Can I Pay for Alcohol Rehab Using Blue Cross Blue Shield of Massachusetts Insurance?
Major health insurance providers like Blue Cross Blue Shield of Massachusetts cover medically necessary alcohol addiction treatment and substance abuse treatment in general. According to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, all state-regulated, commercial healthcare plans must provide the same level of benefits for substance abuse and mental health disorders as they do for medical and surgical procedures.1
Access to SUD treatment was made easier by the changes created by the Affordable Care Act of 2010. Treatment for substance abuse and mental health disorders is one of the essential health benefits, so Blue Cross Blue Shield of Massachusetts provides nationwide coverage for a wide range of medically necessary SUD treatment services. This includes both outpatient and inpatient treatment, detoxification, aftercare, recovery support services, and pharmacotherapy (medications).2
Massachusetts Alcohol Abuse and Treatment Statistics
According to the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS), Massachusetts has consistently ranked among the top 10 states regarding the total number of clients in treatment during the 2009-2017 period. In 2017, the number of patients in treatment was 58,280.3
Out of 351 Massachusetts rehab facilities, 74.1% treat patients suffering from alcohol addiction only, while 94.1% of rehabilitation centers offer treatment for both alcohol and drug addiction. Since SUDs are quite often accompanied by mental health problems, 99.1% of MA facilities provide treatment for clients diagnosed co-occurring mental and substance abuse disorders.3
An Overview of Alcohol Addiction Treatment Services Covered by the BCBS of Massachusetts Insurance
As with all commercial health insurance providers, alcohol addiction coverage can vary significantly depending on your Blue Cross Blue Shield of Massachusetts healthcare plan. To get maximum coverage for the addiction treatment you need, explore the in-network substance abuse providers and facilities. Since Blue Cross Blue Shield of Massachusetts is a major provider, it collaborates with a wide network of doctors, hospitals, and other medical facilities.4 Since private health insurance is accepted in 72.1% of Massachusetts rehab facilities, finding an appropriate facility for your needs shouldn’t be hard.3
Necessary alcohol abuse treatment services are covered under most plans. Blue Cross Blue Shield of Massachusetts is likely to cover:5
- Screenings (for substance abuse in 95.2% of MA SUD facilities, and for mental health disorders in 72.6% of facilities), interventions, comprehensive SUD assessment in 91.2% of facilities, and comprehensive mental health assessment or diagnosis in 49.9%.3
- Medically monitored detoxification from alcohol is provided in 51.9% of Massachusetts rehab facilities.
- Inpatient care at specialized alcohol rehab centers.
- Outpatient therapy and intensive outpatient programs. Outpatient treatment is offered in 63.2% of MA rehab facilities, while intensive outpatient programs are available in 19.7% of facilities.3
- Behavioral therapies such as cognitive-behavioral therapy (CBT) that’s available in 96.6% of facilities and motivational interviewing that’s offered in 98.3%
- Rehab or acute residential treatment and partial hospital treatment.
- Treatment for co-occurring disorders.
Because mental health issues often accompany alcohol and drug abuse, Blue Cross Blue Shield of Massachusetts also provides mental health coverage and guidance for:6
- Depression.
- Anxiety.
- Stress.
- Major life changes.
- Other diagnosed mental health conditions.
What Is Blue Cross Blue Shield of Massachusetts?
Blue Cross Blue Shield of Massachusetts, as an independent licensee of the Blue Cross Blue Shield Association, is a non-profit company established in the 1930s. Blue Cross of Massachusetts was the first organization that offered statewide insurance coverage for hospital stays and, as of 1941, Blue Shield of Massachusetts began providing coverage for doctors’ office visits. These two organizations merged in 1988 and became the Blue Cross Blue Shield of Massachusetts.4
Today, the company serves nearly 3 million members and collaborates with more than 80% of MA doctors and hospitals. Blue Cross Blue Shield of Massachusetts also offers out-of-state coverage and reimburses out-of-network coverage in some cases. It’s one of the largest provider networks in the U.S., with more than 67,000 clinicians.7
Blue Cross Blue Shield of Massachusetts provides personalized care management using Team Blue. Registered nurses, mental and behavioral health specialists, wellness coaches, and service representatives provide guidance to members. These specialists can help you understand and access the necessary care.8
What Parts of Alcohol Addiction Treatment Are Not Usually Covered by BCBS of Massachusetts?
There are elements and services of addiction treatment that, despite being highly beneficial to some patients, aren’t considered medically necessary. Therefore, these services aren’t typically covered by most health insurance plans. They include:9
- All non-medical amenities, usually luxury ones with hotel-like accommodation, spas, saunas, gyms, and swimming pools.
- Assistance and transportation services to and from treatment and, offered in 47.3% of Massachusetts rehab centers.3
- Holistic care services like yoga or tai chi.
- Recreation programs, like pilates.
- Food delivery and nutrition counseling.
