BlueCross BlueShield

bluecross blueshield

Blue Cross Blue Shield Insurance 

Allowing yourself or a loved one to admit they have a substance abuse problem is one thing. It is a whole other story once the admittance turns to seeking treatment. Across the United States in 2017, according to the National Survey on Drug Use and Health, there were nearly 20 million people battling a substance use disorder. Unfortunately, there was only nineteen percent that had sought out help. 

People choose whether or not to seek out treatment for a variety of reasons. Some may shy away due to the stigma, some may do so due to guilt, some may simply due to insurance. Seeking help, however, should always be celebrated. The medical professionals here at Granite Mountain want to make the transition into treatment not only a possibility but as easy as possible. 

Insurance Coverage and Rehab

Insurance is overwhelming. Between the many changes, the terms, the companies, and their various policies. It can be overwhelming to go through any insurance policy. We understand. Blue Cross Blue Shield insurance is no different. Our goal is to help you or a loved one determine whether or not those seeking treatment for addiction or a substance use disorder will be covered by their insurance plan or policy. Our team of treatment staff, specially trained in addiction treatment, are here and waiting to help guide those seeking treatment through their insurance and the specifics of treatment.  

Those of us here at Granite Mountain Behavioral Healthcare are ready to help you or your loved one through addiction treatment services. We strive to help identify which addiction treatment programs accept your insurance, the treatments covered by insurance, and the length of time allotted with the coverage. 

Common Terminology & Policies 

 

  • Premium – Monthly payment option to the insurance company which can be provided by an employer. The employer can pay all or part of the cost. 
  • Coinsurance –  Similar to a copay, the cost is shared for services. A percentage of the whole cost is given to the policyholder to pay for health care related services once the deductible is met. 
  • Deductible – The amount of money a policyholder must meet before insurance starts to cover the costs from health care related services. 
  • Out-of-pocket Maximum – Similar to a deductible, it is the most the policyholder will pay in a year before coinsurance covers the whole billed amount. 

 

Blue Cross Blue Shield Insurance

Blue Cross Blue Shield insurance is a nationwide company that merged from two halves in the 1940s. They currently insure nearly 105 million individuals and families. 

While each policy or plan has variable aspects and provides a plethora of benefits that are able to cover substance abuse or addiction treatment, the options can vary. Each state has its own set of laws and regulations holds its own policies. Causing the policies to fluctuate on what or how much they will cover. 

Blue Cross Blue Shield Common Coverage

 

  • Inpatient Hospitalization
  • Residential Detox or Non-Medical Detox
  • Residential Level Treatment
  • Partial Hospitalization Treatment
  • Intensive Outpatient or Outpatient Treatment

 

Blue Cross Blue Shield Insurance & Addiction Treatment 

Blue Cross Blue Shield covers a variety of rehabilitation facilities and various types of treatment across the United States. As insurance that is accepted in all 50 states, they provide the added bonus of working with 92 percent of healthcare providers and more than 96 percent of hospitals. 

Providers We Have Commonly Encountered:

 

  • Premera Blue Cross of Washington
  • Empire BCBS of New York
  • Horizon BCBS of New Jersey
  • Massachusetts BCBS
  • Illinois BCBS

 

As a network, there are more than 35 independent locally operated agencies within the Blue Cross Blue Shield company. Each agency boasts of their individual help towards their policyholders. This creates a further understanding of the different laws and regulations in regard to each state. 

Policyholders of Blue Cross Blue Shield insurance should have a variety of options towards recovery from a substance use disorder or addiction and a successful and healthy one at that.

Prevention Tools & Resources 

Blue Cross Blue Shield provides a variety of resources for information. Many of which can help those suffering from a substance abuse disorder.

They have recently created a safety program specifically to identify those who may be at risk of drug addiction from prescription pain medication. The program, designed due to the rise in narcotic opioid addiction,  then reduces the dosage of the medication. Thus implementing the safety procedure or addiction prevention tool.

OneHealth, sponsored by Blue Cross Blue Shield insurance, is a mobile phone application (app.) The app provides policyholders and their family members with 24/7 support. By implementing the application the policyholders are provided the necessary education and tools to support treatment and recovery from addiction or a substance abuse disorder. 

