Does Blue Cross Blue Shield Insurance Cover Heroin or Drug Rehab?
Blue Cross Blue Shield is a popular health insurance plan that serves members nationwide—in every state, Washington, D.C., and Puerto Rico.1 Since 1929, Blue Cross Blue Shield (BCBS) has provided healthcare insurance and today serves 1 in 3 Americans.1 Ninety-six percent of hospitals and 95% of doctors and specialists accept BCBS insurance.1
The vast geographical coverage of BCBS increases the likelihood that you or your loved one will be covered when seeking addiction rehab. Consumers need to know that there are laws in place to protect those seeking mental health and addiction treatment. Insurance companies are obligated to provide benefits for mental health and substance use disorders, including opioid (heroin) use disorder. They are required to offer coverage that is available, accessible, and comparable to other health services (e.g., general medical and surgical coverage) to their members who need addiction treatment.2
Addiction treatment centers can check your coverage based on the information you provide, or you can call the number on the back of your insurance card for more information on your specific plan.
What Will Blue Cross Blue Shield Cover?
Depending on your specific plan, BCBS may cover some or all of the cost of the following types of addiction care:3
- Inpatient/residential rehab (highest level of care): 24-hour care, provided in a hospital or a specialty treatment center where you stay overnight and receive 24/7 care from a multidisciplinary team (e.g., medical, psychiatry, counseling, peer support).
- Partial hospitalization program (high level): does not require you to stay overnight, however, are required to attend at least 20 hours of treatment a week.
- Intensive outpatient program (mid-level): requires attendance and participation in at least 9 hours of multidimensional therapies a week.
- Outpatient rehab/therapy (lower level): requires attendance and participation in programming less than 9 hours a week for recovery or motivational therapy/strategies.
If you are seeking heroin treatment for an opioid use disorder and are interested in an inpatient program, providing additional information to your healthcare provider can help. Your immediate safety is of the utmost importance, and for many, their first inpatient rehab comes after a traumatic event or crisis. This information is important to share with your treatment provider.
For many, substance use is combined with other medical conditions or problems (e.g., infection, diabetes, chronic pain, mental disorder, violence, physical abuse, relapse). Although it may be difficult to talk about, it is important to share this kind of information with your healthcare provider. Treatment is not only about your substance use it is also about your safety and your overall well-being.
The more severe your heroin addiction is the more services you’ll likely benefit from. Your insurance plan will cover the highest level of care that meets your current health needs. Treatment often begins with detox (getting the substance out of the body and stabilizing withdrawal), followed by mental health care (e.g., counseling), and learning coping skills, behaviors that support healthy living without heroin or other drugs.
Many programs offer enriched therapies to treat the whole person as well as their family. Improved mental health enables someone with an addiction to gain insight, acceptance, and connectedness to support long-term recovery for a drug-free life.
Does Blue Cross Blue Shield Insurance Cover Mental Health Care?
Yes, Blue Cross Blue Shield insurance covers mental health care. Under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, insurance providers are required to provide coverage for mental health care and addiction treatment.2
For those with co-occurring disorders, which means having both a mental health disorder and a substance use disorder, many insurance plans will cover both and treat both simultaneously. However, stand-alone treatment for opioid use disorders such as heroin addiction falls under this mandate as well.2
How Long Does Blue Cross Blue Shield Insurance Cover Rehab?
The length of time in rehab that is covered by Blue Cross Blue Shield insurance depends on your specific plan. Longer treatment times are generally considered more effective; however individual needs vary. Since there are different types of policies and tiers of coverage, it’s helpful to review your benefits with your insurance provider.
BCBS has been proactive in helping its members get treatment for substance use disorders. Blue Cross Blue Shield has a dedicated resource center to inform readers on potential options for treatment. The BCBS resource center covers withdrawal management (detox), medication assisted-treatment (use of FDA-approved medication, in conjunction with counseling and behavioral therapy to treat addiction disorders), residential care (ranging from a month to a full year), inpatient care (ranging from days to weeks), interim care (daily medication and emergency counseling), outpatient care, sober living homes, and telemedicine options (healthcare provided over the phone or on the internet).4
To find out what your plan covers call the number listed on the back of your insurance card for member services. Ask them what your plan will cover for mental health and substance use disorders. They will likely ask you additional questions related to your health, so have your member ID number handy. If you already have a rehab center in mind, you can ask them to check your in-network benefits for that treatment center.
