Blue Cross Blue Shield Insurance for Drug & Alcohol Rehab, Detox & Mental Health Services

Blue Cross Blue Shield Rehab Coverage

One of the first questions many people have when they’re considering drug or alcohol rehab is whether or not their insurance company will entirely or partially cover the cost of such mental health treatment. Blue Cross Blue Shield is one of the nation’s largest insurance providers, providing coverage to policyholders in all 50 states. The Blue Cross Blue Shield Association is a state-based nationwide network of 36 independent and locally operated Blue Cross Blue Shield Companies. Individual plan availability and coverage may vary between states, but there are some general things to know about Blue Cross Blue Shield drug rehab and mental health coverage.

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Does Blue Cross Blue Shield Insurance Have Drug Rehab Coverage?

Blue Cross Blue Shield policies are offered through many state Exchanges, created by the Affordable Care Act. According to the Affordable Care Act, all Marketplace plans are required to provide coverage for essential health benefits, which includes mental and substance abuse services or treatment. This means that Blue Cross Blue Shield addiction treatment options should be available.

For plans purchased through Exchanges, substance abuse treatment is required coverage, although specific health benefits depend on the particular plan a consumer chooses, as well as the state in which he or she resides. There are options on the Healthcare.gov website to view the individual coverage of Blue Cross Blue Shield plans if they’re available in your state. Blue Cross Blue Shield also offers the Federal Employee Program (FEP), which is part of the Federal Employees Health Benefits Program. It covers more than five million federal employees and retirees, as well as their families.

Under the Basic Option PPO for federal employees, retirees and their families, for an inpatient substance abuse or mental health facility, there is a $175 copay per day up to $875. Precertification is required, and the policyholder can stay in the rehab or mental health facility for an unlimited number of days. For outpatient hospital or facility care, the copay is significantly lower, and for inpatient professional mental health care there is no copay. If a consumer has a BCBS plan not purchased through the Exchange, they likely still have substance abuse treatment coverage, as well as coverage options for rehab, although as was noted above, this does depend on their individual plan as well as the state where they purchased their insurance.

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Blue Cross Blue Shield Mental Health Coverage

While drug or alcohol rehab and mental health are often categorized with one-another when it comes to insurance coverage, there are differences in these two areas that consumers should be aware of.

Is Blue Cross Blue Shield Mental Health Covered by Insurance?

In most instances, Blue Cross Blue Shield will cover mental health treatment. They typically have mental health benefits. This is always true of plans purchased through the Healthcare.gov Exchange. According to the law, along with substance abuse treatment coverage, both inpatient and outpatient, the Affordable Care Act requires coverage including on pre-existing conditions, which includes mental health conditions, as well as substance use disorder. Marketplace plans are prohibited from putting financial limits on any of the essential health benefits covered by these plans.

Blue Cross Blue Shield plans sold through the Marketplace also must have benefit protections similar to what’s allowed with other services. For example, if you have a plan with certain limits to surgery and medical services, these benefits must be comparable to mental health and substance abuse coverage. For Blue Cross Blue Shield policyholders with the Federal Employee Program Basic Option Plan, there is also coverage for mental health. Copays are required for outpatient hospital care and outpatient professional care. For inpatient professional (not facility) care, there is no copay for covered visits. There is a requirement, however, that policyholders use Preferred providers. If you receive your insurance coverage through your employer, your plan may not be required to cover mental health, but most BCBS plans do.

For example, in Texas, BCBS offers behavioral health programs for all non-HMO members. Blue Cross Blue Shield does provide a provider network of mental health care professionals as well as substance abuse providers, and this includes not only psychiatrists and psychologists but also social workers. For outpatient care, a physician referral is not usually required, but preauthorization is.

Blue Cross Blue Shield Behavioral Health Coverage

Mental health and behavioral health are often seen as one and the same, but there are some differences between these two care areas.

Is Blue Cross Blue Shield Behavioral Health Covered by Insurance?

In general, Blue Cross Blue Shield does include a variety of behavioral health options, although, depending on the facility and type of treatment, a copay may be required.

While Blue Cross Blue Shield Exchange plans must cover mental and behavioral health, most employer-sponsored programs provide these options and programs as well.

For example, along with a network of care providers, employer-sponsored programs also have options for resources and support related to behavioral health including not just mental health care but also programs such as weight management and tobacco cessation.

What to Expect from Blue Cross Blue Shield Insurance for Drug Rehab

If you’re a Blue Cross Blue Shield policyholder and you’re currently in the process of researching and exploring rehab options, it can be overwhelming. There are some important things to keep in mind as you go through this process. Answering the question of whether or not BCBS covers rehab is complicated. While the answer is generally yes, based on considerations like the ones above, as mentioned, every state and every policy is going to vary.

Some Blue Cross Blue Shield plans may completely cover the cost of rehab, while others may cover a certain percentage, requiring you to pay the rest out-of-pocket.

Along with the amount of the cost covered by insurance, the length of allowed stays in a rehab facility may vary based on your plan type. Another relevant factor is the type of facility. For example, if you have a PPO plan as opposed to an HMO plan, you will have the option to see a wider network of care providers and visit more facilities.

The best thing to do is contact Blue Cross Blue Shield and determine what your coverage options are, especially since preauthorization is required in most of these situations.

Popular Blue Cross Blue Shield Locations:
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Blue Cross Blue Shield was last modified: August 4th, 2017 by The Recovery Village