Blue Cross Blue Shield Coverage for Alcohol Rehab
What Is Blue Cross Blue Shield Insurance?
Blue Cross Blue Shield (BCBS) has been around since 1929 with the founding of Blue Cross. Blue Shield was formed later on, and the two merged in 1982.1 More than 100 million Americans are enrolled in BCBS healthcare plans today.1 Whether you have a medical, mental health, or substance abuse problem, you can count on Blue Cross Blue Shield coverage for your needs.
Blue Cross Blue Shield Coverage Plans and Tiers
Every healthcare provider offers different tiers and coverage plans for medical insurance. The Affordable Care Act dictates that each tier must cover a certain amount of the total healthcare costs.2 These tiers are represented by different metal levels. The breakdown is as follows: 3
- Bronze: This level covers approximately 60% of medical costs, with a low monthly payment and a high deductible.
- Silver: With this level, you get around 70% of medical costs covered, with a moderate monthly payment and lower deductible.
- Gold: This level covers around 80% of medical costs, with a higher monthly premium and low deductible.
- Platinum: This option provides the highest coverage (around 90%) of medical costs, with the highest monthly payment and the lowest deductible.
Choosing the right tier depends on your specific healthcare needs. If you anticipate using a lot of medical care, then the Gold or Platinum tiers may be best for you. The Bronze or Silver plans may work best for those who don’t think they’ll go to the doctor much.
Where Accepts Blue Cross Blue Shield for Alcohol Rehab?
Blue Cross Blue Shield is accepted in all 50 states.4 More than 90% of doctors and specialists accept BCBS.4 Of course, you should contact your provider for specific details about your plan and its coverage.
Does BCBS Cover Alcohol Rehab Treatment?
BCBS does provide treatment for those struggling with alcoholism. However, the treatment length and services may vary due to your plan level and the nature of your condition. It’s best to contact member services to learn more about what is covered under your plan.
Types of BCBS Coverage for Alcohol
BCBS covers the following types of services for alcohol addiction:5
Alcohol Detox: This is also known as withdrawal management. During detox, individuals can safely rid their body of alcohol’s harmful toxins under the supervision of medical staff.
Outpatient Care: This involves treatment and counseling in an outpatient setting. Participants attend daily sessions within in the facility but can return home at the end of each day.
Inpatient Care: During inpatient care, patients receive 24/7 care and medical oversight during the length of treatment.
Residential Care: This involves living in and receiving treatment at a facility and can remain in residential care for up to a year if needed.
Sober Living Home. Sober living is for people who need a home to stay in while they transition from intensive addiction care to being able to live independently.
Medication-Assisted Treatment (MAT): MAT involves using FDA-approved medications to treat substance use disorders, including alcoholism.
Does Blue Cross Blue Shield Cover Out-of-Network Alcohol Rehab?
Although Blue Cross Blue Shield insurance is widely accepted, some treatment facilities are out-of-network for BCBS.6 Out-of-network means that the facility does not have a contract with BCBS, so there will be more out-of-pocket costs. 6
However, you may be able to receive services covered by BCBS under certain circumstances. 6 For instance, you may be able to attend out-of-network treatment if in-network services cannot be accessed quickly.6 Out-of-network services may also be covered in unusual circumstances that need prior authorization.6
Does Blue Cross Blue Shield Cover Mental Health?
When a mental health disorder and a substance use disorder exist simultaneously, it is considered a co-occurring condition. 7 When dealing with a co-occurring mental health condition, it’s beneficial to undergo treatment that addresses both conditions.
Blue Cross Blue Shield treats behavioral health conditions as well as substance abuse disorders. Treatments for co-occurring mental health conditions may include applied behavior analysis, residential treatment, or cognitive-behavioral therapies.8 Call BCBS to find out the specifics of what would be covered with your insurance plan.
How to Check Your Blue Cross Blue Shield Coverage
The best way to find out if your plan covers addiction treatment is to log into your member account. You can go to the Blue Cross Blue Shield website or use the Blue Cross mobile app. Follow these steps after logging in: 8
- Go to My Coverage.
- Select Medical.
- Select What’s Covered.
- Find behavioral health care, mental health care, and substance use treatment.
Once you’re in this section, you will see information about:8
- Plan requirements for getting services.
- Which services your plan covers.
- How much you will need to pay for the services.
- How much your plan will pay for treatment.
If you’re still unsure about the answers to your questions, you can always verify your insurance at the treatment center you’re planning on attending.
How to Pay Out-of-Pocket Costs
There is a likelihood that some part of treatment won’t be covered by your insurance. It’s helpful to have a backup plan for how to pay the remaining amount. Discuss various options with admissions navigators and counselors. You may be eligible for a payment plan, sliding scale fee, or other financing options.
Even if your insurance doesn’t cover everything, don’t let this be a barrier to obtaining treatment.
Verify Blue Cross Blue Shield Insurance Coverage
To verify your insurance with AAC, call our addiction hotline at and speak with an admissions navigator today. All calls are 100% confidential and our admissions navigators are ready to help you understand your options for treatment.