Does Blue Cross Blue Shield of North Carolina Offer Coverage for Opioid Rehab?
More than 42,000 people died from opioid overdoses in 2016. In 2017, the U.S. Department of Health and Human Services (HHS) declared opioid epidemic as a public health emergency.1 By the year 2020, that number rose and overdoses accounted for more than 48,000 lives lost form opioids alone (excluding methadone).1
Since the passing of Affordable Care Act (ACA) in 2010, all marketplace health plans must cover 10 essential health benefits. Mental health issues like substance abuse disorders are included on that list.Therefore, if you have a Blue Cross Blue Shield of North Carolina healthcare plan, you are likely to have coverage for opioid rehab treatment if your doctor determines it’s medically necessary.2
The BCBS of North Carolina insurance company partners with American Addiction Centers, an accredited provider of treatment services. AAC operates a network of multiple in-network treatment centers across the country, offering evidence-based solutions for addiction treatment.
What Types of Opioid Treatment Does BCBS of North Carolina Include in Its Insurance Coverage?
Since mental health issues concerning opioid addiction are unique to each individuals, treatment typically requires different approaches instead of a single, universal treatment model. Nonetheless, there are several types of successful treatment approaches that might be available depending on your specific situation.3
Your Blue Cross Blue Shield of North Carolina addiction treatment coverage for opioid rehab may include:3
- Different types of professional screenings.
- Safe detox from opioids before starting treatment.
- Treatment for any present co-occurring disorders.
- Outpatient rehab therapies in certain cases.
- Inpatient drug rehab programs for struggling individuals.
Screenings & Assessments
Health screenings are various types of tests that are designed to identify diseases or risk factors in people who are considered healthy and show no symptoms.4 They are an especially important tool in establishing early diagnoses, which increases the chances of a successful recovery.4
Detox is usually the first step and an important component for treatment of substance-related disorders.5 It’s paramount to undergo detox as quickly as possible to avoid potentially negative physiological and psychological consequences that arise due to substance abuse. However, it’s also important to do this in a professional environment where medical professionals can monitor struggling individuals.5
Co-Occurring Disorder Treatment
People with co-occurring disorders typically suffer from substance misuse coupled with one or more mental disorders.6 Co-occurring disorder is diagnosed when at least one disorder of certain type is established independently of the other so symptoms can’t be attributed to only one disorder.6
For persons suffering a long term or severe type of opioid addiction, inpatient treatment represents the highest level of care. It involves patients leaving their homes and committing to a residential environment. Staying in a facility helps patients concentrate on recovery and affords them with constant medical supervision and care.7
Intensive or regular outpatient programs can offer treatments of similar intensity for those that can’t afford inpatient treatment or who are unable to commit to staying in a hospital for various reasons.7 Outpatient treatment can also include different behavioral therapies like individual or group counseling for those that are not considered severe cases.7
American Addiction Centers is a leader in SUD treatment with a large network of addiction rehab facilities in the United States. With centers located in numerous states, it enables you to pick the best option that will help you take the right steps on your road to rehabilitation.
Are There Any Opioid Treatment Services Blue Cross Blue Shield of North Carolina Won’t Cover?
All services that are covered must meet specific medical necessity requirements or they will not be supported by your Blue Cross Blue Shield of North Carolina insurance coverage.8 For medical services to be deemed necessary, they must correspond with the specific early signs, symptoms of disease, or patient complaints that render that service reasonable and necessary.8
For that reason, BCBShield of North Carolina coverage nationwide is usually not extended to health care services that:9
- Don’t fall under a medically necessity (things like food delivery or recreational programs).
- Are regarded as experimental (including various alternative therapies and holistic care).
- Are considered obsolete (meaning some treatment techniques that are considered outdated or are medically no longer justified).
If you’re not sure about the details of your Blue Cross Blue Shield insurance coverage or if you have further questions that need answering, call the number located on the back of your insurance card. You can also call a dedicated helpline that’s confidential, available 24/7 and free of charge.
What Is Blue Cross Blue Shield of North Carolina?
