Blue Cross Blue Shield Coverage for Drug & Alcohol Rehab in the South

Blue Cross Blue Shield (BCBS) provides coverage all throughout the United States and Puerto Rico. There are currently 1.7 million doctors and hospitals in contract with BCBS nationwide, which is more than any other health insurer.1

This page will give an overview on how coverage can be applied to rehabs that take Blue Cross Blue Shield.

Does Blue Cross Blue Shield Cover Addiction Rehab?

Yes. The Affordable Care Act (ACA) mandated that insurance companies should not refuse coverage of addiction treatment by considering it a “pre-existing condition,” and that they have to provide the same level of coverage for mental health issues as they do for primary healthcare services.2, 3

This applies to government-funded plans like Medicare and Medicaid, as well as employer-based insurance policies and ACA marketplace plans, which include Blue Cross Blue Shield.2

While each plan through Blue Cross Blue Shield covers addiction treatment in some capacity, the level of coverage may vary greatly and, in most cases, can only be applied to treatment provided at facilities that are within the BCBS network.

Oxford Treatment Center is within the BCBS network, meaning it accepts Blue Cross Blue Shield of Mississippi and Empire Blue Cross Blue Shield.

Addiction Treatment Services Covered by Blue Cross Blue Shield

Addiction is a complex disease, and treatment is a highly individualized process; in other words, what is effective for someone may be much less effective for another.4

Therefore, the setting of treatment, length of stay, and use (or non-use) of medication in treating substance use disorder (SUD) is highly variable.4 Levels of addiction treatment covered by BCBS at Oxford may include:

  • Medical detox.
  • Residential treatment.
  • The Partial hospitalization program (PHP).
  • The intensive outpatient program.
  • Standard outpatient treatment.

The out-of-pocket costs and how coverage applies may vary based on the form of treatment as well as the specific BCBS policy.

Using Blue Cross Blue Shield to Pay for Rehab

Using Blue Cross Blue Shield or Blue Cross Blue Shield of Mississippi for rehab coverage is simple: First, find a rehab facility that is within the BCBS network. Then, get authorization for the treatment from Blue Cross Blue Shield.

Oxford Treatment Center’s admissions navigators, who can be reached at , can assist with this process.

How Much Does Drug & Alcohol Rehab Cost with Blue Cross Blue Shield?

The cost of treatment depends on a few different factors:

First, there is the facility and level of treatment provided. Typically, more intensive treatment options like inpatient rehab are more expensive than care at an outpatient substance abuse facility.

Then, there is the specific BCBS health insurance policy. Each plan is different, which may affect the amount of insurance coverage for addiction treatment. Usually, plans with low monthly premiums will have higher costs for treatment services (i.e., co-pay, co-insurance rate, and out-of-pocket maximum).

Each plan has its own Summary of Benefits and Coverage, which will help give you an idea of how much your treatment will cost. You’ll need to know the following terms:

  • This is the amount you’ll have to pay on health services each year before insurance begins covering costs.10
  • Co-payment. This is a fee paid out-of-pocket for certain services, such as doctor visits or filling prescriptions.11
  • Co-insurance rate. After your deductible has been paid, you’ll still have to share the cost of certain health services by paying a co-insurance percentage until your out-of-pocket maximum has been reached. For example, if your co-insurance rate is 20%, you’ll have to pay this amount while BCBS covers the remaining 80%.12
  • Out-of-pocket limit. This is the maximum amount you can be charged out-of-pocket for health services within a year (except for monthly premiums). Once this amount is reached, Blue Cross Blue Shield covers 100% of the remaining costs.13

Plans may also apply coverage for treatment differently. For example, one policy may charge a co-payment for each visit to an outpatient clinic, where another plan may charge a co-insurance rate for the entire cost of outpatient treatment.

Even with insurance, the cost of addiction treatment may be difficult to cover. In these situations, it’s often beneficial to review different ways to pay for rehab before you decide to start treatment.

You can find out in minutes whether your treatment at Oxford Treatment Center is covered by filling out the form below. If you have questions, connect with our Admissions Navigators at .