Addiction Treatment

Mental Health Treatment

Blue Cross Blue Shield Coverage for Mental Health & Addiction Treatment

Blue Cross Blue Shield (BCBS) members may have access to coverage for drug rehab, alcohol rehab, mental health treatment, and recovery services. While coverage is not guaranteed, it is a good practice to check on the coverage policy before a member seeks recovery treatment.

What BCBS members should know

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Verify Insurance Benefits

Does Blue Cross Blue Shield Cover Drug & Alcohol Rehab?

Plans offered by Blue Cross Blue Shield organizations generally cover behavioral and substance abuse treatment as part of the benefits they cover for their subscribers. This is so because the Affordable Care Act recognizes behavioral and substance abuse treatment as essential health benefits.

The coverage of BCBS insurance plans for drug and alcohol addiction varies based on whether the rehab facility is in-network or out-of-network, which type of BCBS insurance provider, and the type of care that is required. It is possible they will require prior authorization or proof of medical necessity to get coverage for treatments like inpatient rehab and detox.

Since BCBS runs through regional Blue Cross and Blue Shield Association providers, some benefit variations are present between states, employer-sponsored plans, medicare, and the Federal Employee Program.

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What Addiction Treatment Services May Be Covered by Blue Cross Blue Shield?

Insurance coverage under Blue Cross Blue Shield plans may include several services that are necessitated by addiction.

Medical Detox

Medical detox is most times the first phase of treatment for those struggling with substance abuse dependency. BCBS plans may cover detox services provided by medical professionals who deem the detoxification process medically necessary. The process typically requires prior authorization.

Inpatient / Residential Rehab

Inpatient treatment services are available 24/7. It treats both substance and co-occurring mental health disorders. The coverage of residential treatment by BCBS is mainly dependent on the level of severity, history of treatment, and authorization.

Partial Hospitalization Programs (PHP)

PHPs provide intensive care during the day while allowing provincial clients to go home at night. Some BCBS plans include partial hospitalization programs as a step-down from inpatient services.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs provide therapy several days a week within a highly structured environment and may be included if inpatient care is not considered necessary.

Telehealth Intensive Outpatient Programs (IOP)

Some Blue Cross Blue Shield plans may have coverage for telehealth IOP services when medically necessary. Virtual IOP offers a structured treatment approach to addiction and mental health treatment services through secure online sessions. Banyan Treatment Center can help verify your benefits and determine your eligibility for our telehealth services.

Standard Outpatient Treatment

Outpatient treatment programs include scheduling therapy sessions and continuing recovery. BCBS can sometimes pay for outpatient rehab treatment under a substance abuse plan.

Aftercare/ Continuing Care

Aftercare services such as relapse prevention and support for a recovery program may also be included depending on individual insurance plans.

Note: Length of stay and level of care are typically determined by medical necessity and clinical evaluations.

Does Blue Cross Blue Shield Cover Mental Health Treatment & Therapy?

The insurance plan provided by Blue Cross Blue Shield typically includes coverage for mental health services, which is sometimes a part of addiction rehabilitation.

Coverage may include:

Individual therapy and counseling
Group and family therapy
Co-occurring disorder treatment
Ongoing mental health support

BCBS plans may cover psychiatry and medication management, which include evaluation, prescription medication, and monitoring when appropriate.

Inpatient Mental Health Coverage

Many insurance plans offered through BCBS have inpatient mental health services with coverage, which might include residential treatment for serious mental health issues or co-occurring disorders. Authorizations are required, as necessity conditions must also apply.

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How Much Does Rehab Cost With Blue Cross Blue Shield?

The cost of rehab with Blue Cross Blue Shield will depend upon the coverage details. While BCBS provides coverage for a significant cost of treatment of addiction, the amount that has to be paid out of pocket also varies accordingly.

