Blue Cross Blue Shield Coverage For Rehab
If you have Blue Cross Blue Shield insurance, you may have access to comprehensive rehab coverage for addiction treatment. Harmony Ridge staff is happy to answer every question you may have.
By making the decision to seek professional help for your addiction, you’ve already taken the most important step to getting better – admitting that you have a problem and that you need help dealing with it. Unfortunately, professional help rarely comes free of charge. In fact, one of the reasons why so many addicts delay rehab is a simple fact that they’re afraid they won’t be able to afford it. This is why it’s important to have health insurance that covers mental health treatment programs. Luckily, Blue Cross Blue Shield insurance coverage does include treatment for addiction at the Harmony Ridge Recovery Center in West Virginia, so you can go through rehab without stressing about your finances. However, the extent of your coverage may vary, so keep reading to learn the full extent of your insurance coverage.
Blue Cross Blue Shield Ordinarily Covers Costs Associated With:
Who Falls Under the Blue Cross Blue Shield Insurance Coverage?
Blue Cross Blue Shield is actually an association of 35 different health insurance companies. The Blue Cross Blue Shield insurance coverage is thus delivered by Blue Cross Blue Shield Association licensees, each of which serves a specific region. In some states, BCBS licensees are also in charge of delivering Medicaid services through managed care plans. In West Virginia (as well as Pennsylvania and Delaware), the BCBS policies are managed by Highmark, which is why you may come across references to Highmark Blue Cross Blue Shield or Highmark BCBS.
The Blue Cross Blue Shield Association provides healthcare insurance coverage for more than 106 million people across the USA. This means that one in three Americans rely on BCBS insurance policies. Blue Cross Blue Shield offers a variety of policies, including:
- Employer-provided insurance – you may be a beneficiary because your employer has chosen BCBS
- The Federal Employee Program – as a federal employee or retiree, you are entitled to a health benefits program under BCBS
- Individual or family insurance – you can choose BCBS insurance coverage yourself and purchase the plan that suits you and your family
- ACA plans – if you are uninsured but do not benefit from Medicaid, you may qualify for financial assistance that covers up to 100% of your care at lower premiums
- Medicare and Medigap – if you are over 65 or have a qualifying disability, you can receive affordable insurance through Medicare.
Why should you choose Blue Cross Blue Shield insurance coverage?
If your employer has chosen Blue Cross Blue Shield for you or if it is the most cost-effective option thanks to subsidies, then the choice is pretty clear. But if you are in the market for private insurance of your choosing, you’ll probably want to weigh all the benefits and drawbacks first. The truth is that as long as you choose your plan carefully, you can’t really go wrong with BCBS. More than 96% of hospitals and 91% of healthcare providers across the country accept the BCBS BlueCard. You can even get international coverage.
There are three different levels of insurance – Bronze, Silver, and Gold. Premiums increase from Bronze to Gold while deductibles decrease. If you qualify for a cost-sharing deduction or advanced premium tax credits, there’s also an “Extra Savings” Silver plan which will keep your out-of-pocket costs low for a low-medium premium. You will also get additional benefits such as telemedicine appointments and Tier 1 prescription drugs at 0% co-pay and discounts for certain gym memberships. It is, therefore, easy to see why BCBS healthcare insurance is rated as above average in West Virginia.
How to Check Your Blue Cross Blue Shield insurance Coverage for Addiction Rehab in Harmony Ridge?
All BCBS insurance plans cover at the very minimum the 10 essential health benefits. These are:
- outpatient care
- emergency services
- pregnancy, maternity, and newborn care
- pediatric services, including dental and vision care
- preventive and wellness services and chronic disease management
- laboratory services
- prescription drugs
- mental health and substance use disorder services
- rehabilitative and habilitative services and devices
Mental health services such as therapy and drug rehab in WV are, therefore, covered by BCBS insurance up to 100% at in-network locations like Harmony Ridge Recovery Center. This extends to pre-existing conditions on ACA plans. However, out-of-pocket costs will vary according to the insurance plan. There may, for example, be co-pays for doctor visits that you must pay on a low-premium plan. Or you may have to reach a high deductible amount before your insurance kicks in. Some treatments, which are deemed medically unnecessary, excessive, or experimental may not be covered at all and others may require pre-approval.
