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BCBS of Michigan Insurance Coverage for Opioid Rehab

Can I Count on BCBS of Michigan to Cover My Opioid Rehab?

Opioids are prescription drugs that are usually reserved for people who suffer from acute or chronic pain. Doctors prescribe them as painkillers to people who find it hard to lead normal lives due to persistent pain, but also as part of postoperative care for those who underwent surgery.1

Opioids are considered safe when used in accordance with doctor instructions, but can become highly addictive when misused or taken as a recreational drug. They include substances like fentanyl, codeine, tramadol, but also morphine and illegal street drug heroin.2

With BCBS of Michigan healthcare plans, treatment-seeking individuals have access to some form of nationwide coverage for opioid rehab since it’s included in the list of 10 essential health benefits that all Marketplace plans must cover.3 This is important because opioid misuse has become so widespread nationwide that the Department of Health and Human Services decided to declare opioid misuse a public health emergency in 2017.4

What Types of Addiction Treatment Will BCBS of Michigan Insurance Include in its Rehab Coverage?

It’s estimated that 9.5 million individuals aged 12 or older suffered from opioid misuse in 2020. Most of them were suffering from prescription opioids misuse while around 900,000 individuals were categorized as heroin users.5 Even though heroin use rates have been falling for some time, the worrying trend is an upsurge in use of the synthetic opioid fentanyl.6

Good news is that opioid addiction can be cured in a variety of ways depending on the specific situation and needs of individual patients. Some evidence-based recovery approaches that BCBS of Michigan substance abuse coverage includes are:7

  • Screening that doctors use to assess the medical situation and needs of individuals who misuse opioids.
  • Brief and early intervention that can help solve the problem before it becomes entrenched and manifested in various symptoms.
  • Medically assisted detoxification that helps people get sober and physically better before tackling their mental health issues.
  • Treatment for various types of mental health challenges that might coexist with addiction called co-occurring disorders.
  • Different behavioral therapies that aim to change bad habits and unhealthy lifestyles that lead people to misuse opioids.
  • Outpatient drug treatment programs that can be of varying intensity and duration.
  • Inpatient and residential drug treatment programs that utilize the beneficial and soothing environment of professional substance abuse treatment facilities to achieve long-lasting results.

What Elements of Opioid Rehab BCBS of Michigan Won’t Cover?

Since the adoption of The Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 and The Affordable Care Act (ACA) in 2010, nationwide coverage of mental health issues including addiction rehabilitation has been greatly expanded to include many things which previously weren’t covered by all plans.8

Because individual states reserve the right to mandate insurance benefits, rehab coverage will extend only to those services which are considered to constitute a medically necessary part of the rehab process.9 For this reason, BCBS of Michigan in most cases won’t provide coverage for:10

  • Items that are considered as non-medical amenities.
  • Various holistic care services.
  • Different recreational programs.
  • Food deliveries and diet regimes.
  • Alternative and experimental therapies.
  • Private treatment services.

What Is Blue Cross Blue Shield of Michigan?

BCBS of Michigan is a proud member of Blue Cross Blue Shield Association, which represents a nationwide federation of substance abuse rehabilitation providers. It includes 35 different companies that provide healthcare coverage to almost 115 million Americans in all 50 states.11

BCBS of Michigan is a longstanding nonprofit mutual insurance company that was originally founded in 1939. As the largest health insurer in the state, it serves more than 4.5 million people in Michigan and 1.6 million in other states. It boasts the most extensive network of facilities in Michigan with 152 hospitals which are staffed by more than 33,000 doctors.12

With a commitment to continually increase access to affordable health care, enhance the overall quality of care, and improve the health of citizens and local communities in the state, BCBS of Michigan gives people the option to choose from a long list of available benefit plans, such as:12

  • Traditional plans.
  • PPO (preferred provider organization) plans.
  • HMO (health maintenance organization) plans.
  • Medicare plans.
  • Medicaid and state plans.
  • Wellness-based plans.
  • Plans with health spending accounts.
  • Dental and vision plans.
  • International plan.
  • Pharmacy plans.

