Does Federal BCBS Cover Opioid Rehab?
Prescription opioids are generally safe when used as a pain relief for a short period of time and as prescribed by a health care provider. However, they can still carry a potential risk of opioid misuse and eventually addiction.1
In addition to illegal drugs such as heroin, opioids include strong prescription pain killing drugs like:1
- Oxycodone.
- Hydrocodone.
- Fentanyl.
- Tramadol.
- Codeine.
- Percodan.
Both opioid misuse and substance abuse harm the health of individuals and well-being of communities, which is why making sure that treatment is easily accessible is essential. Under the Affordable Care Act, all plans offered in the Marketplace must cover 10 essential health benefits, including mental health and substance use disorders.2 Therefore, opioid rehab represents a minimum requirement for all Marketplace plans.2
If you have Federal BCBS insurance coverage for substance abuse treatment, there are several addiction treatment facilities nationwide that accept this type of insurance for mental health and addiction treatment, including opioid-related issues.3
In most cases, insurance providers will cover a higher percentage of in-network drug rehab center costs than in out-of-network facilities. In some cases, insurance companies will not support coverage for out-of-network rehab centers and will require individuals to cover all costs themselves.3
What Does Federal BCBS Insurance Cover for Opioid Treatment?
Under the Mental Health Parity and Addiction Equity Act (MHPAEA), health insurance companies need to offer equal benefits for any necessary mental health services, such as opioid treatment, similar to surgical/medical benefits.4 Almost all of Federal Blue Cross Blue Shield plans include some type of coverage for mental health issues depending on the policy you have.
Details regarding your Federal BCBS rehab coverage depend on the policy you have, but usually cover:5,6
- Screenings and interventions.
- Detox.
- Inpatient treatment.
- Outpatient treatment.
- Behavioral therapies.
- Assessment and treatment for co-occurring disorders.
What Federal BCBS Doesn’t Cover for Opioid Treatment?
Not all Federal BCBS healthcare plans are the same and every state legislature differs.7 Even though every person’s addiction treatment is tailored to fit their specific situation and needs, there are certain aspects of treatment that Federal BCBS insurance isn’t likely to cover. They are mostly things that do not constitute an essential part of opioid rehab like:8
- Non-medical amenities.
- Holistic care services.
- Recreation programs.
- Food delivery.
- Private treatment services.
- Alternative therapies.
What’s the Average Cost of Opioid Addiction Rehab?
There are many factors that come into play when determining the cost of rehab treatment. Differences in coverage will vary depending on individuals’ rehabilitation plans and their specific policies. Costs can also vary depending on:7
- Whether it’s an inpatient treatment at a specialized facility or an outpatient program.
- The type of facility as well as amenities and services offered.
- Length of the treatment which differs depending on individual circumstances.
- The medication used for detox and treatment,
- The state in which the treatment is taking place.
- The preferred treatment provider.
Cost of Inpatient Opioid Rehab
Inpatient drug rehab and treatment programs covered by Federal BCBS insurance are typically suitable for those who have a chronic or severe opioid misuse issue. Inpatient addiction treatment involves patients staying at a treatment center. This removes them from outside triggers and challenges that could worsen their condition. The intense 24/7 nature of inpatient programs is one of the main reasons why they’re more expensive than outpatient programs.6
Since the cost represents a major obstacle for certain people, there are free rehab facilities, but they’re typically reserved for people who can’t afford to pay for inpatient treatment. They receive funding from various organizations, like private endowments, charitable donations, and government grants.9
Cost of Outpatient Opioid Rehab
Although opioid misuse is a serious condition that is best treated in a treatment center, Federal BCBS insurance coverage may also include outpatient programs designed to tackle this issue. Outpatient programs are mostly reserved for milder cases and those who have obligations they can’t avoid or postpone. They can also be a possible option for those who can’t afford expensive inpatient programs.6
One of the main reasons why outpatient treatment is cheaper than inpatient treatment is that you can continue living in your own home without paying non-medication costs like a room in a treatment facility.6
Federal BCBS coverage may also include the intensive outpatient program (IOP) that enables people who are in need of intensive treatment to continue their daily lives. This program can be an ideal fit for individuals who have a stable home environment and are not in need of ongoing monitoring. Patients will usually visit a Federal BCBS-covered substance abuse treatment facility 3 to 4 times a week and receive a higher level of care than those who are part of standard outpatient rehabilitation.10
Cost of Opioid Partial Hospitalization Programs (PHP)
Partial hospitalization programs (PHP) can also be referred to as day treatment. They have a treatment intensity and daily schedule that’s in many ways similar to an inpatient program. However, a patient isn’t required to spend the night at a treatment center, which may lower the costs significantly. This makes PHP a possible alternative for individuals who cannot afford a stay at a treatment facility.11
A partial hospitalization program usually takes time during the day and generally entails 20 or more hours per week dedicated to addressing mental health and opioid addiction that does not require 24/7 hospital care. Partial hospitalization may include regular family meetings, different types of medical services, and treatment of any related co-occurring disorders.11
Cost of Medication-Assisted Treatment (MAT)
Medication-assisted treatment, or MAT, is a rehabilitation approach that combines medications and behavioral interventions to treat substance use disorders (SUDs). FDA approved 3 drugs for the treatment of opioid addiction. They are buprenorphine, methadone, and naltrexone.Because opioid addiction is a chronic condition the need for continuing MAT should be subject to periodical evaluation.12
Monthly premiums, deductibles, copays, and your total out-of-pocket costs for opioid rehabilitation and treatment will vary depending on the specific Federal BCBS healthcare plan you have. However, if you have Federal BCBS substance abuse coverage, you can usually count on part of your costs being covered.12
Opioid Rehab vs. the Cost of Opioid Addiction
The total amount spent on substance use disorder rehab represents only a fraction of money that the entire society spends tackling this problem. According to one analysis, $78 billion was spent in 2013 alone on the total costs of prescription opioid use disorders and overdoses in the US. Only $2.8 billion, which amounts to 3.6% was for spent on patient treatment.12
The cost of addiction for wider society is enormous and most of the available research data highlights the need for policymakers, health insurance plans, and care delivery systems to increase capacity, and eliminate existing barriers for outpatient treatment of opioid use disorders.13, 14
In many ways, addiction is an everyday expense and its costs in terms of lost income and health problems are the reason why medical experts tend to say that “substance abuse treatment pays for itself”.14
What Length of Opioid Rehab Does Federal BCBS Cover?
