Does Federal BCBS Cover Alcohol Rehab?
Blue Cross Blue Shield is a system of 35 health insurance companies, and Federal BCBS healthcare plans are accepted at many addiction treatment facilities nationwide. Its Service Benefit Plan, or Federal Employee Program (FEP), provides health insurance to over 5.5 million federal employees and their families across U.S. BCBS Preferred provider network allows patients to choose from a wide selection of doctors, hospitals, and various specialists.1 BCBS companies collaborate with 90% of US doctors and hospitals.2
When it comes to alcohol or drug rehab, insurance coverage can vary depending on your state of employment and the type of insurance plan you have. If you’re seeking alcohol addiction treatment and need to find out if your insurance plan will cover the costs, contacting Federal BCBS directly will provide you with accurate answers. Since Federal BCBS is in-network with a large number of substance abuse providers, patients don’t have to be limited only to services available in their state.2
Federal BCBS plans provide nationwide coverage for mental health issues and disorders, which includes alcohol and drug abuse treatment programs. This means that they have to cover alcohol rehab, at least partially, depending on your policy. Most insurance plans cover medical detox treatment, particularly for patients suffering from alcohol and opioid addiction, because withdrawal from these substances might be quite dangerous and require professional medical monitoring.3, 4
Since BCBS works with a large network of healthcare providers, patients with Federal BCBS insurance plans won’t have difficulty finding appropriate treatment centers. However, Federal BCBS plans sometimes don’t require pre-certification to receive treatment at the chosen facility, so you’d be well advised to look for in-network providers (preferred providers) to receive benefits and avoid paying additional costs not covered by your insurance plan.3, 5
What Does Federal BCBS Insurance Cover for Alcohol Rehab?
All healthcare insurance providers are required by law (the Mental Health Parity and Addiction Equity Act) to provide coverage for medically necessary treatment. Mental health and substance abuse treatment and services are essential health benefits.6
Federal BCBS plans provide substantial nationwide coverage of alcohol abuse treatment services so, even though different plans offer varying levels of coverage, you’re most likely to be covered for all medically necessary services, as determined by a professional, including:7, 8
- Office visits for screening and evaluation.
- Professionally organized interventions.
- Safe, medically monitored detoxification.
- Inpatient treatment.
- Outpatient treatment.
- Behavioral therapies.
- Dual diagnosis treatment.
The Federal BCBS insurance coverage will also depend on the provider you choose. You’ll have to pay for treatment yourself if you opt for a non-preferred (or out of network) provider.3 BCBS insurance can be used in all 50 states and is accepted by over 90% of doctors and specialists.9
What Federal BCBS Won’t Cover for Alcohol Treatment?
Since alcohol abuse treatment is individualized and tailored to each person’s specific needs, it may often involve some additional approaches and services. These additional services may not be covered by a health insurance plan as they’re not considered medically necessary. Those types of services may include:3, 8
- Holistic care services.
- Food delivery.
- Recreation programs.
- Non-medical amenities.
- Alternative therapies.
- Private treatment services.
How Much Is Alcohol Treatment?
As with substance abuse treatment in general, the cost of alcohol addiction treatment varies depending on a large number of factors. Each person’s rehabilitation plan will be different depending on the severity of their addiction, individual needs, and potential physical or mental health issues that often co-occur with their alcohol abuse. Factors that determine the cost of alcohol rehab are:4
- Level of care.
- The type of services offered.
- If any amenities are included.
- The level of treatment intensity.
- How long a treatment program should last.
Cost of Inpatient Programs for Alcohol Addiction Treatment
Inpatient or residential alcohol rehabilitation is usually the most expensive level of addiction treatment since the patient lives at a rehab facility, usually for a month to a year. Each facility has specific rules and approaches and might offer various levels of comfort, treatment, activities, amenities, holistic approaches, and nutrition preferences. These additional perks aren’t generally covered by most health insurance plans.6
Short-term stays in accredited rehab facilities, particularly in combination with mental health disorder treatment, are often considered medically necessary and are, for the most part, covered in BCBS Preferred facilities. However, precertification is required before admission.3
Cost of Outpatient Programs for Alcohol Addiction Treatment
Outpatient alcohol abuse recovery treatment involves weekly visits to a therapist’s office for regular appointments and counseling sessions in a non-hospital setting. The frequency of visits depends on the treatment plan – some patients come in daily, while others 1-3 times per week. Outpatient treatment programs usually last for about two months to a year. However, this type of treatment is not suitable for patients suffering from a serious addiction and those who have had frequent relapses and a history of multiple rehab attempts.10
Outpatient treatment programs are generally less expensive than inpatient treatment, but intensive outpatient treatment is usually more costly. There is also the cost of transportation to consider.6
Cost of Partial Hospitalization Programs (PHP) for Alcohol Abuse
Patients with state and federally supported health insurance programs are usually eligible for partial PHP coverage. It might be possible to include occupational therapy too, if it’s a part of a mental health treatment plan, or patient education about their alcohol abuse disorder. The cost of meals, transportation, or career training is the responsibility of the patient.10
PHP rehab is commonly covered by insurance, after a thorough evaluation of the patient’s condition and making sure that the facility you’re considering is included in your coverage policy. The cost will also depend on the comprehensiveness of the necessary medical care for alcohol abuse-related health issues. Behavioral therapy sessions might include group therapy, individual counseling, or additional therapy approaches, to address the underlying cause of addiction. More severe disorders warrant more intensive treatment. The cost will depend on the duration and level of care. The minimum is usually about 20 hours a week, for 6-8 weeks.10
Medication-Assisted Treatment (MAT) Costs
Most health insurance providers pay for medication-assisted treatment if it’s determined to be medically necessary. Since substance abuse is a chronic condition, it’s generally important to stick with prescribed medication therapy for longer periods.11
Your insurance provider will inform you of how often you need to reevaluate your therapy and will continue to cover it if it’s necessary. The exact duration is determined by your primary care doctor – they will occasionally assess your condition to decide if it’s still required. The cost of MAT depends on the duration of your treatment.11
Even though MAT is most frequently used for opioid addiction, there are also three FDA-approved medications for alcohol addiction.12 One of the most commonly used ones is naltrexone, but it only works while you’re taking it.13, 14
Comparing the Cost of Alcohol Rehab & Alcohol Addiction
Even though the costs of treating SUDs, alcohol addiction included, can be quite cost-prohibitive for a lot of people, it’s particularly important to point out that the cost of untreated addiction might actually be a lot higher. And not just financially – the cost of addiction can spill over to all facets of your life and seriously impact both your personal and professional relationships and commitments, causing various health and legal problems. All these things can add up and end up costing you more than going to rehab:15
- Cost of substance abuse itself.
