Blue Cross Blue Shield Coverage For Rehab

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.

All BCBS insurance plans cover at the very minimum the 10 essential health benefits. These are:

• outpatient care
• emergency services
• hospitalization
• 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.

• 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.

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.

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.

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:

1. Having to rely on substances to get through the day and not being able to go long without using them;
2. Prioritizing substance use over other everyday activities like school or work, food, and hobbies;
3. Isolating yourself from the people around you and losing touch with friends or family members because of it;
4. Having medical or legal issues that you could have otherwise avoided;
5. Feeling unable to quit on your own even after several attempts.

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.

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.