Does Blue Cross Blue Shield of Michigan Cover Alcohol Rehab?
Alcohol dependence rehabilitation programs belong to the substance abuse and mental health disorder category and are therefore covered as behavioral health services. As one of the major nationwide healthcare insurance providers, Blue Cross Blue Shield of Michigan is required by law to provide the same level of coverage for behavioral health services as they do for other medical or surgical care services.1
Behavioral and mental health services, as well as substance use disorder (SUD) services, are essential health benefits. This makes alcohol addiction treatment coverage guaranteed by the requirements of the Affordable Care Act (ACA) of 2010 and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.2
According to the 2017 report by the National Survey of Substance Abuse Treatment Services (N-SSATS), Michigan has consistently ranked within the top 10 states when it comes to the total number of rehab facilities during the previous decade (2007-2017). Out of 537 MI facilities, 456 were included in this report, and they had 54,064 clients in treatment in 2017.3
Blue Cross Blue Shield of Michigan, with its Blue Care Network, has contracts with more than 33,000 doctors and 152 hospitals in the state. However, members have different coverage and benefits depending on the specifics of their healthcare plans. BCBS of Michigan PPO network provides access to all the hospitals and more than 95% of doctors in MI, while the HMO network gives access to more than 6,100 primary care physicians, 22,700 specialists, and most of the state’s top-rated hospitals.4
What Elements of the Alcohol Treatment Program Does Blue Cross Blue Shield of Michigan Insurance Cover?
When it comes to substance abuse coverage in general, including alcohol addiction, Blue Cross Blue Shield of Michigan is required to cover all medically necessary, appropriate, evidence-based, and FDA-approved services and treatment approaches. This includes:5
- Screenings and evaluations for SUDs, mental and physical health issues, as well as any related interventions that are considered necessary.
- Supervised, medically monitored detoxification (available in 67.1% of MI facilities3), with or without pharmacotherapy that may be used to alleviate the withdrawal symptoms.
- Inpatient alcohol addiction treatment programs – also called residential or live-in programs.
- Outpatient alcohol rehab programs, including intensive outpatient programs for more severe addiction cases.
- Behavioral therapies for substance abuse and potential co-occurring mental health disorders. More than 50% of patients diagnosed with some form of substance abuse disorder also get diagnosed with a mental health disorder, and these conditions need to be addressed simultaneously so the patients can get the most out of their alcohol abuse treatment and have better chances of achieving lasting recovery.
Like all ACA-compliant health insurers, Blue Cross Blue Shield of Michigan covers SUD treatment through all of their healthcare plans, divided into ‘metallic’ categories. Each of those tiers covers a certain percentage of the provided services cost:6, 7
- Bronze plans cover about 60%,
- Silver plans cover about 70%,
- Gold ones cover about 80% of the costs.
Most of the US rehab centers are run by private organizations, and more than 80% accept private health insurance from all the major health insurance companies. This means that finding an appropriate one for yourself or a loved one shouldn’t present a difficult task.3 Blue Cross Blue Shield of Michigan has contracts with a wide network of substance abuse treatment providers.4
Are There any Parts of Alcohol Addiction Treatment That the Blue Cross Blue Shield of Michigan Won’t Cover?
Alcohol addiction, like other forms of substance abuse, can’t be treated with a one-size-fits-all approach. Each patient’s program is designed according to their specific needs and may involve certain elements and approaches that can be quite beneficial and effective for that individual but that do not satisfy the medical necessity criterion that ensures the BCBS of Michigan coverage.5
Those services usually include:8
- Various types of non-medical amenities, like those available in high-end rehab centers, including swimming pools, spas, saunas, gyms, etc.
- All sorts of recreation programs or wilderness and nature therapy.
- Food delivery, professional chefs, particular dietary requirements.
- Private services like personal trainers, massages, or transportation.
- Holistic care services like yoga, guided meditation, mindfulness exercises, or tai chi.
- Alternative therapies like hypnotherapy, acupuncture/acupressure, Chinese herbal remedies, or energy healing.