It is best to contact the customer service number on the back of your insurance card to get the most precise answer. Harmony Ridge Recovery Center also has an admissions team that can help you figure out your insurance coverage.
What if your Blue Cross Blue Shield insurance coverage does not include the full cost of rehab?
Although mental health and substance use treatments are a part of BCBS coverage, they may be only partially covered. If that is the case, you have other options. Harmony Ridge accepts different forms of payment for addiction treatment in West Virginia. You can:
- Pay for the treatment in full by yourself. If you have no insurance or find it easier not to involve the insurance companies, self-pay is always an option for taking care of either the full or partial cost of the treatment.
- Take out a personal loan. Banks are sometimes willing to give out loans that help addicts seek treatment if they are unable to cover the costs themselves.
- Change your insurance plan. If your current insurance plan no longer suits you, look into switching to a different coverage plan.
- Switch to a different insurance provider. If you are unhappy with your insurance coverage in general, you can look for a different private insurance provider that will cover your treatment expenses.
- Check if you are eligible for Medicaid, Medicare, and other government subsidies. Federal health insurance plans include mental health services and may be a better option than private insurance.
Does Blue Cross Blue Shield Cover Detoxification Services?
Many Blue Cross Blue Shield has contracts with providers across the U.S. Most people insured with Blue Cross Blue Shield rehab coverage allows coverage for inpatient treatment services, which includes medical detoxification. During the detoxification process, the patient’s body starts to adjust to the lack of substances in which it had previously become dependent on.
Withdrawal symptoms will fluctuate depending on the substance used, how long the person has been using, the standard dose taken, and the person’s physiology.
Depending on the substance use, withdrawal symptoms may include:
- Bone and muscle aches
Some severe withdrawal symptoms include:
- High blood pressure
- High body temp
- Racing pulse
Is alcohol Rehab Covered Under Blue Cross Blue Shield?
- Almost 80% of Americans aged 12 and above have tried alcohol.
- More than 6% of adults and up to 12% of teens in the US meet the criteria for a current alcohol use disorder.
- Up to 30% of all Americans have at some point struggled with alcoholism.
Alcoholism is one of the most common addictions in the world. Unfortunately, due to the near-ubiquitous presence and acceptance of alcohol, staying sober can be difficult. If you find yourself struggling, explore our alcohol rehab WV treatment program. At Harmony Ridge, you can detox under medical supervision, receive therapy for your condition, and learn how to cope with cravings.
The best part is that alcoholism, like all addictions, is considered a mental health issue and is therefore covered by insurance. So if you have Blue Cross Blue Shield insurance coverage, some (if not all) of your alcohol rehab at Harmony Ridge Recovery Center will be covered. However, depending on your plan, there may be some out-of-pocket costs or pre-approvals. Contact your insurance provider directly if you are not clear on your policy. Otherwise, our admissions team can help you better understand the potential cost of treatment.
Is Drug Rehab Covered Under Blue Cross Blue Shield?
Much like alcoholism, drug addiction falls under the category of mental health which is covered by health insurance. BCBS health insurance will, therefore, pay for up to 100% of your drug rehab treatment at in-network substance abuse treatment facilities like Harmony Ridge. As always, co-pays, deductibles, pre-approvals, and other out-of-pocket costs will depend on your insurance policy. But what type of rehab will your insurance cover? At Harmony Ridge Recovery Center WV, you can enroll in:
- Cocaine rehab
- Fentanyl rehab
- Heroin rehab
- Ambien addiction treatment
- Barbiturates rehab
- Benzodiazepine rehab
- Marijuana rehab
- Stimulants rehab
- Opiate rehab
- Meth rehab
We have both inpatient and outpatient programs for all types of drug and alcohol addiction. These can include a combination of detox, one-on-one therapy, group therapy, case management, and more. Contact us to discuss your options and create a unique individual recovery plan. Our admissions team will help you find out whether BCBS insurance will cover every aspect of this treatment.
