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Does Blue Cross Blue Shield Insurance Cover Drug Treatment?

Last Updated: August 15, 2019

I have insurance with Blue Cross/Blue Shield. Will it cover my drug rehab?

Typically, yes. But coverage varies from state to state and plan to plan. That means some programs may cost consumers a great deal out of pocket, while others might provide robust coverage. Call the company directly, using the number on your health insurance card, to find out more about your benefits.

(Please note: American Addiction Centers strives to provide you with the most updated information on each carriers’ addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. AAC is not affiliated or endorsed by the Blue Cross and Blue Shield Association or any of its licensees.)

The Blue Cross and Blue Shield Association owns 36 health insurance companies nationwide, which comprise the Blue System.

The companies cover over 105 million Americans and operate in all 50 states. Commonly referred to as The Blues, Blue Cross and Blue Shield have over half of all federal employees enrolled in their network, as part of the Federal Employee Program®.

Blue Cross Blue Shield’s individual and family plans fall into three or four categories, depending on your state: bronze plans, silver plans, gold plans, and platinum plans. Bronze plans will have the lowest costs, while platinum plans will have the highest monthly costs. Some states will not offer the platinum category. Blue Cross and Blue Shield recommends the bronze-level plan for those who do not go to the doctor often, as it will have a low monthly payment and a high deductible.

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*Insurance Disclaimer: American Addiction Centers will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” American Addiction Centers will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

In summary, the tiered plans of Blue Cross Blue Shield are as follows:

  • Bronze: This level covers around 60 percent of medical costs, with a low monthly payment and a high deductible.
  • Silver: This level covers around 70 percent of medical costs, with a slightly higher monthly payment and lower deductible.
  • Gold: This level covers around 80 percent of medical costs, with a higher monthly payment and low deductible.
  • Platinum: This level covers around 90 of medical costs, with the highest monthly payment and the lowest deductible.

Health insurance through Blue Cross Blue Shield varies by state, however, so it is recommended that you check your state’s specific coverage details.

Checking Your Insurance Coverage

To see what is covered under your Blue Cross Blue Shield health insurance plan, you can either enter the 3-letter prefix before the identification number on your member card on the Blue Cross Blue Shield Association’s website, or you can find your company directly on the website’s listing of the 36 member companies.

Once you’ve found your company, you can log in to check your coverage. At your local company’s website, you can find details, such as your prescription drug benefits or a list of providers in your area. As a member, you can also access the cost estimator for treatment.

Using Blue Cross Blue Shield for Drug Rehabilitation

In general, Blue Cross Blue Shield plans do cover treatment for addiction, at least in part, but again, specifics are based on the individual policy you possess. Most plans cover treatment for medical detox, if determined to be necessary. This would most likely be the case for those suffering from benzodiazepine addiction, alcohol addiction, and opiate addiction. Detoxing from these substances can be dangerous and should always be monitored by medical professionals.

The type of treatment center you choose, as well as the specific professionals who treat you, will be determined by your plan. If you have an HMO (Health Maintenance Organization) plan, you are only covered at HMO-contracted facilities. If you have a PPO (Preferred Provider Organization (PPO) plan, you have the option to see a wider range of providers, and you can see an out-of-network provider at a higher rate.

As with all medical issues, oftentimes, only a portion of detox or addiction treatment is covered by insurance. It’s important to speak with Blue Cross Blue Shield to determine your exact level of coverage, and learn what that means in terms of the specific dollar amount you will pay out of pocket.

The options available to you under Blue Cross Blue Shield are dependent upon your situation and the coverage you have. However, the Blue Cross Blue Shield network is quite large, meaning that those who have this particular insurance will have little trouble finding a center for treatment. The fastest way to go about finding a center for treatment is by using the Blue Cross and Blue Shield Association’s website to search locally for providers near you.

Last Updated on August 15, 2019