If you or someone you love is looking for a rehab that accepts Blue Cross Blue Shield insurance, contact us today at (888) 995-6013 to have our team run a confidential, no-cost verification of your benefits, or click here to complete our insurance form. Get help today using your BCBS benefits.
If you or a loved one is battling mental and/or substance abuse issues, knowing when and where to get help can be difficult. Rest assured that you are not alone. Navigating the managed care system can be overwhelming and confusing. There are several levels of care to consider, including in-network and out-of-network providers and specific treatments.
Here is everything you need to know about Blue Cross Blue Shield rehab coverage for behavioral health services, the umbrella term for mental health and substance abuse treatment.
Mental Health Parity is a Federal law passed in 2008 so insurance companies can’t discriminate against members with mental health and substance abuse disorders. The rules were implemented in 2013, and this law is your biggest advocate for getting the mental health treatment you need.
The law states that group health plans with more than 50 members must provide the same care for mental health and substance abuse disorders as for physical medical conditions. For example, if your BCBS plan has unlimited outpatient visits for diabetes, it must also have unlimited outpatient visits for depression and/or drug or alcohol dependence.
Be aware that this does not mean that you get unlimited services at every level of care for behavioral health treatment. Individualized treatment plans differ for everyone, and what is covered depends on the specific language in your plan.
Each Blue Cross Blue Shield insurance plan has a unique language that states what a Florida treatment center will and will not cover on both the medical and behavioral health sides.
Again, with mental health parity, if something is covered medically, the equivalent must be covered for behavioral health. If there is a limit on medical coverage, there may also be a limit on behavioral health.
The best way to find out what is covered on your BCBS plan is to call our admission team and do the insurance verification process for you. We will be happy to help.
Network status can get a bit tricky to understand. Certain providers will contract with Blue Cross Blue Shield at specific, usually discounted rates. These are considered in-network providers.
This doesn’t mean that you can’t go to out-of-network or non-contracting providers. Depending on your plan’s specific language, you may be able to go to an out-of-network provider, but you may be balanced billed for what BCBS does not cover.
To navigate this, you will want to call the treatment provider to confirm the network status. There should be transparency on both ends of exactly what you will end up paying for your individualized treatment programs.
Behavioral Health includes mental health, substance abuse, and dual diagnosis (disorders of both mental health and substance abuse). There are inpatient rehab and outpatient treatment programs for each category.
For mental health treatment in Florida, the levels of care are inpatient psychiatric hospitalization, treatment at a residential treatment facility (RTC), partial hospitalization (PHP), intensive outpatient (IOP), and outpatient treatment.
In addition to traditional outpatient appointments like counseling and medication management, other therapies such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) can be done in an inpatient treatment center or outpatient rehab.
The levels of care for substance abuse are medical detox in a hospital setting, subacute detox in a residential care facility, residential alcohol or drug rehab, partial hospitalization (PHP), intensive outpatient (IOP), and outpatient treatment. Another treatment that may be utilized for substance abuse disorders is called medication-assisted treatment (MAT), which can be provided at any level of care.
Some treatment providers specialize in dual diagnosis treatment, and your health insurance may cover a combination of any of the levels of care for mental health disorders and addiction.
According to the Affordable Care Act, all care covered by Blue Cross Blue Shield and other insurances, whether medical or behavioral health, is based on medical necessity. Insurance companies use third-party objective medical necessity tools based on symptoms to determine medical necessity and level of care.
The treatment provider will also know the criteria for medical necessity at each level of care. For example, when you seek substance abuse treatment, you will usually be given an intake assessment to determine your appropriate level of care, which is what Blue Cross Blue Shield should cover.
Depending on your BCBS plan language, some levels of care may need to be pre-certified before starting treatment.
When possible, you should call customer care to see if you need pre-certification. Your treatment provider should also know this, and they are the ones who will obtain the pre-certification from Blue Cross Blue Shield.
The only exception is during a behavioral health emergency when someone is either suicidal, homicidal, actively psychotic, or having severe withdrawal symptoms from substances. In these cases, go straight to an inpatient facility or hospital, and your provider will sort it out for you.
Your Blue Cross Blue Shield plan should cover most medications if you are at an inpatient facility. Some medications may require pre-certification at outpatient levels of care, including PHP and IOP. This is something you should ask your provider about to check for you and pre-certify if necessary.
One thing to look for in a drug and alcohol rehab provider is that they have both a state license and national accreditation such as Joint Commission Certification (JCC) and Substance Abuse and Mental Health Services Administration (SAMHSA). You also want to know what insurances are accepted; both in-network and out-of-network.
In addition to traditional therapies such as cognitive behavioral therapy (CBT) and medication management, many providers offer experiential treatments such as equine-assisted therapy, accelerated resolution therapy (ART), EMDR therapy, and SoundPath Recovery.
For more information on our BCBS alcohol treatment options or our BCBS drug treatment options, contact Mending Fences at 888-995-6013. To know more about other insurances, we partner with, such as Cigna or Aetna, see our insurance page.
