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Blue Cross Blue Shield of Tennessee: Opioid Rehabs

BCBS of Tennessee: What Coverage Does It Offer for Opioid Rehab?

Opioids have become the most prescribed class of medications in the U.S. with almost 300 million prescriptions each year.1 Opioid overdose kills almost 80 people in the U.S. every day, which is an increase of nearly four times compared to the year 1999.1 It’s unfortunate that, although there are proven and effective treatment options available, only 1 in 5 individuals who struggle from opioid addiction actually receive some type of treatment.1

Even though the enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Affordable Care Act (ACA) in 2010 helped in increasing access to prevention and treatment of mental health and addiction issues, there is still a lot of work to be done to make people adequately informed about available treatment and payment options.2

If you have or intend to acquire a Blue Cross Blue Shield of Tennessee (BCBST) health insurance policy, you will likely enjoy some form of rehab coverage for opioid addiction since it falls under the mental health portion of your healthcare insurance as one of 10 essential health benefits.3

What Falls Under the BCBS of Tennessee Insurance Coverage for Opioid Rehab?

Since addiction is, like other mental health challenges, a behavioral issue, it requires an individualized approach that takes each patient’s unique situation into account.4 No single treatment will be an ideal fit for every case so different treatment techniques were developed over time, as well as tested and well supported by medical practice.4

Depending on the specific policy you have, most BCBS of Tennessee healthcare plans will provide a certain amount of coverage for:1, 4

Screenings

Medical screenings are conducted by a medical professional who can reliably identify early signs of addiction even before the symptoms appear through open dialogue, medical observation, and tests, or with the help of various screening instruments.1

Brief Interventions

Brief interventions are essentially a kind of medical advice that can take the form of informal counseling or even structured therapies. In general, they involve doctors’ feedback to individuals concerning their level of addiction in relation to safe limits and recommendations about their future actions.1

Detoxification

Withdrawal can at times be very painful, involving hallucinations and convulsions that make people unstable and desperate.5 For this reason patients have to go through a medically supervised detoxification process to cleanse their bodies of opioids. Detox is not a full treatment in itself but the first step toward a successful treatment.5

Inpatient Rehab

Inpatient treatment programs can last for days or weeks in a hospital setting where patients are under constant 24-hour supervision by medical personnel.6 For this reason, it’s usually a suitable option for people with severe addiction issues that are causing mental or even medical concerns which are making them unable to function on their own.6

Outpatient Treatment

Outpatient treatment is usually reserved for those who are still able to function on their own and have enough discipline or willpower to maintain regular attendance.6 Another important factor is their living environment that is free of triggers that would endanger the treatment. Outpatient treatment can vary in intensity and can last a couple of months or up to a year if needed.6

Behavioral Therapies

One of the most popular and effective behavioral therapies is cognitive-behavioral therapy (CBT). It’s a form of psychotherapy that has been proven effective in treating a whole range of issues like depression, anxiety, eating disorders, troubles with alcohol use and abuse, and drug addiction.7 CBT tries to change patients’ way of thinking and behavioral patterns. It can be used in both inpatient and outpatient rehab programs.7

Treatment for Co-Occurring Disorders

Co-occurring disorder, or COD, is diagnosed when a patient suffers from substance use disorder (SUD) and one or more mental health issues at the same time.8 Since these two problems can cause or exacerbate one another, they need to be treated simultaneously.8

What Treatment Services Won’t be Included in BCBS of Tennessee Insurance Coverage for Opioid Treatment?

Since the adoption of the Affordable Care Act, there has been an expansion of services that enjoy coverage when it comes to mental health issues like opioid addiction.2 If you have BCBS of Tennessee health insurance you will be covered up to a point for all the things that your doctor deems as a necessary part of your rehab program.3

Still, there are things that are offered to patients that are not considered a medically necessary part of rehab treatment, such as:

  • Acupuncture.9
  • Cosmetic surgery.9
  • Experimental procedures or drugs.9
  • Health club memberships.9
  • Massage therapy.9
  • Custodial care.10
  • Meditation.10
  • Services furnished outside the United States.10
  • Personal comfort items.10
  • Eyeglasses and contact lenses.10

What Else Should I Know About Blue Cross Blue Shield of Tennessee?

BlueCross BlueShield of Tennessee has been one of the leading players in the healthcare industry since 1945. It’s a taxpaying, not-for-profit healthcare plan provider that aims to lower the cost of healthcare services for its members.11 It strives to achieve its mission of providing its members with a “peace of mind through better health”.11 

BCBS of Tennessee employs 6.700 professionals in partnership with over 20,000 healthcare providers catering to its 3.5 million members making it the largest healthcare operator in the state of Tennessee.12 BCBS of Tennessee healthcare plans are designed to meet the needs of different groups of people and come in various forms, such as:13

  • Individual & Family Plans.
  • Employer & Group Plans. 
  • Medicare Plans.
  • Medicaid (BlueCare TN) Plans.
  • Medicaid With Medicare (BlueCare Plus) Plans.
  • Dental & Vision Plans.

What Are the Usual Costs of Opioid Rehab?

There are several important factors to keep in mind that will impact the overall cost of addiction rehab. Since there’s no universal approach when it comes to addiction rehabilitation, costs can only be calculated on an individual case-by-case basis.14

It’s important to note that the cost of treatment will be influenced primarily by the insurance policy you have since it largely defines what services and benefits you can expect rehab coverage for. The overall costs of rehab will also depend on:15

  • The type of drug rehab center you are receiving treatment in.
  • The length of the treatment which can vary from a few weeks to up to a year.
  • The intensity of a treatment program and the services used in rehab.
  • What type of medication is used during rehab.
  • The legislature of the state you are receiving treatment in. 

