BCBS of Ohio Insurance for Opioid Abuse and Addiction Treatment

Will Anthem Blue Cross Blue Shield of Ohio Provide Coverage for My Opioid Rehab?

If you or your loved one are looking to enter opioid treatment and have a private insurance policy with Blue Cross Blue Shield of Ohio, you are probably wondering whether it covers drug rehab.

Under the Affordable Care Act or ACA, all Medicaid plans, marketplace insurance plans, and private insurance companies such as BCBS of Ohio are obligated to cover mental health and substance use treatment along with other health benefits such as emergency services, hospitalization, prescription treatments, lab tests, and pediatric care.1

The coverage may vary based on your insurance policy, but the treatment coverage is not likely to be denied based on your pre-existing conditions. Understanding the costs of rehab and how to pay for it can be puzzling, as resources aren’t easily accessible sometimes. Fortunately, you can always reach our to the Blue Cross Blue Shield of Ohio helpline or a trusted treatment provider such as American Addiction Centers for more information on your exact coverage.2 

What Is Anthem Blue Cross Blue Shield of Ohio?

Anthem Blue Cross and Blue Shield of Ohio is a member of one of the largest health insurers in the United States. The company offers a wide range of health insurance products and services, including individual, family, and group plans, Medicare and Medicaid plans, and dental, vision, and prescription drug coverage.3 

As one of the largest health insurers in the United States, Anthem Blue Cross and Blue Shield of Ohio (Anthem BCBS Ohio) offers a wide range of health insurance policies and services to its members across 35 states.3

Anthem BCBS Ohio is headquartered in Columbus, Ohio. The company is a part of the Anthem Inc. family of companies, which collectively serves more than 40 million members nationwide.3

What Blue Cross Blue Shield of Ohio Healthcare Plans Include in Their Plans for Opioid Rehab

Most Blue Cross Blue Shield of Ohio rehab coverage policies may include the following treatment options that have been proven successful in treating opioid addiction:4

• Inpatient rehab. Inpatient rehab is an excellent option for those suffering from opioid addiction. It provides a focused and practical environment where patients can focus on their recovery. Inpatient rehab offers a variety of therapies and access to support groups and aftercare. Insurance may cover certain lengths of treatment, minus the co-pay.4,2
• Outpatient rehab. Outpatient rehab is a form of addiction treatment that does not require the individual to live in a rehab facility. They only visit the treatment center for scheduled therapy sessions and checkups several times a week. This type of treatment is beneficial for those who have a healthy living environment and who are able to maintain their daily responsibilities while receiving treatment.4
• Detox & withdrawal. Opioid detox is the process of withdrawing from opioids such as heroin, morphine, or oxycodone. This should be done at a treatment facility with medical professionals on staff to help monitor and manage the detox process. Symptoms of opioid withdrawal can be uncomfortable and even dangerous, so it’s important to conduct detox properly.4
• Screenings & interventions. Opioid screening is a confidential process in which a person’s opioid use is assessed by a medical professional. An opioid intervention is an important process that involves the family and friends of a person with an opioid use problem and a professional interventionist, meant to help people get the treatment they need by raising awareness of the issue.4
• Counseling & behavioral therapies. Counseling and psychotherapy are often covered by insurance plans, so patients can choose the highest quality treatment that may help them change their attitude toward opioid use, gain new skills needed to lead a healthy life, and remain in therapy for as long as needed to completely heal.4,2
• Co-occurring disorder treatment. Treatment for co-occurring mental health disorders requires integrated care practices that address substance use and mental health disorders simultaneously. Following a comprehensive co-occurring disorder assessment, patients will receive a personalized treatment plan that will address both issues, ensuring one does not affect the other.2

What Does BCBS of Ohio Not Cover In Opioid Treatment?

There are certain aspects that are not typically included in the coverage. These include:2

• Treatment services that aren’t considered medically necessary. Insurance companies usually cover all the medical necessities such as detox, various types of treatment, and medications that are required for recovery. However, insurance usually doesn’t cover non-medical services such as private rooms, gym access, private TV, and food delivery.
• Non-evidence-based treatment options. Some treatment centers have a holistic approach to opioid treatment, offering various alternative therapies such as yoga, meditation, acupuncture, or art and music therapy. However, these non-evidence-based therapies are generally not covered by insurance.

How Much Will You Pay for Opioid Treatment With Blue Cross Blue Shield of Ohio Insurance Coverage?

The cost of a rehab program varies greatly by the treatment center and whether you participate in an inpatient or outpatient program. Some non-profit organizations may offer free treatment, while luxury rehab centers might cost significantly higher than standard inpatient treatment.5

The location of the treatment center, length, and services included may all affect the price. Treatment centers in densely-populated or premium locations such as the beach or a mountain retreat may cost significantly higher than treatment centers in a suburb.5

The facility or provider may ask you to pay a co-pay, a small amount of money you must pay upfront. Additionally, finding in-network Blue Cross Blue Shield of Ohio insurance rehabilitation centers will vastly decrease your out-of-pocket costs.2

How Much Does Inpatient Opioid Rehabilitation Cost?

The cost of inpatient opioid rehab depends on the length of treatment, types of services and treatments offered, and the location of the treatment center. Treatment centers that are in-network with Blue Cross Blue Shield of Ohio will generally charge less than out-of-network ones. The insurance company may still limit the length of treatment or require authorization before treatment starts.1

How Much Does Outpatient Opioid Rehabilitation Cost?