Blue Cross Blue Shield is a federation of health care providers that insures 1 in 3 Americans, or more than 100 million people.10 Blue Cross Blue Shield health insurance is accepted in 50 states and by over 90% of doctors and specialists operating in the U.S. so people that have Blue Cross Blue Shield of North Carolina rehab coverage can feel safe knowing they will be covered in every part of the country.11
The Costs Associated With Opioid Rehab
More than 64,000 people aged 12 or older were admitted in Northern Carolina for opioid related issues in 2016 alone, with more than 41,000 of them entering outpatient rehabilitation.12 According to some estimates, per capita combined costs of opioid use disorder and fatal opioid overdose in North Carolina for the year 2017 were 3,832 dollars.13
Since addiction treatment varies to a great extent, the average cost of rehab is very hard to determine. Here are some of the factors that can influence the overall cost of Blue Cross Blue Shield of North Carolina opioid rehab:14
- Type of services offered can greatly influence the cost of treatment because each treatment plan is completely different and designed to target specific individual needs.
- In certain instances, the intensity of services can be a deciding factor because approaches to severe cases will require more professional help and supervision than comparatively mild ones.
- Major factor that influences the cost of rehab could be the duration of treatment, which can be especially influential for inpatient rehab since the cost of staying in a facility rises with the amount of time a patient needs to fully recover.
- Amenities are another factor that can go a long way in determining the overall cost of treatment, since there are many options to choose from in terms of facilities and treatment options like luxury or executive treatment options that can make the rehabilitation costlier.
Cost of Inpatient Opioid Rehab
Since BCBS of NC inpatient drug rehab is tailored to help individuals who suffer from issues that make them unable to navigate their everyday lives without constant medical supervision, these programs offer patients 24/7 structured care under the watchful eye of medical professionals.
In 2012, there were more than half a million inpatient or residential hospitalizations for opioid use disorders in the U.S. and the cost to society accrued to a staggering amount of almost 15 billion dollars.14 In general, per-patient weekly inpatient rehab costs ranged from $682 to $936, but these are just averages and real costs might fluctuate.15
There are several types of residential settings to choose from, which can also vary in price, including:7
- Therapeutic communities, which follow highly structured programs that typically require staying at a treatment center for 6 to 12 months. Their goal is to change individual behavior patterns and attitudes related to drug use that will ultimately enable patients to stay sober and healthy once they step out of the facility.
- Shorter-term residential treatment usually focus on detoxification along with intensive counseling that will serve as a preparation for a community-based rehab.
- Recovery housing is designed as a short-term housing program that enables people to transition from a previous inpatient or outpatient treatment into a self-reliant lifestyle by helping them find a job or integrate into a community life.
Cost of Outpatient Opioid Rehab
Outpatient treatment is traditionally recommended for people with less severe addiction and no additional mental health issues, as well as those that have a stable living employment and a supportive home situation.16
Most outpatient Blue Cross Blue Shield of North Carolina-covered drug treatment programs utilize group counseling and behavioral therapies as major components of treatment. There are also programs designed to treat individuals that suffer from co-occurring mental health issues.16
In certain cases, there is a need for intensive outpatient rehab that can resemble inpatient programs in many ways, including its intensity and approach. However, unlike inpatient programs, intensive outpatient care enables patients to remain in their homes and keep attending their workplaces.16
In general, outpatient rehabs can range in weekly costs from $90 to $208 per person.17 Individual counseling may cost $75 per patient per hour, while group counseling can be around $9 per patient per hour.17 These variations demonstrate how hard it is to determine the price of outpatient rehabs because they can vary in their approach and types of treatment offered.
Cost of Opioid Partial Hospitalization Programs (PHP)
Some patients require longer sessions and partial hospitalization programs, sometimes called daycare or day treatment. Partial hospitalization programs involve at least 20 hours per week (4 hours a day, 5 days a week) of structured programming inside a hospital, with sessions lasting as long as 10 hours per day in severe cases of medically monitored detoxification.18 These programs offer individuals who can still function safely in the outside world an opportunity to participate in treatment while living at home.18
If you would like to join a partial hospitalization program but need more information, you can call a hotline specialized in prescription drugs, or other types of addiction, to get better informed about your health care coverage and explore options available with your Blue Cross Blue Shield of North Carolina coverage nationwide.