What Would Be the Cost of Inpatient Opioid Rehab?

The type of substance abuse treatment facility can be the most important factor when it comes to overall costs. There are several types of inpatient rehabilitation that can be more expensive, like executive or luxury inpatient treatment that offers only the best amenities and services that are available today. There are other factors that will influence the cost of rehab but the second major factor when it comes to the cost of rehab will be the duration of treatment.14

What Would Be the Cost of Outpatient Opioid Rehab?

Outpatient rehab is a very popular form of rehab since its intensity and duration can be adapted as well as the setting in which it’s delivered.16 It’s suited to meet the needs of different types of individuals that suffer from substance abuse. It’s considered a good option for those that can’t afford inpatient rehab since they will be spared from paying for overnight stays in the hospital setting.14

What Would Be the Cost of Opioid Partial Hospitalization Programs (PHP)?

Partial hospitalization programs can be suitable for those that suffer from serious addiction issues but can’t commit to staying in the hospital overnight, be it for financial reasons or existing professional engagements.17 They involve everyday sessions at the hospital that last at least 6 hours a day. This type of treatment is considered a more intense and structured rehab than outpatient programs. It’s a somewhat flexible program making it hard to predict the cost of treatment.16

What Would Be the Cost of Medication-Assisted Treatment (MAT)?

MAT is a treatment approach that uses medically tested and proven medication in combination with behavioral treatments in order to deliver a “whole-patient” approach.18 FDA has recently approved a fourth substance for use in MAT, lofexidine, in addition to the previously available methadone, buprenorphine, and naltrexone.19

MAT is a very effective form of treatment that is still underutilized because people wrongly fear that they will just replace one substance with another, but the truth is these drugs don’t produce the same feeling of “high” as some other opioids.19 Among other things, such as duration and intensity, the price of rehab that includes MAT will vary depending on the medication that is used in treatment.

The Cost of Opioid Rehab Compared to the Cost of Opioid Addiction

There were 44,000 official cases of opioid use disorder in the state of Tennessee in the year 2017, with 1269 people dying from an opioid overdose.20 The same year, 73 million dollars was invested into substance use treatments in Tennessee, while the cost of criminal justice expenses and loss of productivity amounted to 306.3 and 647.1 million respectively.20

It’s evident from this that treatment costs at least 13 times less than the expenses of addiction, and that was before we add the everyday costs of drugs themselves, lost future income, and possible health problems for persons that misuse opioids. Even though rehab can seem like a financial burden its costs are dwarfed when compared to the cost of addiction itself, both for the individual and for the society at large.20 

What Length of Opioid Rehab Is My BCBS of Tennessee Insurance Likely to Cover?

Addiction is a serious medical issue that affects both the mental and physical well-being of individuals. In some cases, patients are likely to suffer an occasional relapse.14 This should not be interpreted as a failure of treatment but as a sign that treatment needs to be reevaluated and modified according to the changing situation.14

When it comes to principles of a successful rehab, it has been shown that duration and rapid entry into rehab are of greater importance than the intensity of treatment.16 Since BCBS of Tennessee offers different health plans to suit various individual needs, the length of rehab treatment coverage will depend on the BCBS of Tennessee insurance coverage you have.

You can easily find out all the things you need to know about your health plan by calling the number that is written on the back of your insurance card.

BCBS of Tennessee-Covered Inpatient and Outpatient Opioid Treatment: Which to Choose?

If you already tried outpatient rehab but haven’t been able to stay sober or you are unable to function in the community following only an outpatient rehab program, you may want to consider undergoing inpatient addiction treatment.

Inpatient rehab has the advantage of 24-hour constant medical supervision and the greatest quality of care since it takes place inside a dedicated inpatient drug rehab center. This provides patients with a structured rehab treatment in a beneficial ecosystem that is free of triggers that might prove challenging for the patients.14

Inpatient rehab also has the advantage of trying to foster a sense of accountability in a more focused environment that besides caring medical professionals includes a support group of people who share the same predicament.14 This will encourage patients to examine their damaging everyday routines and ways of thinking helping them achieve a more balanced and sober lifestyle in the future.14

How Can I Use My BCBS of Tennessee Insurance Coverage to Pay for Opioid Rehab?

Your chances of recovery will likely increase the sooner you get into addiction treatment, so don’t wait and call a doctor to book a consultation. Doctors are qualified to conduct a health screening and assess the severity and type of your SUD mental health challenges. Once the doctor gets acquainted with your specific situation he will be able to find suitable addiction treatment and determine your eligibility to use health insurance for various types of rehab treatment.16

If you don’t have a doctor or you aren’t sure about the next step to take, call a helpline that is confidential, available 24/7 and carries no obligation on your part. Just one call will provide you with all the necessary information you need to make the right choice.

How to Find Opioid Rehab Centers That Will Accept BCBS of Tennessee Insurance

American Addiction Centers (AAC) runs a network of inpatient drug rehab centers of the highest quality that stretches from coast to coast. You can call a medical rehab center directly and talk to AAC’s knowledgeable team that can help verify your health insurance coverage and benefits over the phone. Since every case of addiction differs and depends on several factors, you will be asked questions that will help in determining your situation.

You might be asked about:21

  • The length of time you have been misusing opioids.
  • The severity of your addiction.
  • The type of opioid that you’re misusing.
  • Your personal situation, including your habits and living environment.

All calls are confidential, so you don’t have to worry about having a conversation concerning your engagement in illegal activities.21 It’s important to be honest when answering the questions so professionals can accurately assess your mental state. If you have questions you should also feel free to ask them so you can be sure that the addiction treatment you chose is a good fit for you. 

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