Blue Cross Blue Shield Addiction Resources
Because of the growing number of drug and alcohol addictions across the nation, Blue Cross Blue Shield has expanded its resources. This initiative helps in identifying and assisting with substance addiction solutions.
As of lately, many insurance companies have started prescription pain medication safety programs. This was done in an effort to help reduce the risk of addictions to opioid painkillers like Vicodin or Percocet.
BCBS’s mobile app One Health is another method members and their families receive round the clock support, education, and tools needed to recover from substance abuse successfully.
Blue Cross Blue Shield Policy Coverage For Substance Addiction
Blue Cross Blue Shield offers many different plans, depending on the state in which you’re living. The more basic insurance plans are bronze, silver, gold, and platinum programs. The minimum program, bronze, usually has the lowest monthly cost and the highest deductible amount. The difference is, the platinum plan has higher monthly fees while including more comprehensive coverage at a much lower deductible.
Blue Cross Blue Shield also offers a federal employee program, which consists of two plans: a standard and basic plan option. Although the basic option requires policyholders to use their preferred providers, the standard option allows members to choose between preferred providers and non-PPO. But, the member could be held accountable for the difference in the plan allowance and amount billed if they use their preferred provider.
Contact Harmony Ridge Today!
The first step toward achieving recovery is to reach out to one of the rehabs in WV that can get you on the track to recovery. Our admissions team is available 24 hours a day, 7 days a week, 365 days a year. Give us a call today!Contact Us Today
Must The Addiction Treatment Center Be In-Network?
Another thing to understand is, does the insurance policy includes a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan. People with HMO plans are solely covered at HMO contract facilities only. But, members with a PPO plan will have access to more options for providers they can use.
PPO plans allow members to visit out of network facilities, but the cost is higher. That is why it is vital to speak with your insurance provider about the particular details regarding your plan’s coverage. Selecting a treatment center usually depends on precisely what your insurance policy covers and what costs you’ll pay out of pocket.
Members must contact their Blue Cross Blue Shield rehab coverage representative to find out the cost of addiction treatment. Members usually have most, if not the full cost of treatment covered by their Blue Cross Blue Shield policy.
Coverage For Mental Health Treatment
Regarding health insurance coverage, the Blue Cross Blue Shield plan you choose will sequentially determine the out of pocket cost you will pay for treatment received. The cost will vary depending on several factors.
- Which type of treatments are required?
- What is the length of rehab stay?
- Will you be prescribed any medication during and after treatment?
Blue Cross Blue Shield’s mental health coverage will be determined by which type of treatment is required. The majority of the time, the policy will cover the full cost of therapy and hospital stays for mental health disorder treatment. Policyholders will have to pay the copayment for both inpatient and outpatient addiction treatment services.
The Importance of Therapy During Recovery
Addiction is more than just a physical disorder; this is why detoxing alone is not enough. Instead, you must deal with the mental and emotional aspects of substance use disorders. This is when therapy can be incredibly helpful. Firstly, it can help you better understand yourself and the reasons why you developed an addiction in the first place. Secondly, it can prepare you to deal with the triggers you will face once you leave the rehab center in WV where you are receiving treatment. Finally, therapy sessions, especially in group settings, can provide the support you need to stay sober.
What types of therapy can you get at Harmony Ridge?