How Much Does Alcohol Rehab Cost?
The cost of your or your loved one’s BCBS of Michigan-covered alcohol addiction treatment will depend on the type of insurance policy you have and the therapy program you enroll in. Whether the severity of addiction and life circumstances require inpatient or outpatient treatment, the overall cost will depend on several factors:9
- The number and type of services provided within the rehab program.
- The intensity of services and level of care.
- Duration of treatment, in all settings (outpatient, partial hospitalization, inpatient).
- The type and number of amenities available at specific rehab facilities.
Inpatient Alcohol Rehab Cost
Inpatient alcohol rehab tends to be the most expensive type of addiction treatment, but it also tends to be the most effective. The cost will primarily depend on the length of treatment as residential programs can be short-term or long-term. They all begin with a detoxification process if necessary, and medication is sometimes used to ease the withdrawal symptoms. This usually lasts up to a week.10
After the detox, patients move on to an actual rehabilitation program that can last for about a month in case of short-term programs, or 2-3 months in case of long-term treatment. In most severe cases long-term residential treatment can even last up to a year.11
Outpatient Alcohol Rehab Cost
Outpatient rehab doesn’t require living at the facility. Patients usually come to the treatment center several times per week, so the price will depend on the number of hours they spend getting treatment and the number of provided services. Intensive outpatient treatments are also available for more severe cases. They require more hours of treatment and naturally cost more.10
Partial Hospitalization Programs (PHP) Cost
Partial hospitalization programs could be described as a crossover between inpatient and outpatient programs. The patient doesn’t live at the facility but they do spend more hours there receiving treatment services. They usually go every day and begin with a minimum of 20 hours per week, for several months. The price of these programs will depend on the number of hours and provided services.12
Medication-Assisted Treatment (MAT) Cost
When it comes to pharmacotherapy treatment for alcohol addiction, your insurance will cover only FDA-approved drugs. The generic, low-tier ones will usually be completely or mostly covered, while the higher-tier ones generally require a copayment from you (either a fixed amount or a percentage of the cost), depending on the type of policy you have.10
There are three FDA-approved medications for treating alcohol addiction, but the most commonly used one is naltrexone in oral tablet form.13
The Cost of Alcohol Rehab in Comparison to the Cost of Alcohol Addiction
Even in modern society, both alcohol addiction and attending rehab frequently carry a certain level of social stigma. However, the most common reason for not getting the needed treatment is of a financial nature. A lot of people believe that the price of rehab is cost-prohibitive and therefore unavailable to most.14
However, a lot of research has been done on the subject that proves that the cost of active addiction is actually a lot higher than getting treatment. The main factors that contribute to the high cost of substance abuse are:15
- The cost of active substance abuse itself, meaning the cost of alcohol.
- The cost of lost income caused by neglecting work responsibilities, diminished productivity, or even losing a job due to alcohol-related negligence of professional commitments.
- The cost of alcohol-related health problems, both physical and mental, as well as costs of emergency room visits in case of injuries or alcohol poisoning.
What Length of Alcohol Addiction Treatment Does Blue Cross Blue Shield of Michigan Cover?
Blue Cross Blue Shield of Michigan will cover the length of treatment that is determined to be medically necessary by a team of addiction specialists. This will depend on several factors and the severity of the addiction is one of the main ones.12
When it comes to the effectiveness of substance abuse treatment, a correlation has been documented between longer treatment times and better outcomes. Even though each patient’s needs are different, the BCBS of Michigan coverage they can get for their alcohol addiction treatment will ultimately depend on the insurance plan they have. However, longer treatment programs generally result in fewer relapses and raise the chances of achieving lasting recovery.12
To find out what kind of coverage you or your loved one can get with the health plan you have, reach out to your insurance provider or look up your policy information on your card or insurance contract.
