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Blue Cross Blue Shield of Ohio Coverage for Alcohol Rehab

Does Anthem Blue Cross Blue Shield of Ohio Cover Alcohol Rehab?

Both occasional binge drinking and more severe forms of alcohol abuse present a significant nationwide problem in the U.S., and the state of Ohio is no exception. Despite being among the bottom 10 states when it comes to overall alcohol consumption per capita, there’s still a significant percentage of Ohio residents struggling with excessive alcohol use.1

According to the 2017 National Survey of Substance Abuse Treatment Services (N-SSATS) report, the number of patients admitted to Ohio’s rehab facilities has been growing steadily during the previous decade. In 2017, there were 56,197 clients (3,371 of them under the age of 18) in Ohio’s 497 rehab facilities. As much as 40.2% of those clients were treated for both alcohol and drug abuse.2

Since social drinking is usually not considered alarming, some people might underestimate the severity of their alcohol consumption habits. Even when they do acknowledge them, both the stigma and the perceived prohibitive cost of treatment often deter them from getting help.3

However, all private health insurance providers, including the Blue Cross Blue Shield of Ohio, are required by law to provide the same level of coverage for addiction treatment and mental health issues as they do for medical or surgical care. This includes medically necessary inpatient alcohol and drug rehab, depending on each patient’s healthcare plan.4, 5

What Kind of Coverage Does Anthem Blue Cross Blue Shield of Ohio Provide for Alcohol Treatment?

What treatment services included in your alcohol rehab will be covered by your insurance plan primarily depends on whether the requested type of care is determined to be medically necessary and appropriate for a specific situation, as well as the details of your health plan.6, 7

Blue Cross Blue Shield of Ohio offers a choice of insurance plans with different price levels. The type of plan you have will determine what kind of coverage you can get for alcohol abuse treatment. BCBS of Ohio also offers income-based financial assistance to those who qualify.6

With 316 (77,3%) private non-profit and 64 (15.6%) private for-profit rehab centers in Ohio, Blue Cross Blue Shield insurance will most likely cover alcohol rehab in most of them.2 Anthem BCBS plans offer medical services within a wide selection of hospitals, doctors, and other facilities.9 

When it comes to mental health and substance abuse coverage, including alcohol rehab, Blue Cross Blue Shield of Ohio covers services and treatment that are medically necessary, evidence-based, and FDA-approved. So, if you’re looking to start with treatment for alcohol abuse, the following services are generally covered:9

What Is Anthem Blue Cross Blue Shield of Ohio?

Anthem Blue Cross Blue Shield is the trade name of Community Insurance Company in Ohio.10 This is one of the 34 independent, community-based, and locally operated BCBS companies that provide health insurance nationwide. About 1 in 3 Americans use BCBS health insurance.11 This provider’s coverage also extends to Americans who live or work in other countries.12

Blue Cross Blue Shield (BCBS) companies have been providing healthcare coverage since 1929. They collaborate with a large number of local doctors, hospitals, and substance abuse providers who meet high-quality standards. In Ohio, BCBS offers different price level plans (gold, silver, and bronze) as well as financial assistance for eligible members.13 

Doctors and facilities who have a contract with BCBS are called “in-network providers.” It’s their responsibility to obtain preauthorization for your care, file a claim for you, and seek payment from BCBS services. If you have to use out-of-network services you may pay upfront for them, and then file a claim for Blue Cross Blue Shield of Ohio coverage.14

Due to the sensitive nature of addiction treatment, it’s worth noting that BCBS of Ohio and any involved healthcare workers or treatment centers keep all your medical information private by following state and federal laws.15

What Parts of the Alcohol Treatment Program Are Not Covered by Anthem Blue Cross Blue Shield of Ohio?

Since quality addiction treatment tailors the recovery program to each individual’s needs, it might involve services and elements that are not covered by a Blue Cross Blue Shield of Ohio insurance plan. Those services might include:7, 16

  • Non-medical amenities like saunas, spas, or swimming pools.
  • Recreation programs and activities, like nature and wilderness therapy.
  • Transportation.
  • Private treatment services like massages, acupuncture, and personal training.
  • Food delivery or particular diet preferences.
  • Holistic care services and alternative therapies like yoga, meditation, energy healing, reiki, and hypnotherapy.