Factors That Affect Your Out-of-Pocket Cost

In-network vs. out-of-network providers
Deductibles, coinsurance, and copays
Prior authorization and medical necessity review
Level of care (medical detox, inpatient treatment, outpatient treatment)
Location, state regulations, and plan type (PPO, HMO, EPO, Gold or Silver plans)

What You Can Do Right Now

Banyan Treatment Center is capable of determining your BCBS insurance benefits and explaining them to you before you check in. In addition to this, if possible, Banyan's admission staff members will provide you with an estimate of the total cost based on your insurance plan.

Questions? Get help now

If You Call Blue Cross Blue Shield Directly, Ask:

Is medical detox covered?
Are inpatient or residential programs covered under my plan?
Is PHP or intensive outpatient programs covered?
Do I need prior authorization?
Do I need a Referral (HMO plans)?
Is this facility in-network?
What are my deductibles, coinsurance, and copays?
Are there any restrictions on days, sessions, or visits?

Or, We Can Verify for You (Recommended)

We contact your insurance provider directly
We review coverage details and medical necessity requirements
We explain the benefits clearly and confidentially

How to Find Treatment That Accepts Blue Cross Blue Shield

"Accepting" Blue Cross Blue Shield could also mean the facility is "in-network" or they may offer "out-of-network" options depending on the insurance plan they offer. BCBS plans may also offer coverage for Blue Distinction Centers for people to receive specialized care in these recognized areas, but again, coverage may vary for each plan.

Getting Matched to the Right Level of Care

A clinical assessment will help to determine the best method of treatment and facility of recovery depending on your usage, mental condition, and insurance coverage.

Next Steps: Ensure your BCBS coverage or speak to an addiction specialist by calling our admissions team today.

Questions? Get help now

Frequently Asked Questions

1Does Blue Cross Blue Shield cover mental health treatment?

Many Blue Cross Blue Shield plans provide mental health treatment benefits as part of their health insurance plans. This can include individual or group therapy, psychiatric services, and treatment of other mental health conditions. The level of benefits depends on the plan, location, and medical necessity, and prior authorizations may be necessary for services, including inpatient mental health treatment.

2Does Blue Cross Blue Shield cover alcohol rehab and detox?

In most cases, alcohol rehabilitation and medical detox at a rehabilitation facility can be covered by Blue Cross and Blue Shield insurance policies, provided that it is deemed to be medically necessary. The level and type of cover will depend on individual insurance policies and needs, and this will include inpatient rehabilitation, residential care, and outpatient care.

3Does Blue Cross Blue Shield cover methadone treatment?

While some BCBS plans cover medication-assisted treatment, including methadone, when clinically appropriate and authorized.

4Does BCBS cover Vivitrol?

Vivitrol and other prescription medications that are used in the course of rehabilitation from addictions may also qualify for insurance.

5Which Banyan rehabs accept Blue Cross Blue Shield?

Based on available provider information, Blue Cross Blue Shield coverage may include the following Banyan Treatment Center locations. Coverage varies by plan and state, and insurance verification is required to confirm benefits

Banyan Boca
1000 NW 15th Street
Boca Raton, FL 33486
888-422-1651
Clearbrook Pennsylvania
1100 E Northampton St
Laurel Run, PA 18706
570-405-9934
Banyan Philadelphia
100 N Buckstown Dr, Suite 100E
Langhorne, PA 19047
888-219-0442
Clearbrook Massachusetts
83 Hospital Road
Baldwinville, MA 01436
978-307-6964
Banyan Delaware
21 W Clarke Ave, #4001
Milford, DE 19963
888-900-9681
Banyan Palm Springs
67580 Jones Road
Cathedral City, CA 92234
760-642-1112
Banyan Texas
4168 Co Road 444
Waelder, TX 78959
844-611-5705

Coverage varies by Blue Cross Blue Shield plan and state. Insurance verification is required to confirm eligibility and benefits.

Verify Your Blue Cross Blue Shield Coverage for Treatment

Coverage details vary by insurance carrier, plan type, and location. Banyan Treatment Center is available to help you understand your BCBS insurance benefits and explore treatment options.

Questions? Get help now