People are often ready to get help for behavioral health issues but worry if their BlueCross BlueShield (BCBS) will cover the treatment. Depending on the policy and the member’s location, BCBS does cover at least a portion of treatment. As a result, some programs may have large out-of-pocket expenses, while others are completely covered. But, the best way to know what BCBS covers is to call them directly.
Almost 105 million people nationwide have coverage through BCBS. That’s nearly 1 in 3 people. But, each policy varies and provides different benefits for addiction treatment.
Universal BCBS covers part of the cost of the following programs:
The BCBS Association owns 36 health insurance companies. However, each company is independently operated. They are located across the country and are part of the Blue System. Also, half of the federal employees are part of BCBS’s Federal Employee Program.
BCBS individual and family plans fall into one of four categories. However, plans are dependent on where the member lives. BCBS plans include bronze, silver, gold, and platinum plans.
For example, bronze plans have lower monthly costs, while platinum plans have the highest monthly cost. However, platinum plans are not available in all areas. For the most part, BCBS recommends the bronze plan for healthy adults. Even though bronze plans have a low monthly cost, they have high deductibles.
The tiered plan coverage is as follows:
For members to get a clear explanation of coverage, it’s vital to call BCBS.
BCBS understands the risk of addiction that accompanies some mental health disorders. So, they offer tools to help identify issues with SUD. In addition, BCBS has resources to help find treatment.
Furthermore, BCBS has a “prescription pain medication safety program.” This program helps those at risk of addiction lower their risk. Specifically, this program is for opioids like Percocet and Valium.
OneHealth is a mobile platform. It provides members and their families with 24/7 support. This app is loaded with tools to support the recovery journey.
Blue Distinction Center for Substance Use Treatment and Recovery is a national program. It recognizes nationally accredited treatment centers that improve outcomes with patient-centered, evidence-based treatment.
The BCBS provider directory allows members to search for providers. Members can do so by name or treatment type. However, to find an in-network provider, members need their policy information on the insurance card.
BCBS plans offer partial coverage of behavioral health disorder treatment. However, coverage depends on the policy type and the location of the member. For example, one state member may be covered while a member in a close state is denied.
It can be complicated to understand BCBS policies and coverage. The best way to get clarity is to call BCBS. But, at Sana Lake BWC, we can also help members understand their treatment coverage.
BlueCross BlueShield covers some percentage of behavioral health treatment. However, most plans cover detox costs when necessary. Medical detox is essential for individuals suffering from alcohol, opioid, and benzo addiction. Because withdrawal from these substances is life-threatening, it should only be done under medical supervision.
The type of treatment program and the center a member chooses also affect coverage. If a member has an HMO (Health Maintenance Organization) plan, BCBS only covers HMO-contracted centers. However, PPO (Preferred Provider Organization) plans offer a range of providers. Members with PPO’s can see out-of-network providers but at a higher out-of-pocket expense.
Because each member’s policy is unique, it’s important to speak to a BCBS representative. They can explain the policy, so members understand their treatment coverage. Mental health treatment can be costly. As a result, the cost is a significant factor in which treatment center is chosen.
Because SUD is common with mental health disorders, detox is often the first step to recovery. But, not all members need medical detox. However, withdrawal from substances such as alcohol and opioids is dangerous and requires medical supervision. So, if medical detox is necessary, it’s crucial to know what’s covered.
BlueCross BlueShield policies cover both inpatient and outpatient detox. However, what portion is covered depends on the policy, and the treatment center is chosen. If the member has an HMO plan and chooses an HMO-contracted center, detox is likely covered. But, a PPO plan gives members more centers to choose from.
BCBS goes above and beyond others with behavioral health coverage. They are more flexible on detox and behavioral health treatment options. The best way to find a treatment center for the least out-of-pocket expense is to call BCBS.
A member’s inpatient treatment coverage depends on their policy and the state they live in. For example, each state has its own rules and regulations regarding insurance coverage. Inpatient treatment coverage also depends on the treatment center and its location.
For instance, a member with BCBS receives treatment for SUD at a hospital. Another member with the same policy receives treatment at a residential center. The coverage for services will differ between members because of the facility type.
It’s crucial to know if pre-authorization is required before entering treatment. Some plans through BCBS do require it. However, Coverage for treatment is not based on the type of addiction. For example, BCBS will cover the same costs for alcohol use disorder (AUD) as it does for heroin addiction.
Inpatient programs offer 24/7 support at the highest level of care. Knowing some definitions of standard health insurance terms can help you understand your policy better. These terms include some of the following:
Premium: A premium is a monthly payment made to the insurance company to maintain coverage. Sometimes, an employer will cover a part of this payment.
Coinsurance: Coinsurance is a cost-sharing service. These services cover healthcare and prescription medications.
Deductible: A deductible is an amount a person pays before insurance starts to cover more of the bill.
Out-of-pocket Maximum: Out-of-pocket maximum is the maximum amount of money a person will have to pay per year. Once the yearly maximum is met, then insurance covers 100%.
Bronze Plan: Bronze plans have a minimum monthly payment and only covers in-network providers.
Silver Plan: Silver plans have a little higher monthly payment, but they cover a little higher percentage of medical bills.
Gold Plan: Gold plans have high monthly payments but offer a higher percentage of coverage. People with gold plans can usually use in-network and out-of-network providers.
Platinum Plan: Platinum plans are not offered in every state. Platinum plans cover 90% of all healthcare needs. The high percentage of coverage also has a high monthly payment for coverage.
Many members with SUD also have mental and behavioral issues; this is also called a dual diagnosis. Furthermore, members with a dual diagnosis need to receive integrated treatment. For this reason, members struggling with SUD are also covered for mental health issues.
Insurance companies shouldn’t offer different coverage for behavioral health issues than it does for a physical injury. So whatever mental or behavioral problems a member has, BCBS should cover a portion of the cost.
Common Behavioral health disorders include:
BlueCross BlueShield coverage again depends on the member’s policy, location of treatment, and treatment type.
During the struggling times of Covid-19, many people are stuck at home. So, in addition to covering the costs of Covid-19 treatment, BCBS is expanding access to care. BCBS companies are finding ways for members to receive treatment from home. These efforts are not only for those in treatment pre-pandemic, but it’s also for those suffering from depression and other issues because of isolation and worry.
BCBS companies in each state offer different behavioral health options during the pandemic. A few examples include:
At Sana Lake BWC, we understand that the cost of treatment is a significant factor. And for members with BCBS insurance, it can be hard to know how much is covered by insurance. If you or a loved one is ready to start their recovery journey, let us worry about getting the best coverage from your BCBS policy. Contact us today and start living your best life.