The Cost of Different Alcohol Rehabilitation Programs

The cost of alcohol abuse disorder treatment can vary depending on the level of care that each patient’s condition requires. Issues that lead people to addiction are personal and different, so they often warrant specifically tailored approaches and services, which affects the total cost of treatment. Depending on the severity of one’s addiction, either inpatient or outpatient care is recommended, and the duration of treatment might differ significantly.17

Certain amenities and services could be quite effective and beneficial to one’s recovery but also raise the overall cost of treatment. The key factors that determine the price of treatment include:4

  • The intensity of treatment and the number of accompanying services.
  • Quality and level of care.
  • Differences in the duration of treatment, both outpatient or residential/inpatient.
  • The choice of amenities at the rehab center, like gyms, swimming pools, or other wellness options.

Inpatient Alcohol Rehab

Inpatient alcohol rehab, or residential treatment, means that the client will be living at the rehab facility until they complete the treatment program. Depending on the severity of addiction, personal needs, and circumstances, some patients can achieve sobriety after short-term treatment, while others require a longer stay at the facility.17

Short-term treatment is less expensive as it usually lasts up to a month. More severe addiction, particularly if accompanied by co-occurring mental health issues that often go hand in hand with alcohol abuse, may warrant longer stays at the facility. The treatment could, in such cases, last for 60-90 days, or even up to a year. This will naturally impact the price of treatment.18

Outpatient Alcohol Rehab

Outpatient is generally less expensive than inpatient treatment, but the cost will ultimately depend on the intensity and hours of treatment, and all the included services. This type of rehab is usually recommended to people with less severe alcohol abuse disorders and is well suited for those who can’t take time off from professional or personal responsibilities. Outpatient treatment can also be a form of aftercare for some patients, after completing residential treatment. 17 Most of Ohio’s rehab patients (93.2%) are in outpatient treatment.2

Partial Hospitalization Programs (PHP)

Partial hospitalization programs are offered in 13.7% of Ohio’s facilities.2 This type of treatment requires more hours of therapy than outpatient treatment, but the patient doesn’t live at the facility. These programs are appropriate for people whose alcohol abuse is moderate and who have a stable home life or a healthy support system of friends and family. It usually requires regular meetings with an addiction specialist, and therapy sessions, usually about 20 hours a week, for about two months. Duration of treatment and the level of care will determine the cost of the treatment.19

Medication-Assisted Treatment (MAT)

Medication-assisted treatment is covered by Blue Cross Blue Shield of Ohio when it’s medically necessary, FDA-approved, and the prescriptions are filled in in-network pharmacies. BCBS prescription drug coverage includes medications from the Anthem Preferred Drug List, but each plan has its limitations and exclusions.6 Coverage levels are different for generic and brand-name medication. Higher “tier” medication may require a higher percentage of the cost as coinsurance from the patient, or a fixed copay added to the insurance-covered amount.14, 20

The cost will also depend on the duration of treatment. Your primary care physician and substance abuse specialist will assess your condition from time to time and collaborate with your insurance provider to determine if medication is still necessary.21 MAT is offered in 39.9% of Ohio facilities.2 There are three FDA-approved medications for alcohol abuse treatment. The most commonly used one is naltrexone in oral tablet form.17, 22

The Cost of Alcohol Addiction in Comparison to the Cost of Rehab

One of the main reasons why people with substance abuse issues, including alcohol addiction, never thoroughly consider their treatment options is the perceived high cost of rehab. However, the cost of active addiction is actually much higher to both the individual and the community.23

Many factors make SUDs detrimental and quite costly to society in general. About $442 billion are spent each year on SUD-related healthcare costs or lost due to criminal justice expenses or work productivity loss.24

Personal costs of untreated alcohol addiction are also higher than the price of treatment, and they include:23

  • The cost of active alcohol use.
  • Lost income because of diminished productivity, or losing a job in cases of serious neglect of professional commitments.
  • A wide range of health issues related to prolonged alcohol consumption.
  • Acute dangers like alcohol poisoning.
  • Injuries, car crashes, or DUI/DWI-related legal problems.
  • Mental health problems, suicides, violence, and domestic violence.

What Length of Alcohol Rehab Is Covered by Anthem Blue Cross Blue Shield of Ohio?

The duration of treatment is always determined on a case-to-case basis by a team of substance abuse specialists. Specific approaches and the length of treatment will vary based on each patient’s needs. Even though longer treatment times show better results in achieving and maintaining sobriety, most healthcare plans, including those provided by Anthem Blue Cross Blue Shield of Ohio, cover the duration of treatment determined to be medically necessary.25

However, different BCBS of Ohio healthcare plans provide various levels of coverage. The length of stay at inpatient rehab centers depends on the specific plan you have. Some additional amenities, services, or other elements of treatment may have to be paid out-of-pocket.26

To make sure what kind of coverage you’re eligible for, you should carefully read your insurance policy information or simply contact your provider to guide you through your plan benefits and coverage options.