Substance Abuse Coverage

Although Blue Cross Blue Shield provides medical insurance across the United States different locations provide a variety of options for insurance plans or policies.  The most common insurance plans are the metal policies. Metal policies refer to the bronze, silver, gold or platinum level.

The Bronze Plan is the lowest level of coverage for insurance. It is the lowest monthly cost but comes with the highest deductibles. Whereas the upper-level insurance plans (hence the more cherished metal types as their label,)  Platinum or Gold, have a higher cost but provide better insurance coverage and lower deductibles.

As for a Federal Employee Program policy, generally consisting of two different policy options, basic or standard.. The basic option provides policyholders a required preferred network of providers. The standard Federal Employee Policy option (PPO plan) allows the policyholders their choice of providers, preferred or non-preferred.

Insurance policyholders can still face having to pay at times due to the amount the insurance will cover and what the actual bill total is. Such as the difference of what the plan allows and the total amount billed by the non-preferred (out-of-network) provider. 

Addiction Treatment Centers & Blue Cross Blue Shield

Blue Cross Blue Shield insurance is accepted by the majority of substance abuse treatment centers in the United States. The full cost of the center may not be covered in some cases. Due to insurance coverage differences from one state to the next, a claim may be covered and approved in one and in another rejected.

We have encountered some extremely strict insurance policies. Some of which have only provided coverage for hospital treatment. Lacking coverage or benefits for addiction treatment or even to cover mental health. Thus, the saying for policyholders of Blue Cross Blue Shield insurance is as such, “If you’ve seen one insurance policy, then you’ve only seen one”.

Blue Cross Blue Shield insurance, or any insurance, can be very intricate to sift through. Especially when the policies and their various coverage from one state to the next changes. That only provides us here at Granite Mountain the opportunity to extend our helping hand. Thus our addiction treatment services find the highest level of care possible with the least cost to you or your loved one.

It is always recommended for a policyholder to contact their agent. However, that can prove to be disadvantageous for treatment services. Allow us to save you the hassle of doing so. We base the vast majority of our referrals on previous experiences. Providing real-life accounts from previous clients who not only received treatment but also had their treatment covered by their insurance. 

In-Network?

Blue Cross Blue Shield insurance plans or policies are generally going to be either an HMO (Health Maintenance Organization) plan or a PPO (Preferred Provider Organization) plan. 

  1. An HMO plan generally covers services within facilities only by those contracted by the HMO.
  2. A PPO plan covers a larger area with the option for the policyholders to have a choice in their providers.  

Even with the choice of provider with a PPO plan, facilities that are not within their network of providers may not be covered in full extent. 

Due to insurance plans covering different aspects of health care the policyholder should always discuss the plan with their agents. If not the policyholder, allow a great resource like ourselves here at Granite Mountain to do so. 

Detox

In some cases, those suffering from a substance abuse disorder or addiction may need to go through detox. Not everyone that seeks treatment will need to. However, with some substances like alcohol or opiate addiction medical detox may be required. 

Detoxing can be very difficult and not recommended without medical help or supervision. The withdrawal symptoms can be dangerous and sometimes deadly. Attending a facility that specializes in medical detox can be costly. Thus the importance of knowing whether or not insurance will cover the expense. Including policies with Blue Cross Blue Shield.   

A policyholder’s Blue Cross Blue Shield insurance policy can cover either an inpatient detox or outpatient detox. However, like many insurance policies, only a portion will be covered for medically assisted detox. 

As stated previously, insurance coverage varies. The degree of variance depends on the type of plan or policy held and the kind of addiction treatment facility being considered. 

An HMO insurance plan will only cover detox facilities that are HMO-contracted. Whereas a PPO insurance plan allows for a larger choice in facilities specializing in medical detox. 

Blue Cross Blue Shield insurance does have an upper hand over other insurance companies by offering more options for both detox and general addiction treatment. Policyholders with Blue Cross Blue Shield searching for a detox facility that is covered should find one without much hassle.

Again, a policyholder should contact their agent to go over the details of the insurance plan they are covered by. Therefore, leaving no room for error in choosing the correct detox facility to attend with the least cost out of pocket. There is always the option to contact us at Granite Mountain to hash out your policy’s coverage for you or a loved one.  

