Does Alcohol Rehab Fall Under Blue Cross Blue Shield of North Carolina Insurance Coverage?

Alcohol abuse has been on the rise in North Carolina since 2012. It became the 3rd most common preventable cause of death in this state. Nearly 4000 deaths were caused by excessive alcohol use in 2017, most commonly due to poisoning, liver damage, car crashes, and suicide.1

Blue Cross Blue Shield of North Carolina is a nationwide health insurance provider that covers medically necessary, FDA-approved, and evidence-based treatment of substance abuse disorders (SUDs), including alcohol addiction. The coverage of treatment costs depends on the type of health insurance plan and individual needs. It also depends on whether you use the services of your in-network primary care provider and behavioral health providers. You can also get BCBS of North Carolina coverage for mental health conditions, like depression and anxiety, since they tend to co-occur with substance use disorders.2

Healthcare industry reforms and implementation of parity laws, most notably the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, require that all state-regulated healthcare plans and insurance providers cover medically necessary treatment of mental health issues and SUDs. Since Blue Cross Blue Shield of North Carolina is one of the leading health insurance companies, they provide nationwide coverage in required settings, including residential and outpatient alcohol and drug treatment programs.3,4

North Carolina Rehab Statistics

Out of 794 rehab facilities in North Carolina, 472 were included in the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS) report. These rehab facilities reported a total of 49,179 patients in addiction treatment. Among them were 2,329 patients under the age of 18.5 This is particularly alarming since young people in North Carolina start consuming alcohol at the average age of 14.6

Most substance abuse treatment facilities in North Carolina are private for-profit facilities (252), while 184 are private non-profit. While 73.5% of NC facilities treat clients with alcohol abuse only, as many as 56.7% of patients are diagnosed with co-occurring mental and substance abuse disorders, and 40.3% of NC clients are treated for both alcohol and drug abuse.5

Private health insurance is accepted in 62.3% of NC rehab facilities.5

Blue Cross Blue Shield of North Carolina Insurance: What Services Are Covered?

All Blue Cross Blue Shield of North Carolina health insurance plans will provide coverage for appropriate and medically necessary treatment and services of mental illness and SUDs, including alcohol abuse. The covered amount will depend on the choice of a primary care physician, facility, and SUD treatment provider. You will get maximum coverage if you go to in-network doctors and facilities.7, 8

Blue Cross Blue Shield of North Carolina provides coverage for the following elements and services of alcohol addiction treatment:9, 10, 11

Evaluation, screenings, and interventions. Comprehensive mental health assessment is provided in 54.4% of NC rehab centers.
Supervised and medically monitored detoxification from alcohol, offered in 74.4% of NC facilities.
Inpatient treatment, both short and long-term.
Outpatient treatment, including intensive outpatient treatment programs.
Behavioral therapies (offered in 97.7% of NC facilities), most commonly cognitive-behavioral therapy (CBT). Aside from individual counseling and therapy, marital or couples counseling is attended by 59.7% of NC rehab patients.5
Dual diagnosis treatment for patients with co-occurring disorders is offered in 428 NC rehab facilities since 56.7% of SUD clients are diagnosed with co-occurring mental health and substance abuse disorders.5

What’s Anthem Blue Cross Blue Shield of North Carolina?

Blue Cross and Blue Shield of North Carolina is a non-profit company that provides health insurance for more than 3.81 million members. It’s an independent licensee of the BCBS Association. Its preferred provider organization (PPO) is a network of providers that includes 96% of doctors and 99% of general hospitals in North Carolina. It also provides BlueCard® coverage that can be used in all 50 states.12

BCBS of North Carolina offers 3 plan levels to accommodate different health and budget needs. Members can choose between large network coverage, which is more expensive but provides better benefits, and local provider networks. Blue Cross Blue Shield of North Carolina healthcare plans are available in three ‘metallic’ levels:13

Bronze (covers 60% of medical costs on average)
Silver (covers 70% of medical costs)
Gold (pays for 80% of costs)

These levels were created by the Affordable Care Act to make the provided plan coverage easy to understand. It’s a way to show users how much of their medical costs will be covered on average by the plan they choose. Aside from coverage and benefits, they also vary by cost.13

Each plan includes a network of preferred providers. Larger networks allow you to choose from a wider selection of in-network doctors, hospitals, and other facilities. These plans have a higher monthly premium. Blue Cross Blue Shield of North Carolina also offers out-of-network coverage, but you’ll get the maximum coverage by using your plan’s in-network providers.14

Additionally, to make health insurance more affordable, the federal government offers subsidies to help people to pay for health insurance. This type of financial aid depends on household income and size.15, 16

Ias There Something Blue Cross Blue Shield of North Carolina Won’t Cover for Alcohol Rehab?