How Much Would BCBS of Michigan Opioid Rehab Amount To?

According to SAMHSA’s annual report, there were 32,334 admissions for opioid misuse in the state of Michigan for the year 2017. The number of admissions for the year 2008 was 16,876 which means that in 10 year period the number of people who sought opioid addiction treatment practically doubled.13

Furthermore, not all people have the same determination to get better nor do they all respond equally to treatment. Some individuals may need more intense forms of rehab to achieve full recovery, while others need longer duration of treatment, making it hard to ascertain the overall costs before recovery starts.14

If treatment is taking place inside a substance abuse treatment facility the costs will be greater than in case of behavioral therapies or outpatient rehab. Some facilities provide more expensive and luxurious amenities and their price will reflect this. Since every case of opioid addiction differs in duration of misuse and the severity of dependence, it’s hard to determine the costs of treatment before medical screening.14

How Much Would BCBS of Michigan Inpatient Opioid Rehab Amount To?

Due to the fact that inpatient rehab takes place inside an addiction treatment center, costs will depend on factors that are related to facility treatment. This means that rehab duration becomes a very important factor since treatment can be based on a short-term stay of around 30 days, or it can be a long-term rehab that lasts for several months.14

Another factor is the type of facility since some facilities offer very luxurious programs that provide only the best of amenities and services and cater to patients who are accustomed to the highest levels of luxury or are able to pay for treatment out of their pocket. There are also options for people that need an inpatient drug treatment program but are unable to afford it in the form of state subsidies and government grants.14

How Much Would BCBS of Michigan Outpatient Opioid Rehab Amount To?

Outpatient rehab is the most popular form of addiction treatment in Michigan with 26,409 admissions, representing 35% of 75,553 people who sought help for addiction in 2017.13 One of the reasons for this is that outpatient rehab is a very adaptable form of treatment that can meet the needs of different types of patients.15 This adaptability also makes it hard to predict the cost of treatment.

It can be adjusted in terms of duration but also in terms of intensity. In case of mild addiction cases, outpatient treatment utilizes various behavioral therapies and individual and group counseling sessions. Outpatient rehab is cheaper that inpatient rehab because patients are spared the expenses that come with full hospital care.15

Intensive outpatient treatment, or IOT, is designed for those that need inpatient level of intensity but are unable to commit to hospital for the duration of treatment, whether because of budgetary constraints or due to their job situation. Outpatient treatments can also vary in terms of length of treatment and the number of weekly sessions.15

How Much Would BCBS of Michigan Partial Hospitalization Programs (PHP) Amount To?

Partial hospitalization programs are somewhere between IOT and inpatient drug treatment since they are more intensive than IOT with patients spending nights in their homes. It is a good option for those that have a stable home situation or live in a supportive environment that is void of potential triggers and bad influences.15

PHP include sessions of at least 30 hours per week with daily appointments in the hospital. PHP provides patients with a structured environment of rehab center with constant medical attention. Sessions can last up to 10 hours a day or 50 hours per week in case of severe cases. The patient also needs to be willing to regularly attend their PHP sessions.15

How Much Would BCBS of Michigan Medication-Assisted Treatment (MAT) Amount To?

The use of medication for treatment of opioid addiction has been proven very effective in helping people who suffer from opioid addiction. They not only help in managing painful consequences of withdrawal and opioid use but also reduce the risk of potential infectious diseases, drug related criminal activities and unwanted overdose incidents.16

Medication used in MAT are proscribed in combination with psychosocial therapies, social support groups and mutual-help programs in order to deliver a comprehensive addiction treatment approach that aims to treat both physical and mental health resulting in full recovery.17

Cost of treatment will depend on the duration of treatment and the setting in which it’s taking place, but also on the type of substance used. So far FDA approved 4 substances for treatment of opioid addiction and misuse:16

  • Methadone.
  • Buprenorphine.
  • Naltrexone.
  • Lofexidine.