Inpatient Treatment

Blue Cross Blue Shield, like many other insurance agents, have policies specific to each state. The state and the addiction treatment facility where the insurance member or policyholder receives care and/or addiction treatment services also play a role in coverage. Such as, for those suffering and receiving treatment for their addiction or substance abuse disorder within a hospital may find their insurance coverage may be different than if they sought out treatment within a residential or inpatient treatment center. In the same notion, the service provided by a physician’s office will be different than that of service provided at a hospital or addiction treatment facility.

Many insurance companies have a pre-certification or pre-approval needed before covering a service. Blue Cross Blue Shield insurance plans may need one before covering the cost of an inpatient hospital or addiction treatment facility in the cases of substance abuse or addiction. 

If the policyholder has a policy or plan that will cover treatment for addiction, all substance abuse disorders will be covered. Essentially meaning that no substance will be denied and the policy will be able to help out with the cost of treatment.

Costs and Services

Inpatient addiction treatment programs provide the most intensive care and treatment in substance abuse disorder. They provide medical detox services, peer support, guidance, and therapy.

 Inpatient Rehab Cost Estimate 

  • Bronze Plan – In-network providers have a minimum deductible. Out-of-network is not generally covered.
  • Silver Plan – In-network providers have the deductible and a percent of coinsurance.in Out-of-network is not generally covered.
  • Gold Plan – Require coinsurance percentage, smaller than Bronze or Silver plans, and the deductible. No coverage for out-of-network.
  • Platinum Plans –  In-network services will either be copay each day ( there is a daily max amount) or a percentage of coinsurance. Out-of-network services covered occasionally if so the percentage of coinsurance and the deductible is higher.

Mental Health Treatment

Living with a mental health disorder can be a nightmare. Luckily for those that have a policy with Blue Cross Blue Shield insurance they are able to be provided help with costs through their coverage.

Behavioral and mental health disorders often co-occur with addiction problems. Thus the term dual diagnosis (Co-occurring psychological disorders). When a dual diagnosis occurs, both addiction treatment and mental health care are necessary. This ensures that those suffering receive the help they need. Unfortunately, the care necessary for co-occurring psychological disorders can sometimes provide a challenge to those seeking treatment. Knowing what options are available and how you or your loved ones Blue Cross Blue Shield insurance policy covers can give the help and the resources needed you need. 

The coverage needed for a physical health ailment should be applied the same towards mental health services. However, that is not always the case. 

Common Mental & Behavioral Health Disorders

 

  • Depression
  • Anxiety
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder

 

Those suffering from a mental health disorder and a substance abuse disorder have options within treatment that will provide care targeting both disorders. Blue Cross Blue Shield insurance provides health insurance coverage for this specific treatment program. Again, policyholders that are suffering should always speak with their agent or an organization like ours to discuss and understand their policy and coverage. 

Granite Mountain is Here to Help

Benefits as a Blue Cross Blue Shield Policyholder & Using Our Services:

 

  • We review each Blue Cross Blue Shield health insurance plan.
  • We determine if there is coverage for treatment within the policy.
  • We determine what kind of addiction treatment and how much will be covered by insurance.
  • Blue Cross Blue Shield health insurance is accepted in all states and by nearly all treatment facilities. By examining the policy we can provide the locations that fit best with each individual plan.

 

We understand that the specifics of insurance policy coverage is confusing. They are not designed to be easily understood. Us here at Granite Mountain Behavioral Healthcare will clarify the specifics of the insurance policy coverage of Blue Cross Blue Shield for you and to you. We are here to be sure you have a better understanding of what your insurance will cover and to provide you with an understanding of what may, or may not, come out of your pocket.

Understanding addiction treatment center options is important. Not only for you or your loved one’s sobriety but also for long-term health reasons and goals. Us here at Granite Mountain Behavioral Healthcare do a thorough job of explaining what an insurance policy covers as well as which addiction treatment centers are available. Allow us here at Granite Mountain to help, contact us at (877) 338-6287.

Article Reviewed by Gregory Struve

Gregory StruveGreg received a Master’s in Counseling from the Adler Graduate School in 2006. He trained at one of the top trauma and anxiety treatment centers in the world until 2008, when he became a faculty member at Grand Canyon University. From 2011 to 2016 he directed a program that lead the field in terms of innovative treatment of anxiety and trauma. During that time he even made several appearances on A&E’s intervention.