Therapy is not a one-size-fits-all treatment; different people with different needs will benefit from different types of treatment. It’s important to find something that works for you. At Harmony Ridge, you’ll have access to different types of therapy, such as:
- individual therapy for addiction – helpful for people who don’t do well in group settings or require therapy for a co-occurring disorder;
- group therapy for addiction – a widely accessible form of addiction treatment that provides support and community for participants;
- cognitive behavioral therapy for substance use disorders – a way to restructure brain processes that lead to maladaptive behaviors, especially in patients with co-occurring anxiety disorders;
- family therapy for addiction – provides professional assistance to the people in your life that have been affected by your addiction and helps you move past your issues together;
- art therapy rehabilitation – for people who find it difficult to open up in conversational therapy, art therapy provides an alternative creative outlet instead;
- EMDR therapy for drug addiction – the novel Eye Movement Desensitization and Reprocessing therapy may be able to train your brain out of maladaptive coping mechanisms like drug seeking and into more productive ways of thinking;
- motivational interviewing for substance abuse – a form of behavioral therapy suitable for those who otherwise lack the motivation to quit;
- dialectical behavior therapy for addiction – the main focus of the treatment you will receive at Harmony Ridge Recovery Center, also known as talk therapy or psychotherapy;
- holistic therapy for addiction – combining multiple approaches to therapy to achieve the best results possible.
Coverage For Dual-Diagnosis Treatment
Many people who struggle with addiction also suffer from other mental illnesses. For some, substances are a way of dealing with the symptoms of mental illness. For others, substance use alters brain chemistry and causes mental health issues. A dual diagnosis like this affects around 13 million adults in the US. Some of the most common co-occurring disorders include anxiety, depression, eating disorders, and personality disorders. These can complicate treatment and recovery. That’s why it’s important to receive proper therapy for addiction as well as any co-occurring disorders. The therapy is a part of your rehab plan and you can use your insurance to cover up to 100% of the cost of it.
What Are The Telltale Signs That You or Someone You Know Need Rehab?
Some substances, like alcohol and prescription medication, are acceptable in limited quantities. They only become a problem once you can no longer control your use of them. But there is a fine line between taking painkillers to manage actual pain and doing it because your body is craving them. So how will you know when it’s time to seek professional help? Here are some red flags that it’s time to consider going into rehab:
- Having to rely on substances to get through the day and not being able to go long without using them;
- Prioritizing substance use over other everyday activities like school or work, food, and hobbies;
- Isolating yourself from the people around you and losing touch with friends or family members because of it;
- Having medical or legal issues that you could have otherwise avoided;
- Feeling unable to quit on your own even after several attempts.
Insurance For Inpatient Vs. Outpatient Addiction Treatment
Addiction isn’t a disease that can be treated overnight. However, with the proper form of addiction treatment and with help from addiction treatment specialists, it is possible to start working on a renewed lifestyle of sobriety.
Whether or not your insurance provider covers inpatient or outpatient programs is very important to know. You’ll want to understand which treatment option works best for you.
For people wanting to get away from friends and family who abuse drugs and alcohol, will choose to live at a residential treatment center. This kind of inpatient treatment program will provide patients with round the clock monitoring, treatment, and support.
Most people who used heavily during their substance abuse will prefer the structure of an inpatient treatment program. For people with a mild form of addiction, and have a healthy support system and reliable transportation, an outpatient rehab program might be a better fit. This is because outpatient rehab programs allow people to schedule their treatment sessions around their day to day responsibilities.
The length of an outpatient treatment program will vary. A standard outpatient treatment program requires a few hours of treatment per day, a few times per week. An intensive outpatient treatment program requires several hours per day of addiction treatment.
Inpatient Addiction Treatment Services And Costs
Some coverage options for insurance companies plans will usually include:
- Bronze plans: This plan will usually require the policyholder only to use in-network providers. Typically, out-of-network providers are not covered.
- Silver plans: This plan requires a coinsurance percentage and the plans deductible for services that are not in-network. Out-of-network services are usually not covered.
- Gold plans: Once the deductible has been met, often, there is a coinsurance percentage also required. Frequently, any services out-of-network will not be covered.
- Platinum plans: This plan offers different copayments or coinsurance percentages for treatments that are in-network. While out-of-network providers might be covered, it usually comes with a higher deductible or coinsurance percentage.