- Private treatment services like personal training or massage therapy.
- Alternative therapies like acupuncture, mind/body techniques like reiki, hypnosis, or Chinese herbal therapy.
However, Blue Cross Blue Shield of Massachusetts has a wellness program for its members that can help them save up to 30% on some holistic and wellness services.10
How Much Does Alcohol Rehab Typically Cost?
The cost of SUD treatment, alcohol rehab included, varies greatly based on multiple factors. Addiction treatment programs are individually tailored to each patient’s needs, the severity of their addiction, lifestyle, and background.11,12
Among others, some factors that influence the cost of alcohol rehab are:11
- The level of care, type, and the number of services.
- The quality and intensity of treatment and the number of hours of care.
- Different treatment durations times and whether the program is inpatient or outpatient.
- The type of amenities offered at a certain rehab facility, since some private rehab centers offer a high end, luxury accommodation, gyms, spas, swimming pools, and other wellness options.
Inpatient Care for Alcohol Addiction
Alcohol rehab in an inpatient or a residential setting requires a stay at the rehab facility. The duration of stay is one of the main factors that influence the cost of rehab. Less severe alcohol addiction usually involves up to a week of detox and a short-term stay at the rehab facility (about a month). Long-term inpatient programs can last 60-90 days or, in more severe cases, up to a year.12, 13
Outpatient Care for Alcohol Addiction
Outpatient rehab is the least expensive form of addiction treatment. It’s appropriate for patients with moderate alcohol abuse issues or those who can’t take time off from work and/or personal responsibilities. It usually involves weekly visits to the rehab center for meetings with an addiction counselor, and both individual and group therapy. The cost will depend on the number of hours and services provided to the patient. Outpatient treatment can also be a form of aftercare for patients who have completed inpatient treatment.12
Alcohol Partial Hospitalization Programs (PHP)
Partial hospitalization programs are more intensive than outpatient ones and generally involve more hours at the rehab facility, but the patient lives at home during treatment. These programs usually last for a couple of months and require a minimum of 20 hours of treatment per week. The number of hours of therapy, included services, and the duration of treatment will determine the cost.14
Medication-Assisted Treatment (MAT)
Medication-assisted treatment for alcohol abuse involves the use of one of 3 FDA-approved medications for alcohol addiction. The most commonly used one is naltrexone in oral tablet form. The cost and the Blue Cross Blue Shield of Massachusetts drug coverage will depend on the duration of treatment and the tier of prescribed medication.12
Since alcohol addiction is a chronic illness, it’s important that the medication is taken regularly for as long as your doctor and addiction specialists determine it’s necessary. Specialists involved in your treatment will collaborate with your insurance provider and occasionally evaluate your improvement to see if you should continue taking the prescribed pharmacotherapy.15 Naltrexone oral tablets for alcohol treatment are used in 41.6% of Massachusetts facilities.3
The Cost of Alcohol Rehab in Comparison to the Cost of Alcohol Addiction
The main reason that deters a lot of people from getting treatment for their alcohol or drug addiction is the perceived high cost of treatment. However, on both personal and societal levels, the cost of active addiction is a lot higher. The costs of untreated SUDs are detrimental and more expensive for society in general and the addicted individual. Each year, about $442 billion is either spent on substance abuse healthcare expenses and criminal justice proceedings or lost due to diminished work productivity.16, 17
The key factors that make alcohol addiction more expensive than treatment include:16
- The expenses of active addiction, meaning the cost of alcohol itself.
- Lost income, which is usually the result of neglecting professional responsibilities, missing work, or getting fired.
- The money spent on treating numerous health problems that occur as a result of prolonged and excessive alcohol use.
- Acute health dangers like alcohol poisoning and injuries like car crashes.
- The cost of legal problems, most commonly DUI/DWI-related.
- Mental health issues that arise from alcohol use (like anxiety and depression) that sometimes even lead to suicide.
- Violence in general, but especially domestic violence, neglecting family responsibilities, or child endangerment.
Duration of Stay in Alcohol and Drug Rehab Centers Covered by Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Massachusetts, and other private health insurance providers, are legally required to cover medically necessary, FDA-approved, and evidence-based treatment. Even though patients completing longer alcohol or drug abuse treatment programs have better chances of maintaining sobriety, having fewer relapses, and achieving lasting recovery, the decision about the type of treatment is made through a collaboration of a team of specialists.18
Since quality addiction rehab programs tailor the treatment to accommodate the needs and circumstances of each patient, everybody’s treatment program will involve a different duration of stay at the facility, different number and types of services, therapy, and medication. As there are many different types of health plans and tiers of coverage they provide, this will also determine the length of stay at a rehab facility.9
You can look up the conditions of your health plan in the contract you have with your provider, or you can call the Blue Cross Blue Shield of Massachusetts helpline and have one of their representatives explain your benefits and insurance coverage.
