About the Blue Cross and Blue Shield Association
Nationwide, the Blue Cross and Blue Shield Association has 36 companies that provide health insurance, and all of them comprise the Blue System.
These 36 companies cover around 105 million Americans with health insurance and work in all 50 states. Blue Cross and Blue Shield are commonly known and referred to as The Blues. As part of the Federal Employee Program, more than half of all federal employees are enrolled in their network.
What are the Levels of BCBS Coverage?
Mainly, the BCBS companies provide two primary types of health insurance that are coverage by: PPOs and HMOs. An HMO organization asks its members to stay “in network” and receive care from in-network care providers. Those providers have contracts with BCBS and provide their services for discounted rates. If you have an HMO plan, then you’ll need to use in-network providers if you want the services you use to be covered by your insurance. For specialty services, individuals typically need to be referred by their primary care provider (PCP).
A preferred provider organization, or PPO is more flexible than an HMO plan, as it allows for the members to look for “out of network”care. Although this may be a big plus, these services are usually covered at lower percentages. What this means it that even though someone with a PPO plan can look for medical care and treatment services through different health care providers that are not necessarily in network, they will likely be required to pay more for those services. If you’re using a PPO plan, you may not need to have a referral from your PCP in order to look for mental health services or specialty medical services.
What are your other options?
Another option is for you to have a HSA, or health savings account, which allows members to place money in it and use it to pay for their healthcare services. This is a very flexible tax-free spending account.
BCBS insurance plans also have “metal tiers” in addition to HMO, PPO, and HSA. The tiers that are offered can vary from one state to another, but generally, you have three or four options, like: Bronze, Silver, Gold, and Platinum.
What’s copay, and how does it work?
One other out-of-pocket expense that you might be required to provide is copay. A copay is what you pay when you receive your healthcare services. These amounts are usually required for emergency department services rather than visits to your primary care provider. Copays are set by your insurance provider and can differwhen it comes to specialty services. A copay is what’s usually collected each time an insurance member uses some services and is used toward deductibles orconsidered as a part of the annual maximums.
Your Treatment and Rehab Options with BCBS
Drug and alcohol addiction problems are classified as both mental and physical health diseases. There are many different options for treatment that are available to those that seek help and want to start their road to recovery and sobriety. Here are your different options:
1. Psychiatric help, which helps patients by going through individual counseling sessions. Psychiatrists can also give their patients medication to help their recovery process.
2. Licensed clinical social work, which helps patients by providing group substance abuse treatments, including personal and family therapy.
3. Psychological help, which covers individual, family, and group therapy. They can sometimes provide neuropsychological tests for patient.
If a patient is deemed to need intensive treatment in order to beat their addition, here’s what’s covered and available through BCBS:
1. Out-patient rehab facilities.
2. Intensive out-patient rehab.
3. In-patient detox.
4. In-patient rehab facilities.
Not all BCBS policies cover all of the four forms of treatment, or all of the three psychological assistance that we mentioned above. There are some copays involved when it comes to in-network providers. If you want to use a provider that’s out of the network, you will be required to pay a deductible as well.
How do BCBS Policies Work in different states?
Blue Cross Blue Shield is accepted by most addiction treatment centers, at least on some level. Your coverage would vary a lot though, from one state to another. It is not uncommon for a person that has a policy in one state to have all claims approved in that state, and denied in a neighboring state.
Does BCBS Cover Detox Services?
BCBS has a lot of providers with many different policies in states across the country. There are a lot of government employees that have insurance policies under its Federal Employee Program, which covers in-patient visits by a professional and can also include detox. During this phase, your brain will adjust to the lack of drugs or alcohol in your body. Withdrawal symptoms can include irritability and a feeling of sickness in your stomach, although those symptoms should go away within a couple of days.
Is Rehab Covered?
BCBS providers can cover rehab, although it all depends on the policy that you have. The Federal Employee Program covers individual therapy and group sessions that you can go to while you’re on outpatient rehab, but you do have required copay. They can also ask you to obtain precertification before you seek residential treatment.
What are your Blue Cross Blue Shield Benefits?
Here’s a list of some of the other benefits you have when you’re a BCBS policyholder and you need the help of Addiction Treatment Services:
- We’ll go through and review your BCBS insurance plan.
- We’ll help you determine whether your plan covers your drug or alcohol addiction treatment.
- We’ll help you determine which treatment would be best for you and how much of it is covered by your insurance policy.
Almost all treatment centers in the U.S. accept Blue Cross Blue Shield health, so what we’ll need to do is find the ones that will work best for you.
We are aware that the specifics of your coverage can sometimes be confusing to you, and that’s why we are here to help you and make it easier for you to understand.
Understanding your options is the most important part both for your long-term health goals and your sobriety.