Length Of Addiction Treatment Blue Cross And Blue Shield Plans Cover
Everybody recovers from drug and alcohol addiction at a different pace, which is why Blue Cross Blue Shield insurance companies offer plans that cover addiction treatment. Rather than giving an amount of time covered for, the insurance company will cover some of the treatment based on the amount of coverage and deductible.
People with additional coverage through their employer could qualify for a greater length of treatment. The insurance provider and treatment center must keep all information discreet as a patient privilege.
Specialty Drug And Alcohol Addiction Treatment
t is required by The Mental Health Parity and Addiction Equity Act that group healthcare plans and health insurance companies are required to provide equal amounts of coverage for mental health services. This includes substance abuse treatment like they do with medical coverage.
The act was created to increase substance abuse and mental health coverage for people across the nation that need help.
The result was that many Blue Cross Blue Shield companies could provide members with affordable coverage, which is indicated in the pricing.
Most Luxury Addiction Treatment Centers Will Offer Amenities Which Include:
- Designer linens
- Elegant dining rooms
- Holistic treatments
- Spa treatments
- State-of-the-art fitness centers
Taking Time Off Work
Addiction can quickly drain your savings. So it’s no surprise that many people who struggle with addiction live paycheck to paycheck. If you are in a similar situation, you may be hesitant about starting treatment for fear of losing your job. However, getting help with addiction is important and the sooner you start with your rehab, the sooner you can get better. So consider your options carefully before looking into your Blue Cross Blue Shield insurance coverage plan.
If your place of employment offers unpaid family and medical leave, you can use this for mental health problems like addiction. And if it doesn’t, you can use whatever paid time off you have. Keep in mind that you are not under any obligation to disclose your medical conditions to your employer. You may have to justify your leave with a doctor’s note, but if you are not comfortable discussing your addiction at work, you have the right to keep this information confidential.
Using Blue Cross Blue Shield Rehab Coverage
Generally, Blue Cross Blue Shield plans will cover addiction treatment, at least partially, but the specifics are based on the personal policy. Most programs include treatment for medical detox if determined to be necessary.
This would most likely be the case for those suffering from benzodiazepine addiction, alcohol addiction, and opiate addiction. Detoxing from these substances can be dangerous and should always be monitored by medical professionals.
The type of treatment center you choose and the specific professionals who treat your plan will determine you. If you have an HMO (Health Maintenance Organization) plan, you are only covered at HMO-contracted facilities. If you have a PPO (Preferred Provider Organization) plan, you can see a list of providers and all out-of-network providers at a higher rate.
As with a majority of medical issues, only a portion of detox or addiction treatment is covered by insurance. It’s essential to speak with Blue Cross Blue Shield to determine your exact level of coverage. Learn what that means in terms of the specific dollar amount you will pay out of pocket.
The options available to you under Blue Cross Blue Shield are dependent upon your situation and the coverage you have. However, the Blue Cross Blue Shield network is quite extensive, meaning that those who have this particular insurance will have little trouble finding a center for treatment. The fastest way to go about finding a center for treatment is by using the Blue Cross and Blue Shield Association’s website to search locally for providers near you.
Information To Have Available When Calling
It is imperative to have relevant information with you when contacting an addiction treatment center.
The admissions counselor will ask you various questions that surround the person suffering from substance abuse. So, when reaching out, make sure your insurance card is in hand so the admissions consultant can verify the plan specifics and benefits of your policy.
Helpful information includes the exact substances used, the length of use, the usual dose used, and the administering method, like snorting or injecting. It is also imperative to provide the admissions consultant with information about any co-occurring mental disorders, like depression, anxiety, schizophrenia, or a personality disorder. The reason being is because most addiction treatment centers also specialize in treating co-occurring disorders and dual diagnosis.
Get Help Today
At Harmony Ridge Recovery Center, our team is here to ensure that you receive every bit of financial help you are entitled to with your Blue Cross Blue Shield coverage plan. Do not hesitate any longer.