How to Choose Between Blue Cross Blue Shield of Michigan Inpatient vs. Outpatient Alcohol Rehab Centers Nationwide
Choosing between inpatient and outpatient alcohol rehab programs should be driven by recommendations and assessments made by a team of addiction specialists. Your or your loved one’s physical and mental health should also be taken into consideration when deciding to enroll in a substance abuse program. However, since people’s life circumstances can differ significantly, it may be up to the treatment-seeking individual to make the final decision and choose the program that’s suitable for their needs.10
Keep in mind that inpatient or residential treatment has been proven to result in longer-lasting sobriety and diminished rates of relapse. This is due to several factors:12
- The quality of care is usually more comprehensive in residential programs as patients are being monitored daily and the treatment approach is adjusted according to their progress.
- A specific inpatient treatment ecosystem is created by living with others who are going through a similar experience, so patients can find support and comfort in the fellowship created in such an environment.
- Support groups are available in both inpatient and outpatient settings, but closer bonds are created between people sharing their daily lives and supporting each other 24/7. Live-in programs also help counselors and therapists to form more thorough insights through their work with patients.
- Residential treatment creates a more focused environment since there are no outside distractions, common everyday stressors, triggers, or enabling persons and situations.
- Accountability will ultimately depend on each patient’s personal characteristics, but participating in the program 24/7 and having the constant support from both the counselors and other patients might help some people truly commit to recovery and stick to the program.
Using BCBS of Michigan Insurance for Alcohol Treatment
The process of getting help for your or your loved one’s alcohol addiction usually starts with your primary care physician who needs to perform an initial evaluation and refer you to an in-network specialist. They normally look for any physical health conditions that may need to be taken into account when designing a suitable treatment program. The process usually consists of these steps:16, 17
- Consulting a doctor (the treatment-seeking individual’s primary care physician) and getting a referral, in case the patient has an HMO plan. People with PPO plans don’t need a referral to see a specialist within the network.
- Finding a suitable rehab program can be done either by getting a recommendation from a doctor, addiction specialist, or other people who have already successfully completed their rehabilitation program.
- Determining your or your loved one’s ability to use insurance – to do this you need to check if your preferred rehab center is in-network with Blue Cross Blue Shield of Michigan. Depending on the type of plan the patient has, it’s also possible to get nationwide out-of-network insurance coverage from BCBS of Michigan. However, this usually means that the insurer will cover a smaller percentage of the cost.
- The last step is a collaboration between the chosen rehab center and Blue Cross Blue Shield of Michigan to determine the rehab coverage for the patient’s alcohol rehabilitation program. The covered percentage of the cost will depend on their insurance plan, and whether they selected an in-network substance abuse treatment facility.
How to Find Inpatient Alcohol Rehabs That Accept Blue Cross Blue Shield of Michigan Insurance Coverage
If you feel hesitant about making things official and would like to get some general information about alcohol addiction and treatment first, there are 24/7 addiction hotlines that are both free and confidential, like all your medical information. This is a safe way to get all the information you need before contacting your insurance provider and initiating the rehab process. This is a safe and private way to find out how to get appropriate help for yourself or a loved one.16
When you do decide to take the first step, you can call the Blue Cross Blue Shield of Michigan helpline and get the most accurate information from your health insurance provider. Alternatively, you can call the rehab center you’re interested in and check if they’re in-network with BCBS of Michigan.
Getting Guidance From an In-Network Treatment Provider
One of the substance abuse treatment providers that are in-network with Blue Cross Blue Shield of Michigan is the American Addiction Centers (AAC). This is a nationwide network of top-notch rehab facilities that offer a full continuum of care and meet the highest standards of alcohol abuse treatment, including additional options and specifically designed programs, such as therapy for couples battling addiction together.
You can easily check your coverage and payment options by reaching out to AAC and having one of the admission navigators check your benefits during the call – just make sure to have your insurance card with you. Admission navigators can also refer you to local rehab facilities. Another way to check your coverage is to verify your benefits online by filling out and submitting a form on the AAC website.
AAC’s admissions navigators can answer any questions you may have about the treatment, explain the intake process, and the following steps of an alcohol addiction recovery program. They can also help you get admitted as soon as possible if you or a loved one are experiencing an acute crisis and feel the need to start with treatment right away.