Opioid Rehab vs. the Cost of BCBS of Michigan Opioid Addiction

According to the latest research from 2021 by the CDC, combined costs of opioid use disorder and fatal opioid overdose for the state of Michigan were a staggering 41,396 billion dollars, and that’s just for the year 2017. During that year 2,033 people died in Michigan from opioid overdose. The same report estimates that only 134.5 million was spent on substance abuse treatment which is just a tiny fraction of the overall amount.18

In addition to these costs that fall on the state and the taxpayers, the individual costs of maintaining an opioid addiction coupled with loss of income and job opportunities as well as future costs of opioid related health issues which burden long-term drug users clearly show that benefits of treatment far outweigh the costs of addiction.18

What Length of Opioid Rehab Does BCBS of Michigan Cover?

Length of treatment will depend on how long the person has been misusing, how severe their addiction is, and how well they respond to treatment. Opioid addiction is a combination of mental and physical health problems and as such requires a personalized approach that is tailored to specific individual needs.14

Opioids produce lasting changes in the brain that make it hard for people to think clearly and make informed decisions concerning their wellbeing and addiction. For this reason they can experience relapse episodes once they stop using and may need to enter into treatment again. In order to avoid this, it’s advisable to stay in treatment for at least 3 months and in cases of methadone maintenance even more.14

If you have questions about the length of your BCBS of Michigan rehab coverage and treatment options, call the number that is located on the back of your insurance card. You can also call a BCBS of Michigan helpline that will provide you with answers and make it easier to understand which duration of treatment is suited to your particular situation.

Choosing between BCBS of Michigan Inpatient vs. Outpatient Drug Rehab Centers

If your situation is not severe and you are still able to meet the requirements of everyday life and schedule, then outpatient rehab may be a good addiction treatment option. Outpatient rehab could also meet your needs if you have an encouraging and healthy family unit that will provide support during treatment.15

Still, if you have the option it might be best to look into an inpatient rehab program since it offers the greatest quality of care. Since it takes place inside a specialized substance abuse treatment facility it offers 24/7 professional medical care. Once you are inside the center, doctors are able to monitor your situation and progress, and adjust the treatment accordingly.14

Inpatient drug rehab centers offer a structured daily schedule within a focused environment. This encourages accountability and helps individuals deal with all the aspects of their addiction. Patients will spend time in a beneficial ecosystem that utilizes various support groups and amenities that will tackle their co-occurring disorders and aid their overall recovery.7

Due to the fact that starting with recovery is not an easy decision to make, in many cases entering into treatment as soon as possible can be as important as the type of drug treatment program, so keep that in mind when making your decision and choosing a suitable inpatient rehab center.14

How to Use BCBS of Michigan Insurance for Opioid Rehab?

Using your BCBS of Michigan insurance coverage to enter into addiction treatment is easy and starts with a visit to a doctor. Doctors alone are qualified to conduct a medical screening and evaluate your overall mental health situation. Since there is no one-size-fits-all approach when it comes to opioid addiction, clinical assessment represents an important part of treatment.19

After looking into your case, the doctor will determine your ability to use insurance for opioid rehab and recommend suitable treatment that best addresses your personal needs before providing you with a referral. After that you can start looking into one of BCBS of Michigan supported nationwide inpatient rehab centers that can help you determine the extent of your drug rehab coverage.

How to Find Opioid Rehabs That Accept BCBS of Michigan Insurance Coverage?

American Addiction Centers offer dedicated hotlines that help those who suffer from heroin abuse as well as hotlines that aid people with prescription drugs problems. Hotlines will be able to help you get acquainted with all the aspects of rehab, including verifying your drug rehab coverage, checking your benefits and providing advice on alternative payment options.

American Addiction Centers runs the largest nationwide network of trusted rehab centers that deliver top quality recovery solutions in every corner of the country. No matter which part of Michigan you live or wish to take treatment in, AAC has got you covered. You can start by choosing the preferable substance abuse treatment facility that will address your overall needs by looking into:

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