Cost of Medication-Assisted Treatment (MAT) for Opioid Addiction
There are several approved medications for treatment of opioid use disorder that are meant to mimic the euphoria of original drug use while eliminating cravings and painful symptoms of withdrawal, most common being:19
These medications are proven to reduce the risk of criminal behavior which results from drug use and increase the likelihood of a person remaining in treatment which will automatically minimize the risk of deaths from overdose.19
These medications are proved safe to use and there is no maximum duration of treatment so patients have the option of consulting with a medical professional in choosing the type and duration of treatment that will best serve their individual needs.20
How Much Does Opioid Rehab Cost Compared to Addiction?
Since the year 2000, drug overdose took the lives of 28,000 North Carolinians destroying many families and communities along the way.21 At the same time, economic costs of opioid misuse related to loss of productivity, health care, and criminal justice expenses exceeded 78 billion dollars.22 With only 3.6% of that money going to treatment, benefits of rehab far outweigh the costs, both for individuals and for society at large.23
What Length of Opioid Rehab Will My BCBS of North Carolina Insurance Cover?
Some people misuse opioids for a long time, while others take greater quantities even though they use them for comparatively shorter periods of time. Additionally, everybody reacts differently to drug use and people misuse different types of opioids, so every case is different requiring individually tailored solutions for their substance misuse.16
Treatment programs that last less than 3 months are rarely advised because most patients need at least 90 days to stop using drugs or to at least significantly reduce their intake.16 For example, methadone maintenance requires at least 12 months of rehab while in some cases patients continue benefiting from methadone maintenance programs for years.16
If you want to know more about your Blue Cross Blue Shield of North Carolina mental health coverage, call the helpline number on the back of your card and you’ll get all the relevant information you need to make the right decision.
Is It Better to Go to an Inpatient or Outpatient Center Covered by Blue Cross Blue Shield of North Carolina?
There are many reasons why inpatient rehab is considered as the ultimate solution for long term and severe users. It provides patients with:16
- The greatest quality of care since patients are constantly under the watchful eye of medical experts that can modify their treatment plan according to their rehab progress.
- A beneficial treatment ecosystem that will help them change their everyday habits and that provides them with structured and comprehensive care.
- A support group of people suffering from similar issues that will empathize with their predicament and show understanding for what they are going through.
- A more focused environment that offers incentives to stay sober and is free of all the triggers and challenges that caused their addiction in the first place.
How to Use BCBS of North Carolina Insurance for Opioid Rehab?
The first step in getting your Blue Cross Blue Shield of North Carolina insurance to cover your treatment is to consult with a doctor. Doctor will look into your case and use the provided information to determine your ability to use insurance coverage and propose an appropriate treatment solution that is best suited to your particular situation, giving you a referral.24
The next step is to choose the in-network inpatient drug rehab center that best suits your needs, taking into account the location of the facility, amenities, and rehab programs offered. After you choose the appropriate facility, you can give them a call to determine the extent of your coverage and get all the information on how to get started with your treatment of choice.24
How to Find Opioid Addiction Treatment Facilities That’s In-Network With BCBS of NC Insurance?
If you want to know more about the specifics of your Blue Cross Blue Shield of North Carolina addiction treatment coverage, you can get in touch with your insurance provider or a trusted center such as one of the facilities operated by American Addiction Centers nationwide. The AAC offers addiction hotlines that will help you verify the extent of your health insurance coverage. Our knowledgeable admissions navigators will take their time to listen to your story, check your benefits, and help you make an informed decision about your desired rehab treatment.
American Addiction Centers partnership with Blue Cross Blue Shield of North Carolina insurance as one of its in-network drug treatment providers gives you the option to choose one of advanced treatment facilities that are located throughout the U.S. so you can undergo your treatment in one of industry leading centers.