The Choice Between Inpatient vs. Outpatient BCBS of Massachusetts Covered Alcohol and Drug Rehab Centers
This choice shouldn’t be made lightly on your own. It’s crucial that a team of addiction specialists and your primary care physician are involved, since their recommendations and evaluation should be key to such an important decision. To make an informed decision, talk to all the specialists involved in your treatment, but also consider the following factors and ask anything you need to know about them.9
Even though 92.2% of all SUD clients in Massachusetts rehab centers are attending outpatient treatment, there are multiple reasons why inpatient treatment is associated with better results and higher chances of achieving lasting recovery:14
- The quality of care. Make sure to check if the rehab center you’re considering has licensing, certification, or accreditation by federal, state, and local agencies and organizations. The highest quality rehab programs are accredited by CARF and the Joint Commission.
- The treatment environment is a specific ecosystem created in inpatient settings through the support and companionship of people who understand one another and what they’re going through. This can help maintain motivation, keep the focus, and follow through with the treatment program.
- Support groups are also a helpful element of both inpatient and outpatient treatment. Aside from individual counseling and therapy, patients can also attend group, family and marital counseling, or 12-step facilitation. Since alcohol abuse can put significant strain on partner relationships, especially when both partners are battling addiction, couples counseling is attended by 73.6% of Massachusetts’ rehab clients.3
- Inpatient program setting provides a more focused environment. Individual counseling or therapy is attended by 89% of rehab patients and it can significantly help them to get to the underlying causes of their addiction. As many as 67.3% of MA SUD patients are diagnosed with co-occurring mental health and substance abuse disorders.
- Outcome follow-up after discharge is provided after the completion of the residential program and can include outpatient services, support groups, sober living, and other aftercare services.
- Personal accountability is a trait that every patient brings to their treatment, no matter what type they attend. However, the nature of the inpatient treatment setting tends to put a stronger emphasis on responsibility for one’s actions and helps patients keep the motivation to adhere to the program and commit more fully to recovery.
How to Use BCBS of Massachusetts Insurance to Cover Alcohol Rehab
The easiest and safest way to get answers to all your questions and guidance through your alcohol addiction recovery is by contacting someone from Blue Cross Blue Shield of Massachusetts helpline. Their Team Blue service representatives can explain everything about your substance abuse coverage or plan benefits, present you with all the options, and help you make informed decisions. They can direct you to in-network substance abuse providers and estimate the cost and coverage of the alcohol treatment program you need.8
The process of finding an appropriate facility and starting your rehab involves several steps:19
- First, you need to consult your doctor or a primary care physician for an initial evaluation and referral to an addiction specialist. They will also evaluate your general health.
- The second step is finding a suitable rehab program, with the guidance of both your doctor and your insurance provider.
- Determining your ability to use insurance is the next step, depending on the type of plan you have and the treatment and services you need, by choosing an in-network provider to minimize out-of-pocket costs.
- Your chosen rehab facility will work with Blue Cross Blue Shield of Massachusetts to determine the alcohol or drug rehab coverage for your treatment.
What Facilities Accept Blue Cross Blue Shield of Massachusetts Insurance & How Can I Find Them?
To check your benefit details, you can call the BCBS of Massachusetts helpline or check your benefits by logging into your MyBlue account on their website.5 Team Blue care managers can provide general information and explain protocols, reach out to your provider if necessary, and help you access your benefits, as well as behavioral inpatient and outpatient care. They can find in-network specialists who can treat your condition.6
If you don’t feel ready to start discussing the specifics, you can get more general information from a free, 24-hour addiction hotline. Their representatives will answer all your questions and evaluate your situation to give you advice and recommend the next steps. You can feel free to share your story since the confidentiality of all medical information is protected by law.
In-Network Substance Abuse Treatment Providers
One of the in-network substance abuse providers of Blue Cross Blue Shield of Massachusetts is the American Addiction Centers (AAC). This is a nationwide network of top-notch substance abuse treatment facilities that offer a full continuum of care and personalized recovery programs to accommodate every patient’s needs and circumstances.
Calling the AAC hotline is another way to get information about your Blue Cross Blue Shield of Massachusetts benefits and coverage for alcohol addiction treatment, both in MA and nationwide. One of the AAC admission navigators will answer your call and, if you have your insurance card with you, they can verify your coverage right away, or explain possible payment options. This is also the perfect chance to find out more about what addiction treatment looks like and ask about the initial steps of intake and assessment, as well as other elements of treatment.
You can also check your benefits by submitting an online form on the AAC website.
Local Alcohol Rehabilitation Centers in Massachusetts
In case you feel the need to start your recovery right away, the admission navigators can evaluate the situation and provide guidance. It’s worth knowing in such cases that 27,1% of Massachusetts facilities offer interim services when immediate admission is not possible.3
Even though AAC runs leading rehab facilities nationwide, most people tend to opt for local substance abuse facilities. You will get the highest quality treatment programs in any of the local Massachusetts facilities:
