Blue Cross Blue Shield (BCBS) Coverage in California
If you’re a California resident with Blue Cross Blue Shield (BCBS) coverage, you’re one of roughly 4.5 million covered members.1 BCBS in California provides high-quality, affordable healthcare coverage to millions of residents. In addition to providing coverage for basic health services, your BCBS CA plan may also provide coverage for alcohol rehab and treatment. Be sure to check with a BCBS representative to verify your unique benefits and coverage.
Does BCBS Cover Alcohol Treatment in California?
Generally speaking, BCBS covers a wide variety of healthcare and mental health services. Many BCBS CA plans will provide coverage for inpatient, outpatient, and partial hospitalization programs (PHPs), as well as medication-assisted treatment (MAT).2 In compliance with federal healthcare laws, BCBS CA treats all mental health services equally with physical healthcare services in terms of coverage limits and details.
Under the health care reform law referred to as the Affordable Care Act (ACA), all health plans must provide some level of coverage for mental and behavioral health services.3 Specifically, treatment for substance use disorders, which include alcohol use and abuse, must be covered in some capacity by insurers, including your BCBS plan.3
Frequently Asked Questions
To help you learn more about alcohol treatment coverage under BCBS plans in California, review the answers below to commonly asked questions:
Does BCBS Cover Rehab in CA?
BCBS plans cover the costs associated with rehabilitation in California, provided that the facility at which care is being received is an in-network provider, and a Mental Health Services Administrator (MSHA) from BCBS CA has authorized your treatment (unless it’s an emergency).2 Out-of-network providers may also be covered, but at a lower cost. Check with your specific summary of benefits and coverage to view your plan’s details.
How Long is Treatment Covered?
The covered length of treatment will depend upon your situation and your plan selected. Be sure to talk with a BCBS CA representative to verify your levels of coverage.
Are both Outpatient and Inpatient Rehab Covered?
Under all BCBS plans, many different types of treatment methods for substance use disorders are covered, including inpatient and outpatient care. According to the BCBS Substance Use Resource Center website, the following types of treatment options may be considered and covered:4
- Detox treatment (also referred to as withdrawal management): With this type of treatment, you’d be evaluated, stabilized (detoxed), and prepared to enter a recovery program.
- Inpatient care: With this type of treatment, you’d have 24/7 care in a hospital or clinical setting, typically for 30, 60, or 90 days. Detox treatment is typically done within an inpatient setting.
- Residential care: Similar to inpatient care, residential care involves living at a facility and receiving treatment, but it’s typically for a longer period of time, often months or a full year.
- Outpatient Care: With this type of treatment, you’d receive counseling and treatment at a facility, but you’d return home following your session(s) each day.
Please note that the treatment methods explained above are not an all-exhaustive list, and specific treatment may not be the recommended option for you. Only a provider can determine what type of treatment you may respond to the best.
Does BCBS in CA Cover Co-Occurring Disorders?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a co-occurring disorder means that someone has both a mental health disorder and a substance use disorder.5 The National Institute of Drug Abuse (NIDA) reports that an estimated 7.7 million Americans have a co-occurring disorder.6 This means that it’s incredibly common and that if you’re struggling with both a substance use disorder and mental health disorder, you’re not alone.
To effectively treat a co-occurring disorder, an integrated approach to treating both the substance use and mental health disorder is recommended. Because the ACA mandates coverage for mental and behavioral health services, including substance use disorder treatment and behavioral health treatment, your BCBS plan in CA should provide some level of coverage for treatment of your co-occurring disorder.2
How to Check My BCBS CA Coverage
Checking your BCBS CA plan coverage before seeking treatment is essential in order to avoid surprise medical bills. Understanding your coverage will help you feel empowered when you go to choose a health care provider because you’ll know that you’re choosing affordable and quality health care.
But, understanding how to check your BCBS plan details can be confusing. To do so, call the number on the back of your insurance card and speak to a representative who can walk you through your plan’s details. Another way to check your coverage, which may be quicker and easier, is to do so online.
Using the Blue Cross mobile app, or the website, log in to your account. If you don’t have an account online, be sure to follow the site or app’s steps to create an account. You’ll need to have your insurance card handy if you’re creating an account.
Once you’ve logged in:7
- Navigate to “My Coverage” and click on that link.
- Then, select “Medical”.
- Then, select “What’s Covered.”
- Then, you’ll be able to find your behavioral health, mental health, and substance use treatment coverage details. Here is where you’ll be able to obtain information about your plan’s requirements for getting services (e.g., preauthorization details, in-network vs. out-of-network details, and referrals), covered services, your payment responsibilities, and your plan’s payment responsibilities.
Click here to learn more.
Seek Treatment
If you have Blue Cross Blue Shield (BCBS) insurance in California, you may be eligible for coverage that helps reduce the cost of alcohol rehab. BCBS plans often include benefits for inpatient, outpatient, and detox services, but coverage can vary. Use our search tool to find rehabs near you in California that accept BCBS insurance. Filter by treatment type, location, and more to explore programs that align with your coverage and recovery goals. Getting help is possible, and insurance may make it more accessible than you think.