Blue Cross Blue Shield PPO Coverage for Addiction Treatment
Table of Contents
- Blue Cross Blue Shield PPO Coverage for Addiction Treatment
- Does a Blue Cross Blue Shield PPO Cover Substance Abuse Treatment?
- Health Insurance Terms You Should Know
- What are the Types of Blue Cross Blue Shield Policies?
- Understanding the BCBS Tier System
- What Types of Treatment Does a BCBS PPO Rehab Offer?
- Get a Blue Cross Blue Shield Rehab Matched to Your Needs Now!
- BCBS PPO Rehab FAQs
- Medically Reviewed By
Established in 1929, Blue Cross Blue Shield (BCBS) Insurance is a vast network of associated healthcare organizations that offer healthcare insurance across the United States. About one-third of Americans use services provided by companies registered with Blue Cross Blue Shield, making BCBS one of the country’s largest providers of health insurance.
Over nine out of ten U.S. doctors and hospitals are part of Blue Cross Blue Shield’s expansive network. Blue Cross Blue Shield is the health insurance provider of choice for millions of federal government employees. Its coverage has many advantages that can be helpful to the millions of Americans battling mental health illness or addiction.
Although many Blue Cross Blue Shield policies include benefits to help pay for addiction treatment, the specific options and programs available will depend on your home state and your particular insurance plan. Using BCBS PPO rehab services is often among the most coveted options for those seeking assistance.
If you or a loved one are battling addiction or mental health problems, Find Addiction Rehabs is here to help every step of the way.
Keep reading to learn more about using a Blue Cross Blue Shield PPO plan for rehab, and what you need to know to find the right forms of care now!
Does a Blue Cross Blue Shield PPO Cover Substance Abuse Treatment?
Nearly all Blue Cross Blue Shield insurance plans cover treatment for drug or alcohol addiction and mental health disorders. The level of coverage for substance abuse treatment depends on your insurance plan.
According to the Mental Health Parity and Addiction Equity Act (MHPAEA), health insurance providers and group health plans must offer equal coverage for medical and mental health services like substance addiction treatment.
This law was created to help more Americans have access to substance addiction and mental health treatment. However, you may find that you may find reasonably priced coverage from many Blue Cross Blue Shield providers.
The amount of your insurance coverage will differ depending on factors such as:
1. Your location
2. The kind of facility; whether in- or out-of-network
3. The length of your stay
4. Details of your insurance policy
Drug and alcohol addiction treatment costs can differ significantly from one individual to the next and from one drug and alcohol rehab center or program to another.
Benefits of Choosing an In-Network BCBS PPO Rehab Center
Providers of an insurance company’s network have agreed to a predetermined fee schedule. If you get treatment in an in-network facility, our out-of-pocket costs will be less than they would be if you went to an out-of-network hospital or clinic.
If you go to rehab centers that are not part of your insurance network, you may have to pay for the entire cost of your treatment out of pocket.
When deciding on a treatment provider, picking rehabs that accept Anthem or other forms of Blue Cross Blue Shield clients in-network is usually preferable. You may be able to work out a payment plan with the facility if you need treatment but can’t find an in-network physician or would instead go to an out-of-network facility.
Health Insurance Terms You Should Know
Below are some standard terms you need to know to be able to understand your BCBS PPO rehab coverage:
- Premium: A policy’s premium is the money you pay each month for your insurance coverage. You are still required to pay your premium whether or not you end up using your health benefits.
- Benefits: These are the services that your insurance with covers.
- Covered person or service: The services or people that insurance will provide benefits for or to.
- Group: A group is a collection of people with similar health insurance needs, such as a company’s employees.
- Deductible: The amount you will be responsible for paying out of pocket for medical care before insurance benefits start is called the deductible. For instance, if your health insurance policy has an annual deductible of $400, you’ll be responsible for the first $400 of any medical expenses incurred that year. Some services, like an annual medical examination, may be covered even before meeting the deductible.
- Copay: A copay is a specific fee paid during service, such as at the pharmacy counter or the doctor’s office.
- Coinsurance: Once your deductible has been met, you will be responsible for paying a percentage of the remaining treatment costs, known as coinsurance. If your insurance plan covers 70% of the cost of inpatient rehabilitation and you’ve already met your annual deductible, you’ll be responsible for 30% of the total cost. If your deductible has not been met, you will be responsible for the entire cost of the service until you do. After that, your insurance company will pay 70%.
- Out-of-pocket maximum: This is the maximum amount of money you will have to pay each year out of pocket for medical care. After the deductible has been met, all remaining out-of-pocket payments for covered medical services are subject to the agreed-upon coinsurance percentage until the yearly maximum is reached.
- Annual limit: The annual limit on the total amount of money your plan will pay for a specific service or procedure in a given year.
- In-network: Providers that have an agreement with the insurance provider so that a higher level of benefits is paid out. Using in-network service providers will maximize your benefits.
- Out of network: The term “out of network” refers to treatment providers without agreement with a particular insurance provider.
- Primary care physician: Your primary care physician is the doctor you select as your leading source for healthcare. This doctor will coordinate your treatment with other specialists as needed.
What are the Types of Blue Cross Blue Shield Policies?
Below are the common types of BCBS health insurance policies:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Catastrophic Plans
BCBS HMO Plans
Policyholders with the BCBS HMO plan can choose to see any of the network’s tens of thousands of doctors. However, these plans also typically cover out-of-network emergency medical care.