With your Federal Blue Cross Blue Shield (BCBS) opioid rehab nationwide coverage, the benefits you are entitled to and the length of coverage will depend on the insurance plan you have. It may also depend on the state where you decide to seek treatment. Similarly to other types of substance abuse, opioid addiction is a chronic disease. Therefore, many patients will require long-term or repeated care to stop using completely and take back control over their lives.6
Since detox is not a treatment in itself but only a first stage of treatment, long-term institutional care is the best way to completely change your life and eliminate the need and urge for drugs. Federal BCBS healthcare plans offer various kinds of policy plans that are tailored to specific individual needs. If you hold a Federal BCBS insurance plan, you may have substantial coverage and benefits for SUD treatment, but it’s always best to check with your insurance provider or treatment facility.15
Choosing Between Federal BCBS Inpatient vs. Outpatient Opioid Rehab Centers
When you are deciding whether to enter inpatient or outpatient treatment, this will mainly depend on your medical professional’s assessment and recommendation. They will take into account multiple important factors.16 One of the most important factors can be your employment status. So, if you have a 9-to-5 job that you cannot take leave from, outpatient treatment can be a good solution for you.16
Outpatient Treatment
Many outpatient programs offer individual and group counseling, as well as treatment for co-occurring mental health issues in addition to opioid use disorder.16 Outpatient treatment could be the best solution for people who:17
- Can’t commit to inpatient treatment because of their job situation.
- People who have a warm and caring home environment.
- Have enough will power and determination to attend and follow the rehab procedure.
- Are not dealing with severe addiction.
Inpatient Treatment
On the other hand, inpatient programs are more extensive and can vary in duration of stay. For example, they can be short-term programs that implement intensive but relatively brief treatment based on a modified 12-step approach.16
Inpatient treatment can also combine various approaches to rehab, last longer, and designed to challenge and ultimately change individuals’ bad habits, beliefs, and destructive behavioral patterns.16
Inpatient hospital-based programs combine health care and addiction treatment services for people with mental health and medical issues. A big advantage of residential treatment is that patients can live with people who share similar experiences. They can support and motivate each other in a more focused environment designed as a beneficial treatment ecosystem.1
Inpatient programs are usually suitable for people who:17
- Will benefit from a more focused environment and heightened accountability.
- Are struggling in their everyday lives and can’t function on their own.
- Completed less intensive treatment without success.
- Have long term or severe opioid addiction issues.
- Are more prone to relapsing or withdrawal.
How to Use Federal BCBS Insurance for Opioid Rehab?
The Blue Cross and Blue Shield Federal Employee Plan, or FEP®, has been a part of the Federal Employees Health Benefits Program (FEHBP) since the program started back in 1960. Treatment for opioid addiction is typically a part of the mental health portion of your Federal BCBS insurance coverage.19
To start with your Federal BCBS insurance covered opioid rehab program, you’ll need to consult a doctor first. A medical professional will determine whether opioid addiction treatment is necessary and find a suitable rehab program that will address your medical issues based on your specific situation and personal preferences. Next step will be working with one of the Federal BCBS rehab centers to determine the coverage you’ll have and all the details of your treatment.19
How to Find Opioid Rehab That Accepts Federal BCBS Insurance
If you or a loved one are struggling to maintain abstinence, American Addiction Centers (AAC) can be a first step on the road to a healthy life. As a network of nationally recognized treatment facilities, AAC can help you find a program that suits your needs.
All you have to do is dial AAC’s free and confidential hotline number. Whether you call a specialized hotline for heroin addiction, reach out to operators offering advice for prescription drug abuse, or call a general helpline for substance abuse, knowledgeable admissions navigators will help you or your loved one gather all the information needed.
AAC navigators will offer understanding and helpful guidance because they truly understand what you are going through. You can get all the necessary information, verify if your insurance covers treatment, check your specific benefits, and receive a personalized treatment recommendation with just one call.
Around 5.6 million individuals who are current or former federal employees and their families enjoy Federal BCBS addiction treatment nationwide coverage, which is more than half of nearly 8 million people who receive their benefits through the FEHBP.19
AAC treatment centers are in-network with this provider and can help you gather all the necessary information on your insurance. AAC treatment centers are located across the United States, giving you access to quality treatment and multiple options to choose from.