Inpatient vs. Outpatient Alcohol Rehab Centers Covered by Anthem Blue Cross Blue Shield of Ohio

The choice between inpatient  and a less time-consuming, outpatient addiction treatment is based on recommendations and guidance of substance abuse specialists, after a thorough assessment of each patient’s case. The key factor is the severity of one’s addiction, as well as potential co-occurring mental health disorders. Dual diagnosis is quite common among SUD patients and co-occurring mental health issues need to be addressed simultaneously with addiction. This is an important part of an effective alcohol addiction treatment.19

Inpatient programs also provide the patient with a safe environment by removing them from their usual lifestyle that might be triggering or enabling their alcohol abuse. It gives them a chance to take a break from the stress of everyday life and focus on recovery.16

If you’re looking for an appropriate Blue Cross Blue Shield of Ohio-covered substance abuse treatment facility, or deciding between inpatient and outpatient treatment options, you should consider the following certain criteria carefully:19

  • Quality of care. The safest indicators to look for are licensing and accreditation. In Ohio, 96.3% of facilities are accredited by federal, state, or local agencies and organizations. The highest quality rehab centers are accredited by The Joint Commission and CARF.2
  • A specific treatment environment creates a safe, supportive, and stress-free ecosystem. The companionship formed between patients in a residential setting can provide support and enhance motivation.
  • Support groups are provided in both inpatient and outpatient treatment programs and can also provide help to family members or spouses of patients battling addiction. There are also specialized rehab programs for couples who want to fight addiction together.
  • Living at a rehab facility offers a more focused environment that enables individuals to fully commit to recovery without outside distractions. 
  • Comprehensive, intensive, and individualized treatment with the level of care specifically tailored to your needs.
  • Personal accountability should also be taken into consideration when choosing the appropriate program. Willpower and adherence to program requirements are essential for successful recovery, and inpatient rehab programs can help keep people on track.

How to Use Anthem Blue Cross Blue Shield of Ohio Insurance Coverage for Alcohol Rehab?

When you decide to start looking for an alcohol rehab center, the first thing you need to do is get an evaluation from your primary care physician. Based on their initial assessment, you will get a referral to a specialist who can guide you through the next steps of treatment. Sometimes, to determine if treatment is medically necessary and covered by your plan, you or your doctor might need to contact Blue Cross Blue Shield of Ohio to get prior authorization.6

You will get the maximum coverage for all services if you visit in-network doctors and other facilities like laboratories or pharmacies.26 The process of starting alcohol addiction rehab involves these key steps:26

  • Consulting an in-network primary care physician.
  • Finding an appropriate rehab program that will fit your circumstances and needs.
  • Determining your ability to use the insurance plan you have and minimize any potential out-of-pocket costs.
  • Working out the details of your program with the chosen rehab center to determine the coverage Blue Cross Blue Shield of Ohio will provide.

What Alcohol Rehabs Accept Anthem Blue Cross Blue Shield of Ohio Insurance?

Finding Blue Cross Blue Shield of Ohio-covered rehab centers shouldn’t be a challenging task since they collaborate with a wide network of US healthcare providers. You can use BCBS of Ohio Helpline to locate in-network providers and services. You can also call one of the free, 24-hour addiction hotlines to get general information about different options and a referral to substance abuse centers. Their advisors can give you accurate advice and guidance regarding alcohol abuse issues.10

BCBS companies are in-network with 90% of US doctors and hospitals, so they can provide coverage for high-quality care nationwide.10 One of such partners is America Addiction Centers (AAC), a network of top-notch substance abuse treatment centers across the U.S.

You can easily verify your BCBS of Ohio insurance coverage by reaching out to the AAC helpline and having one of the admission navigators verify your benefits or discuss payment plans during the call. Make sure you have your insurance card with you. They can also explain the intake process and the initial steps of addiction treatment, including potential same-day rehab admission if necessary

You can also fill out and submit an online verification of benefits form on the AAC website.

Local AAC Treatment Centers in Ohio

AAC’s nationwide network of leading substance abuse treatment centers provides high-quality, effective care for people suffering from alcohol abuse issues, as well as substance abuse in general. However, if you, like many others, want to attend treatment in a rehab facility near you, there are a lot of local options for the residents of Ohio:

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