What If My Blue Cross Blue Shield Policy Does Not Cover Heroin Rehab?
Opioid use disorder covers all opioid-related substances, including heroin. If your insurance provider does not cover a specific rehab center of your choice, ask if there is a financing option or a scholarship option available that you can apply for. Often, when discussing health coverage with your insurance representative there are more resources they may be able to offer that can offset the cost of rehab for you.
It’s important to recognize that getting the right treatment, and quickly, is critical. Heroin use can lead to a chronic, long-term disorder. The National Institute on Drug Abuse reports that people who use heroin experience life-threatening emergencies, including decreased respiration and heart function, and even death.5 Other medical complications include heart, lung, and skin infections, and mental health disorders such as depression and antisocial personality disorder.5
In-Network Versus Out-of-Network Rehab Centers
To help you take full advantage of your health benefits, most insurance companies have an online member portal where you can check your plan’s coverage and in-network provider list. The information to access the online portal should also be on the back of your insurance card, or you can call member services to ask.
It is also important to understand which providers and rehab centers are in-network versus those who are out-of-network with your insurance plan. Knowing which addiction treatment centers, providers, and other specialists are in your network will help you compare services, locations, and the quality of the treatment provided. Understanding what different programs offer will also help you determine which one will best meet your individual needs.
In-network providers (e.g., hospitals, treatment centers, physicians) have contracted with your specific insurance plan. The cost to you may be 80/20 where your insurance plan pays 80% of the bill and you pay the other 20%. It’s best to check what your projected out-of-pocket costs will be before making a final decision though. Typically, your insurance will pay a larger portion than you, and in some cases, they will cover all the cost of your rehab expenses if you’ve already met your deductible.
Out-of-network providers are those that have not contracted with your insurance carrier. Your out-of-pocket expenses are usually much higher, in some cases up to the full cost of care. If you decide to go with an out-of-network treatment provider, let them know this upfront. There may be a self-pay cost reduction available to you under those circumstances.
When seeking the right treatment provider, it’s important to understand your specific plan coverage so you know what your financial obligation will be. This will help you navigate what treatment centers are covered by your insurance plan so that you can make a well-informed decision.
Check Your Benefits
Insurance benefits are packaged to meet your health needs whenever and wherever you may need them. Most insurance plans require that you check your benefits first before accessing treatment. Exceptions usually apply in emergencies and most insurance providers waive this requirement in that situation; however, it must be a true emergency so be aware of your plan’s authorization process.
American Addiction Centers help people gain access to treatment and are here to help you right from the start. Our expertise in working with various insurance plans makes assisting you at this critical time one less thing to worry about.
American Addiction Centers has a large network of insurance plans we contract with. This enables us to verify your insurance coverage quickly so you don’t have to worry or deal with this on your own.6 We understand that seeking help for addiction is difficult and that getting you the help you need is urgent. We are committed to helping you through the process.
You can even check your health benefits now to see immediately if American Addiction Centers is in your network. If we’re not in-network, we will help you find a treatment center that is.
Don’t wait, call our helpline today at [phone] to speak with our admission navigators who can check your benefits while you’re on the phone, it only takes a few minutes.
Let’s verify your coverage for treatment at an American Addiction Centers location. Your information is always confidential.
- Blue Cross Blue Shield. (2021). Personalized healthcare, nationwide.
- US Department of Health and Human Services. (2018). Parity policy and implementation.
- The Change Companies. (2013). What’s new in ASAM criteria.
- Blue Cross Blue Shield. (2021). Substance use resource center.
- National Institute on Drug Abuse. (2018). What are the medical complications of chronic heroin use?
- American Addiction Centers. (2021).