Harmony Ridge Recovery Center is in-network with Blue Cross Blue Shield. Therefore, we will work together to make addiction treatment coverage accessible and available. Our team recognizes the importance of catering to the patient’s health status and budget simultaneously.
If you or a loved one requires an addiction treatment program, but are still unsure if it’s affordable, contact us today for a free consultation. Our staff will answer any, and all your questions. get you the answers you seek about your Blue Cross Blue Shield rehab coverage options.
Life After Rehab
Your recovery doesn’t begin and end with you staying in a rehab facility in West Virginia for a limited amount of time. For many people, addiction is actually a life-long battle. You may relapse and need rehab again, replace your substances with a different addiction, or simply struggle with cravings even if you don’t react to them. There is no shame in needing help after your initial treatment. In fact, Harmony Ridge Recovery Center provides counseling for chronic relapse issues and can help you develop an aftercare or relapse prevention plan.
If you’re still unsure if you can handle addiction triggers in your everyday life, you may want to consider a sober living house in WV first. This can be a good middle step between rehab and living on your own. Here, you’ll find support and community in other people who are learning to steer clear of drugs and alcohol. Keep in mind, however, that sober living homes are not considered a form of hospitalization. Hence, your Blue Cross Blue Shield insurance coverage is unlikely to extend to this type of accommodation on a long-term basis. If you cannot afford to stay at a sober living house, look into outpatient programs that your insurance will cover. There are plenty of therapy and treatments that you can receive under your BCBS healthcare program.
Does my insurance plan cover prescriptions?
In general, BCBS insurance plans cover prescription drugs, but not all drugs might be covered. You can check the preferred drug list on the BCBS website. Before you do so, make sure that you know your medicine’s exact name, the dose that you need to take, and how many pills your doctor prescribes for you. Depending on your plan, you might be able to get coverage for some drugs that are not on the preferred drug list.
What is a PCP (Primary Care Physician)?
PCP, also known as a primary care provider, personal care physician, or personal care provider, is a medical professional who serves as the first contact with the health care system. PCP can be your pediatrician, internal medicine doctor, family medicine doctor, or OB/GYN. If you don’t select your own PCP, Blue Cross Blue Shield will assign one to you.
What do I do if I am denied coverage or receive erroneous charges?
The best thing to do in any of these cases is to contact your Blue Cross Blue Shield customer service department. You can find the number on the back of your membership card. If this is not possible, you may want to talk to your local BCBS company, as BCBC itself does not maintain information about its members.
You will want to have your account number ready, as well as any paperwork/other information that might be relevant to the case. This includes (but is not limited to) dates and doctor references.
How do I find more information about coverage that is supplemental to Medicare?
BCBC maintains a medicare guide on its website. There, you can find all of the available Medicare choices, including private fee-for-service plans, medical savings account, and various other plans that may be available to you. Some BCBS companies also participate in prescription drug and Medicare advantage choices and may offer you additional options. You can always contact your BCBC representative for further instructions.
What are HMO and PPO?
HMO stands for Health Maintenance Organization. This organization provides financial relief that is associated with comprehensive medical services, most often in return for a fixed, prepaid fee.
PPO stands for Preferred Provider Organization. This organization provides health care services at a discount, as well as incentives for its members to utilize health providers within their network. The health providers themselves offer discounted service prices to the PPO, allowing the organization to provide better prices to its members. PPO also provides coverage for services rendered from out-of-network providers, albeit at a slightly higher price.
I missed the open enrollment deadline. Can I still purchase health insurance from BCBS?
Most of the time, the only way to sign up for a BCBS health insurance plan is during the open enrollment period. However, there is a “special enrollment period” that you might be able to take advantage of. To qualify for this opportunity, you must have had a “qualifying life event” within the last 60 days or experienced complications that prevented you from enrolling during the open enrollment period. Each state has its own rules that govern special enrollment, and you may want to get in touch with your local BCBS representative.