BCBS PPO Plans
BCBS’s PPO plans offer increased flexibility. Policyholders can choose from a broad network of healthcare providers. Consultations with specialists or primary care physicians outside Blue Cross and Blue Shield network providers will result in higher out-of-pocket expenses than when visiting an in-network facility or provider.
A BCBS PPO policy allows the policyholder the most treatment alternatives, including the freedom to choose a rehab center that best suits your unique need for mental health and addiction treatment.
Policyholders with PPO plans are not restricted to using facilities within their insurer’s network for care, allowing them to seek treatment wherever they like. PPO insurance is accepted by the largest network of rehabs that accept Blue Cross Blue Shield, making it the best option for clients traveling out of state for treatment.
PPO policies are the also best option for people seeking mental health and addiction simultaneously, known as dual diagnosis treatment, as well as those seeking other forms of specialized programs.
Catastrophic policies feature lower rates than comprehensive plans and are, therefore, more attractive to young adults.
Unfortunately, the deductibles for these policies are significantly higher than average and are not well suited for seeking inpatient or residential rehab care.
Understanding the BCBS Tier System
Except for Catastrophic plans, the Affordable Care Act (ACA) classifies all health insurance policies into one of four tiers, or “metal levels,” to make it easier to compare them. Each of the four levels—Bronze, Silver, Gold, and Platinum—offers roughly the same core benefits.
The only difference is in the percentage of your healthcare costs that your plan will cover. Monthly premiums and deductibles would change with each tier:
1. Bronze plans: These plans cover about 60% of medical expenses. The monthly premiums for bronze plans are relatively modest, while the deductibles are high.
2. Sliver plans: With a higher premium and a lower deductible, silver plans cover about 70% of medical expenses.
3. Gold plans: These plans feature high monthly premiums and low deductibles. They cover about 80% of medical expenses.
4. Platinum plans: These plans have the highest monthly premiums and lowest deductibles.
Bronze, Silver, and Gold plans are accessible in most areas across the country, while the more expensive Platinum plans are limited to only a few states.
What Types of Treatment Does a BCBS PPO Rehab Offer?
Mental health and addiction treatment options vary widely depending on the severity of the addiction and the individual’s unique needs. Your doctor or a treatment provider is the best person to advise you on treating your condition.
While a clinical evaluation is usually conducted to decide the best course of treatment, the following are some most common rehab treatment options:
Medical Detox and Withdrawal Management
Detoxification under medical supervision can lessen the severity of withdrawal symptoms while the body gets rid of the substances. With the support of trained professionals, you can safely and painlessly get through withdrawal and get ready for further addiction treatment.
Inpatient Treatment Programs
Inpatient or residential treatment programs involve living in the rehab center during treatment. You’ll work through feelings, form new routines, and get used to life without drugs or alcohol. This is a viable choice for people with extensive addiction backgrounds, chronic relapse histories, and others that need 24/7 medical attention.
An outpatient program may be the best option for you if you need to maintain responsibilities at home, school, or work while receiving care. These programs allow you to live at home during treatment.
Intensive Outpatient Programs (IOP)
If you can live at home but require more assistance than what is provided by a standard outpatient program, you may be a candidate for intensive outpatient treatment. With an IOP, you can continue your regular routines at home after receiving treatment during the daytime during the week.
Partial Hospitalization Programs (PHP)
Individuals who require full-time care but can safely return home at night may benefit from a partial hospitalization program. You’ll spend many hours per day at treatment, sometimes up to five days a week.
Aftercare services help you maintain the positive adjustments you’ve made to your life after completing therapy. Participating in an aftercare program will give you the encouragement and guidance necessary to sustain your new routine and sobriety.
Get a Blue Cross Blue Shield Rehab Matched to Your Needs Now!
If you are battling addiction, we want you to know that you are not alone. Our compassionate team at Find Addiction Rehabs is here to help you step out of your comfort zone, face challenges, and forge a personalized path to recovery and sobriety.
A quick call can and will help you find facilities nationwide, matched to your needs. Reach out now for a confidential consultation and get options for your recovery today!
BCBS PPO Rehab FAQs
What can I do if my BCBS PPO policy doesn’t cover the total cost of treatment?
Depending on the specifics of your BCBS insurance, the company may pay for a portion or all of your rehabilitation expenses. Insurance often won’t cover everything linked to your stay in a drug or alcohol rehab clinic.
While not everyone has insurance that will pay for the entire cost of therapy, nobody should be denied the chance to get better because of a lack of financial resources. It would be best if you didn’t let the cozy of treatment stop you from obtaining help, no matter the situation.
Sliding scale payment plans, where the total cost of care is determined based on the patient’s income and financial circumstances, can help make rehab more affordable. Other options include scholarships and grants.
* Disclaimer: Find Addiction Rehabs is not affiliated with or endorsed by Blue Cross Blue Shield. Details about BCBS coverage are intended for informational purposes only. The specific details of your plan may vary and the specific treatment services you require may or may not be covered. Please call our representatives today for more definitive details on your plan and options.
Deborah Tayloe is a freelance writer specializing in health and sciences. Deborah earned a B.S.Ed. in Secondary Education/English, accompanied by a Spanish minor. Her writing expertise allows her to craft engaging, impactful articles to help people be well.
In addition, she holds a fully accredited Certificate of Natural Medicine and is a certified Herbalist. Through her understanding of complementary medicine, Deborah helps medical professionals give people the information they need to embrace natural approaches to wellness.
When she’s not working, Deborah trains for 5K races and advocates for animal rights.