expenses. Across the U.S., more than 10 million workers suffer from some type of SUD. The fact that this is a leading cause of disability speaks to the severity of the national addiction crisis.2
Treatment, prevention, and implementation of evidence-based interventions are significantly less expensive than consequences of alcohol and drug abuse. What’s more, each dollar spent on SUD treatment saves $4 in healthcare costs and $7 in criminal justice costs.2
The cost-effectiveness of rehab is also quite clear when compared to the severe consequences to the personal and professional lives of people suffering from alcohol addiction. Even though the cost of treatment can be quite high and is one of the main reasons for not dealing with one’s substance abuse issues, the cost of active alcohol addiction significantly outweighs it through:2, 18
- The cost of alcohol addiction itself.
- Lost income due to diminished productivity and neglecting professional commitments.
- Numerous alcohol-related health problems.
- Mental health problems, suicides, and overdoses.
- Violence, domestic violence, and homicides.
- DUI/DWI-related legal problems and injuries, like car crashes.
Duration of Alcohol Rehab Covered by BCBS of Illinois
The length of alcohol rehab can’t be the same for everybody. Since each person is different, they will move through the process at their own pace. However, even though longer alcohol treatment programs tend to produce better outcomes and longer-lasting sobriety, BCBS of Illinois will only cover the medically necessary duration of treatment. This is determined by specialists in addiction treatment in collaboration with the BCBS of Illinois.6
Because of different insurance policies, not everyone will have the same benefits and coverage tiers. This is why the length of stay at a rehab center will be determined by your BCBS of Illinois substance abuse coverage and will most likely not cover the entire treatment plan created for your particular needs.5
To get accurate information about what kind of alcohol addiction coverage your health plan will provide, reach out to BCBS of Illinois so they can walk you through your options and the conditions of your alcohol rehab coverage. Don’t forget to have your insurance card with you when you call.
How to Decide Between BCBS of Illinois Inpatient & Outpatient Centers for Alcohol Addiction Treatment?
An inpatient or residential alcohol rehabilitation program is best suited to individuals with more severe forms of addiction. For patients with a history of relapse or those with a dual diagnosis, addressing both their alcohol addiction and mental health issues simultaneously is essential to successful recovery.6
Living at a rehab facility is also advised for patients who would benefit from removing themselves from their usual daily lifestyle and environment to avoid stress and triggers that might hinder recovery. This is also true for people who don’t have a healthy support system of friends and family and have better chances of achieving sobriety if they separate themselves from people and places that enable their substance use.6
If someone’s spouse or partner is having the same or similar substance abuse problems, a possible solution may be to address them together as a couple, so they don’t pull one another back from making progress.6
Another crucial factor to consider when choosing the type of treatment is the cost. Inpatient facilities are more intensive and costly. Calling the BCBS of Illinois helpline can help you determine how much of the cost will be covered by insurance and how much you’d have to pay out-of-pocket.19
Most high-quality rehab facilities work with major insurance providers like BCBS of Illinois to make the most out of your plan. Some of them offer low-cost or free rehab or sliding scale fees and payment plans so that everybody could get the needed treatment even if it’s not fully covered by their health plan.19
So, How to Make the Final Decision?
The decision about the appropriate type of treatment should be made according to your preferences but also the professional recommendation of addiction specialists. To give yourself the best possible chances of alcohol-free life, keep in mind these factors:14
- Regardless of the type or duration of treatment, the facility you opt for should be licensed and accredited. This means that you will get a high quality of care in any case.
- The specific treatment ecosystem, safe environment, and peer companionship can provide you with much-needed motivation and support.
- Comprehensive treatment with the appropriate level of care should be personally tailored to your needs in any high-quality rehab center.
- Several types of support groups are offered in both inpatient and outpatient settings.
- A more intensive and focused treatment might be the factor to make you decide in favor of an inpatient treatment setting.
- Personal accountability is something that you need to bring to treatment wherever you go. The ability to commit to sobriety and keep the motivation and focus, in inpatient or outpatient rehab, is essential.
How to Use BCBS of Illinois Insurance for Alcohol Rehab?
If you’ve decided to start looking for help for your alcohol addiction, there are a few crucial steps that will guide you to the appropriate treatment program:19
- The first step is to consult your primary care doctor. They can refer you to addiction specialists after assessing your situation, evaluating the severity of your alcohol abuse, as well as your overall health.
- Finding a rehab program can start by asking your primary care doctor for a referral, and taking into consideration the benefits of your health plan. Some health plans might allow you to make an appointment with a behavioral healthcare provider directly, but it’s more common to get authorization first.20, 21
- To determine if you can use your health plan benefits, you can call the BCBS of Illinois hotline or visit their website for members, Blue Access for Members, and enter your personal information to search for available options according to your plan and network.10
- BCBS of Illinois will collaborate with a chosen rehab facility to determine your coverage for alcohol addiction treatment nationwide.
What’s the Best Way to Locate a BCBS of Illinois-Covered Alcohol Treatment Facility?
There are several ways to find doctors, specialists, facilities, and pharmacies that are in-network with your insurance provider and get the maximum coverage of all needed services. If you’re still gathering information about alcohol addiction and rehab, you might want to call one of the 24/7 alcohol addiction hotlines, which can provide you free guidance and referral to addiction treatment centers near you.22
You don’t have to share any personal information but providing it will help the hotline representative to offer more accurate advice. Your medical information is confidential and protected by law. It can’t be shared without your explicit permission. All medical records and information are kept private and confidential.22
Another way to check your BCBS of Illinois insurance coverage is to contact the substance abuse treatment providers you’re interested in. American Addiction Centers (AAC) is a nationwide network of treatment facilities that works with all major insurance companies, including BCBS of Illinois.
AAC enables patients to get maximum rehab coverage for all medically necessary services, and find the best payment options for those elements of treatment that may not be covered. Their admission navigators can check your coverage quickly while you’re on the phone and explain the process of starting addiction treatment. They can explain the initial intake process and assessment, offer same-day admission in case of an acute crisis, and describe the different elements of treatment.
You can easily find high-quality rehabilitation programs in facilities near you and check that they’re in-network with BCBS of Illinois by filling out and submitting a verification of benefits form on the AAC website.