Since substance abuse treatment best practice requires individualization of each patient’s treatment, certain recovery programs might include approaches and services that are not fully covered by one’s health insurance plan. In such a case, you may have to pay a copayment (a fixed dollar amount), or a coinsurance, a percentage of the cost for the received services.14

Some of the elements of alcohol or drug addiction treatment might not be considered medically necessary despite being beneficial for certain groups of patients. Such services, usually not covered by most plans, include:9

Holistic approaches and services like yoga or meditation.
Alternative therapies like acupuncture, energy healing, hypnotherapy.
Recreation activities and programs, like nature or wilderness therapy.
Private treatment services, like personal training or massages.
Food delivery, special dietary requirements, and meals made by professional chefs.
Non-medical, high-end amenities like gyms, spas, or swimming pools.

Blue Cross Blue Shield of NC also offers educational wellness programs to help members make informed decisions about their health. These programs are offered through independent third-party providers.2

What’s the Average Cost of Alcohol Rehab?

The cost of SUD treatment, including alcohol abuse, varies significantly depending on the individual needs of each patient. Since treatment programs are designed to address different levels of addiction severity, as well as personal circumstances and characteristics of each affected individual, a thorough evaluation by a team of specialists is required before deciding on a treatment plan.9

The most common factors that influence the cost of addiction treatment include:17

The number and type of required services.
Level of care and the intensity of treatment.
How long the treatment should last.
Amenities that a specific rehab facility offers.

How Much Is Typically Inpatient Alcohol Rehab?

Inpatient (also called residential, or live-in) treatment is offered in 16.1% of North Carolina’s rehab facilities. The main price-determining factor of this type of treatment is the length of stay at the rehab center.5

Depending on the severity of addiction, and other factors like potential co-occurring mental health issues, or the lifestyle and environment the patient is coming from, this type of treatment can be short-term (usually a month-long program) or long-term (usually 60-90 days, in some cases up to a year).18

Patients are provided with regular monitoring, intensive treatment, and, if necessary, medical attention. This is usually the most costly type of addiction treatment, but it’s also the most effective in achieving lasting sobriety.19

How Much Is Typically Outpatient Alcohol Rehab?

Outpatient treatment program is the most common type of addiction treatment. It’s the least expensive and disruptive to patients’ everyday lives. It’s suitable for people with moderate addiction, as well as those who are unable to take time off from professional or personal responsibilities. As many as 94.5% of North Carolina rehab patients attend outpatient treatment, while 8.5% of them are in intensive outpatient treatment.5, 20

The cost depends on the intensity of treatment and the type and number of provided services. It consists of regular visits to the rehab facility for meetings with SUD specialists, usually for a few hours per week. Patients attend individual and/or group counseling, most commonly cognitive-behavioral therapy (CBT) sessions. Outpatient treatment is offered in 83.3% of North Carolina‘s rehab centers, and 41.1% of them provide intensive outpatient treatment.5, 20

How Much Is a PHP for Alcohol Rehab?

Partial hospitalization programs (PHP) are more intensive than outpatient programs, but the patient doesn’t live at the rehab facility. They usually last for a month or two and involve a minimum of 20 hours of treatment services per week. The number of hours of treatment and included services will determine the cost of PHP.19

There might be some additional costs that Blue Cross Blue Shield of North Carolina insurance plans don’t cover, like meals, transportation, as well as any personalized services determined to be beneficial to a particular patient but not considered medically necessary by the insurance provider.19

How Much Is MAT for Alcohol Addiction?

Medication-assisted treatment (MAT) is covered by Blue Cross Blue Shield of North Carolina insurance when it’s medically necessary. Its cost will depend on the duration of treatment. Since alcohol addiction (like substance abuse in general) is a chronic disease, the prescribed medication must be used regularly.21

Only FDA-approved medication is covered by health insurance plans. Three FDA-approved drugs are used for alcohol addiction treatment.22 The most commonly prescribed one is naltrexone in oral tablet form. This type of pharmacotherapy is available in 22% of NC facilities.5

Blue Cross Blue Shield of North Carolina drug coverage will depend on the type of plan you have and the category or tier of prescribed medication. Generic medication can be fully covered by insurance while brand-name drugs might require adding a fixed copay to the covered amount or paying a certain percentage of the cost of the medication.11

Medication falls into several different categories or tiers. The least expensive medication is usually Tier 1, and drugs that belong to Tiers 5 and 6 are the most expensive. To get maximum coverage, it’s important to get your medication from in-network pharmacies.14

Is Alcohol Rehab More Expensive Than Addiction?