The cost of outpatient rehabilitation will depend based on the frequency of visits to the treatment center and the scope of services provided. The insurance company may still limit the number of visits covered. In general, outpatient treatment is less expensive than inpatient but requires strong dedication from the patient to be as effective.1,4

How Much Do Partial Hospitalization Programs Cost?

Partial hospitalization involves approximately 20 hours per week of visiting a treatment center and attending a structured treatment program. As such, its price falls between inpatient and outpatient treatment. While intensive partial hospitalization programs offer an array of benefits, longer-term, low-intensity treatment may offer greater cost-effectiveness.6

How Much Does Medical-Assisted Treatment Cost?

In the U.S., the cost of medical-assisted treatment for opioid abuse may range from $126 per week to $1,176 per month. This is a big range, and the cost may vary depending on the treatment prescribed treatment center, and the level of care needed.7

For example, medication-assisted treatment (MAT) with methadone or buprenorphine at a certified opioid treatment program may be cheaper than other forms of treatment.7

In addition to the maintenance drug therapy for opioid dependence, the costs include regular visits to the treatment center for counseling, therapy, and assistance with drug administration.7

Comparing the Cost of Treatment to the Cost of Addiction

When talking about the costs of opioid addiction, apart from the cost of substance use and treatment necessary to prevent it, the sum encompasses a wider array of costs associated with the following:7

• Treating opioid overdose
• Treating babies with opioid addiction
• Lost income due to lower productivity
• Injuries gained during intoxication (traffic accidents)
• Related health issues (such as high STD transmission)

The average annual cost of substance abuse treatment is close to $1,500 per patient, while the average annual cost of opioid abuse is roughly $11,000, factoring all the aforementioned costs. This figure is not exact because treatment costs are determined by a number of factors discussed previously.8

Cost is often a deterrent for people seeking addiction treatment, as only close to 18% of those who needed treatment received in 2014.4 

If you’re struggling with substance abuse, treatment is an investment that can pay off. Opioid abuse can have a significant impact on your life, relationships, and life span. So, it’s important to seek help. Treatment may seem expensive, but it’s worth it over the long run.4

What Length of Rehabilitation Does Blue Cross Blue Shield of Ohio Insurance Cover?

Your chosen Blue Cross Blue Shield of Ohio healthcare plan and your state will determine what mental health and SUD benefits you receive, including treatment length.1 Generally, longer treatment periods are associated with higher recovery rates, although there is no single treatment length or intensity that suits everyone. Inpatient treatment may last anywhere between 30 to 90 days or more, with medication-assisted treatment possibly lasting significantly longer.9  

If you need to learn more about your insurance plan and what length of treatment it covers or need any help finding a rehab center, you can always call the Blue Cross Blue Shield of Ohio helpline and talk to their dispatchers about what your BCBS of Ohio insurance plan entails. They can also help you find local treatment centers that are in-network with the insurance company and explain more about how the costs of treatment are covered.

How to Know If You Need Inpatient or Outpatient Treatment 

Inpatient rehab is the most common type of rehab for those dealing with prolonged or severe opioid addiction. It usually requires a stay of at least 30 days at a specialized treatment facility. Patients live on-site and participate in a structured program which may include various forms of therapy, counseling, and support group meetings. Outpatient rehab is usually cheaper, as patients attend rehab sessions several times a week, but are not expected to stay at the facility.4

Inpatient rehab provides a number of benefits to those who are struggling with addiction to opioids.4 

• It provides a safe and supportive environment in which patients can receive treatment for their addiction. This environment is crucial, as it can be difficult for someone who is addicted to opioids to stay sober outside a specialized facility.
• Inpatient rehab provides around-the-clock care and supervision, which can be vital for ensuring that patients stay on track with their recovery. 
• Inpatient rehab can give patients the opportunity to receive intensive treatment for their addiction, which can lead to a successful, lasting recovery faster.

How to Use Blue Cross Blue Shield of Ohio Substance Abuse Coverage for Rehab?

Following a drug addiction assessment with a doctor or a medical professional, you should get in touch with your insurance company to verify your benefits and find an adequate, in-network addiction treatment program.2 

You can also call a treatment center via their specialized hotlines and get in contact with their admissions navigators who can verify your insurance plan covers the stay, determine if there’s a co-pay amount you need to provide, and offer alternative financing options such as sliding scale fees. Once you’ve confirmed your coverage, you will go through the intake process which will help the residential experts determine the best course of treatment.2

Getting the Help You Need Through Blue Cross Blue Shield of Ohio Substance Abuse Coverage

If you or your loved one need a safe, focused environment to heal, American Addiction Centers’ specialized and evidence-based inpatient programs accept Blue Cross Blue Shield Of Ohio coverage nationwide and will work with you to determine your private pay benefits or find alternative payment options on the spot during the phone call.

AAC admissions navigators will help you make an informed decision and choose from one of many treatment facilities in Ohio, including:

• Accredited treatment centers in Columbus.
• Profesisonal opioid rehab facilities in Cincinnati.
• Recognized inpatient treatment facilities in Cleveland.

Of course, many other treatment centers accept Blue Cross Blue Shield of Ohio coverage nationwide. To find a facility or program that best suits your needs, you can reach out to AAC via a phone call to the specialized 24/7 prescription drug hotline or one of their other helplines, email, or by filling an online form. All hotline calls are completely confidential, so it’s advisable that you answer any questions asked by the admissions navigators truthfully. This way, they can gather the necessary information and suggest the best course of action for you or your loved one.