- Losing income due to poor performance.
- Cost of alcohol-related health issues.
- Legal problems, most commonly DUIs/DWIs.
Getting treatment for substance abuse also impacts societal costs – they are reduced by lowering rates of drug-related crime and criminal justice costs. The healthcare system benefits from fewer drug-related accidents, overdoses, and deaths. And both the individual and the society benefit from higher workplace productivity and lower rates of interpersonal conflicts.16
What Is the Length of Alcohol Treatment With Federal BCBS Rehab Coverage?
The duration of treatment that any insurance provider will cover is usually limited to what’s determined to be medically necessary. This, of course, will depend on each person’s needs and circumstances, the severity of their addiction, and potential comorbidities like physical or mental health problems. In general, longer rehab times have higher rates of successful outcomes and maintaining long-term sobriety, with fewer instances of relapse.3
However, not everyone’s insurance policy offers the same benefits and tiers of coverage, so the actual length of stay at a rehab facility will depend on your specific health plan and the evaluation of medically necessary treatment.3
You will get the most accurate estimate of your options and coverage from your health insurance provider. Call the Federal BCBS helpline and make sure to have your insurance card with you. You can also get this information by filling out an online form on their website.
How to Decide Between Federal BCBS Inpatient & Outpatient Alcohol Treatment Programs Nationwide
Deciding whether inpatient or outpatient alcohol rehab is an appropriate treatment program for you is something that should be determined by addiction specialists, after a careful examination and assessment of your needs, circumstances, the severity of your addiction, and general health. However, not everybody has the same lifestyle, support system, or financial means.8, 12
Some people can’t take time off from work so inpatient rehab is not a viable solution for them. Others may not have a healthy support system, so removing themselves from their everyday environment might help them avoid falling back into old patterns, particularly if alcohol abuse is common in their friend group or they have a partner struggling with addiction issues.10
A number of individuals will decide based on what coverage they can get with their insurance plan. When choosing a treatment program that has the best chances of leading you to recovery and lasting sobriety, there are several factors to keep in mind:10
- The quality of care in licensed and accredited facilities should be high, regardless of the type of treatment.
- The treatment ecosystem of peer companionship can help you find and maintain motivation.
- The necessary level of care should be provided in the facility you choose.
- Support group options are available in both inpatient and outpatient programs.
- A more focused environment and intensive treatment are provided in an inpatient setting.
- Accountability is also important. Some people can commit to treatment, keep their motivation, and focus even in outpatient rehab, especially if they have a strong support system among friends and family.
How to Use Federal BCBS Insurance Coverage for Alcohol Rehab?
The first thing you need to do before starting treatment at any of the alcohol rehab centers is to make sure that the facility in question is one of the Preferred (or in-network) providers for Federal BCBS alcohol treatment. You should also consult one of the BCBC representatives to find out what services are covered, and which ones you’d have to pay for yourself. Sometimes it’s necessary to get pre-certified by Federal BCBS before going to a substance abuse treatment facility. The process goes like this:3
- Consult a doctor to determine medically necessary treatment for your alcohol abuse disorder.
- Find a suitable rehab program, ideally in a BCBS Preferred provider facility.
- Determine the ability to use insurance with your provider.
- Federal BCBS will determine substance abuse coverage for your treatment in collaboration with the chosen rehab center.
How to Find Alcohol Treatment Programs That Accept Federal BCBS Insurance Coverage
You should start with an honest conversation with your primary care provider about your alcohol abuse issues and your desire to start treatment. They can perform an initial evaluation and refer you to local addiction specialists and rehab facilities. If you don’t feel ready to talk to your doctor yet, there are numerous 24-hour alcohol and drug addiction hotlines you could call. They are completely free and confidential, and their trained representatives can provide you with accurate information about alcohol addiction treatment. The confidentiality of any personal information you choose to share is protected by law, as is all the information about your addiction issues, diagnoses, and treatment.17
As a nationwide substance abuse treatment provider that works with Federal BCBS, American Addiction Centers (AAC) will help you explore different payment options you have at your disposal or take advantage of the full benefits of your Federal BCBS healthcare plan. You can call the AAC helpline and have one of the admission navigators check your benefits during the phone call – make sure to have your health insurance card with you.
Aside from verifying your insurance, they can answer any questions about addiction treatment and provide you with a clear picture of your options. You’ll find out what part of the treatment can be covered by your insurance plan benefits and anticipate any additional cost you’d have to pay yourself. You can also check your coverage by submitting an online form.
The AAC team can help you get started with the initial steps of treatment, explain the intake evaluation process, and what the alcohol abuse treatment program consists of. AAC runs a network of high-quality addiction treatment centers nationwide, and you can easily find an alcohol and drug rehab center near you with Federal BCBS coverage, as well as same-day admission in case of an acute crisis.