In 2010, the cost of excessive alcohol use in North Carolina amounted to $7 billion during that year. Both personal and public health suffer the consequences and high costs of excessive alcohol use. Alcohol addiction increases the rates of violence, suicide, homicide, and other forms of risky behavior. SIn fact, 23% of suicides in North Carolina were alcohol-related.1

A lot of people underestimate the severity of their alcohol abuse, and even when they do acknowledge the threat it presents to their health and safety, as well as personal and professional commitments, the seemingly prohibitive cost of addiction treatment deters them from seeking help.23

However, the cost of active alcohol addiction is much higher than the cost of treatment, for both the individual and the society, due to:23, 24

The cost of alcohol itself.
Loss of income, diminished productivity, alcohol-related missteps that may lead to prolonged absence from work, or even job loss.
A wide range of alcohol-related health problems and poisonings.
Injuries and traffic accidents. In 2017, 26% of all traffic deaths in North Carolina were alcohol-related.1
Alcohol-related mental health issues that, in some cases, might even lead to suicide.
Violence and domestic violence.
Alcohol-related legal problems, most commonly DUI/DWIs.

How Long Will My BCBS of North Carolina Policy Last for Alcohol Addiction Treatment?

The length of alcohol addiction treatment that will be covered by Blue Cross Blue Shield of North Carolina will depend on a thorough evaluation by a team of specialists to determine the best course of action and approach for each patient’s needs. Longer treatment times are the most effective for achieving lasting sobriety, but this will depend on the severity of each patient’s addiction and their life circumstances.9

Since health plan policies and benefits ultimately determine substance abuse coverage, you’ll get the most accurate information from your healthcare provider. You can call the BCBS of North Carolina helpline (the number on your health insurance card) and ask about your coverage options.

In case you need general information and guidance about alcohol abuse, you can call one of the free, 24-hour addiction hotlines. Trained helpline representatives can offer accurate information about alcohol abuse, evaluate your situation, refer you to specialists or quality rehab facilities, and suggest the first steps you could take to start your recovery.25 The confidentiality of your medical information is protected by law and this includes anything you share with a helpline advisor.19, 27

Should I Go to an Inpatient or Outpatient Facility?

There are multiple reasons why inpatient treatment programs are typically more effective and why they raise one’s chances of achieving long-term recovery. This is a serious decision to be made with a team of specialists, but there are some factors that you should take into consideration when deciding on the type of treatment:19

The safest way to determine if the chosen treatment will provide the proper quality of care is checking if the facility is accredited by relevant federal, state, or local organization or agency. To be sure you’re choosing a high-quality rehab facility look for Joint Commission and CARF accreditation. In North Carolina, 89.4% of facilities have licensing, certification, or accreditation from a relevant authority organization or agency.5
Inpatient treatment environment creates a specific mutual support ecosystem of peers and provides comprehensive care. This enables patients to fully focus on recovery.
Support groups and 12-step facilitation is offered in both outpatient and inpatient settings. In North Carolina, this type of service is available in 69.5 % of facilities. Group counseling is available in 90.5% of facilities, while 73.7% of rehab centers offer family counseling, and 55.3% offer marital counseling.5
Accountability for one’s progress and commitment. Even though this depends on the personal traits of each individual, inpatient treatment minimizes all distractions and allows patients to take a break from the stress of everyday life, including potential triggers and enabling factors that may lead to relapse or loss of motivation.

How to Use Blue Cross Blue Shield of North Carolina Insurance Coverage for Alcohol Rehab?

The process of finding an appropriate substance abuse treatment facility consists of several key steps:28

Consulting your primary care physician to help you decide what type of care is necessary, and connect you to SUD specialists and services. Your doctor will also assess your physical health. A team of behavioral health providers (therapists, psychologists, psychiatrists, and addiction counselors) will coordinate your alcohol abuse treatment with your primary care provider and design an appropriate program.2
Finding a suitable rehab program after a comprehensive substance abuse evaluation and assessment for potential co-occurring mental health disorders.
Determining your insurance coverage with the help of BCBS of North Carolina. This is usually done by nurse advocates who can advise you over the phone. They will manage your case, answer your questions, and direct you to in-network substance abuse providers.
Substance abuse treatment providers will communicate with you, your doctor and collaborate with BCBS of North Carolina case managers (or nurse advocates) to determine coverage for treatment at the chosen alcohol and drug rehab center.

How Can I Find an Alcohol Rehab Facility In-Network With BCBS of North Carolina Insurance?

The easiest way to find an appropriate and covered rehab center is to call the Blue Cross and Blue Shield of North Carolina helpline. You can find the customer service number on the back of your member ID card. They will connect you to a high-quality substance abuse provider.28

One of the top-rated in-network substance abuse treatment providers is American Addiction Centers (AAC). Calling the AAC helpline is another way to verify your coverage. You can talk to an AAC admission navigator who can verify your insurance coverage easily during the call and answer any questions you might have about the treatment.

They can guide you through the different payment options, explain the initial steps of intake and assessment, or help you with the same-day admission process if you feel the need to start treatment immediately. You can also submit an online form on the AAC website to check your coverage.

Local AAC Treatment Centers in North Carolina

AAC is a nationwide network of leading SUD treatment centers that provides the highest quality of personally tailored, individualized programs for different types of clients. The AAC network can offer top-notch alcohol addiction treatment in North Carolina, including:

BCBS of North Carolina Approved Alcohol Detox