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BCBS – Washington

One of the first questions many people have when they’re considering substance abuse, mental health, or behavioral health treatment is whether or not their insurance company will entirely or partially cover the cost. Blue Cross Blue Shield (BCBS) is accepted in all 50 states and covers more than 100 million Americans. BCBS is made up of more than 35 independent and locally operated agencies, and more than 96 percent of hospitals and 92 percent of healthcare providers work directly with a BCBS agency. Blue Cross Blue Shield is accepted, at least on some level, by most addiction treatment centers, although coverage can vary widely from state to state.

The Mental Health Parity Act stops discrimination so that mental health treatment and substance abuse/addiction treatments are considered equal to treatment for medical health issues. In the past, insurers could place higher co-pay prices on mental health services and employers could limit the number of days their employees were hospitalized and/or attending outpatient services. These historical moves have made it much easier to obtain care. Lower prices and better cooperation within the workplace can help clients get the help they need sooner.

Oftentimes only a portion of detox, addiction treatment, or mental health treatment will be covered by your insurance. It’s important to speak with your insurance company to determine your exact level of coverage and to understand what that translates to in terms of the amount you will pay out of pocket.

Let’s get started with some common terms and definitions:

Copayment: a fixed dollar amount you are required to pay for covered services at the time you receive care.

Deductible: a fixed amount of the eligible expenses you are required to pay before reimbursement by your health plan begins.

In-network: services provided by a physician or other health care provider with a contractual agreement with the insurance company and paid at a higher benefit level.

Out-of-network: services provided by doctors and hospitals who have not contracted with your health plan.

Out-of-pocket maximum: also called OOPM, this is the most you have to pay out of your own pocket for expenses under your insurance plan during the year. Deductibles, coinsurance, copays and other expenses for in-network essential health benefits (EHBs) apply to the OOPM.

Preauthorization: the process by which members or their primary care physicians (PCP) notify the health plan in advance of treatment plans, such as a hospital admission or a complex diagnostic test. Also called pre-notification.

Premium: the ongoing amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. The premium may not be the only amount you pay for insurance coverage. Typically, you will also have a copayment or deductible amount in addition to your premium.

CareFirst Blue Cross Blue Shield offers several types of insurance plans for those who need substance abuse treatment. Plans are categorized as bronze, gold, or platinum. Bronze plans offer the lowest monthly premiums but usually have higher deductibles and out-of-pocket expenses. Platinum plans come with the highest monthly premiums but often do not have deductible requirements, which means the lowest costs for medications and medical services.

In-Network Vs. Out-Of-Network Insurance Coverage

CareFirst offers insurance coverage for services provided at addiction treatment centers that are in-network. In-network providers have a pricing agreement with CareFirst, and insured individuals can enjoy the lowest out-of-pocket expenses when they choose an in-network provider. When an out-of-network provider is chosen, individuals may be responsible for up to 100 percent of the cost of service.

Bronze Health Insurance Plan

Drug And Alcohol Detox Coverage

The CareFirst BlueChoice HMO HSA Standard Bronze health insurance plan covers drug and alcohol detox, including both inpatient and outpatient detox services. Once the deductible is met, expect to pay 20 percent coinsurance for all services.

Inpatient Drug And Alcohol Rehab Coverage

Inpatient rehab for drug and alcohol addiction is covered for in-network providers. Expect to pay 20 percent in coinsurance once the deductible has been met for rehabilitation services, including drug and alcohol detox, counseling, behavioral therapy, and relapse prevention.

Outpatient Drug And Alcohol Rehab Coverage

Outpatient rehabilitation for drug and alcohol addiction is covered for in-network providers. After the deductible has been reached, individuals seeking recovery from a substance use disorder can expect to pay 20 percent for individual and group counseling and therapeutic services.

Gold Health Insurance Plan

Drug And Alcohol Detoxification

The CareFirst BlueChoice HMO HSA Gold health insurance plan covers drug and alcohol detox after the $1,500 deductible is met. For inpatient services, individuals with substance use disorder can expect to pay a flat rate of $600 per day for their treatment. When an outpatient program is utilized, individuals will be responsible for paying $25 per office visit.

Inpatient Drug And Alcohol Programs

The CareFirst BlueChoice HMO HSA Gold insurance plan charges a flat rate of $600 per day after the deductible has been met.

Outpatient Drug And Alcohol Programs

The CareFirst BlueChoice HMO HSA Gold health insurance plan charges a $25 copay per visit for outpatient drug and alcohol rehabilitation services.

Premium Health Insurance Plan

Drug And Alcohol Detoxification

The CareFirst BlueChoice HMO Standard Platinum health insurance plan covers inpatient and outpatient addiction treatment services as well as mental health services. There is no deductible associated with the plan. However, individuals are expected to pay a copay amount for each service.

Inpatient Drug And Alcohol Programs

Inpatient rehabilitation services for drug and alcohol dependency and mental health are covered under the CareFirst BlueChoice HMO Standard Platinum insurance plan. There is no deductible requirement for inpatient services, including detox, counseling, and therapy. However, individuals are responsible for a copay of $250 per day for the duration of treatment.

Outpatient Drug And Alcohol Programs

Outpatient rehabilitation services for addiction are covered by the CareFirst BlueChoice HMO Standard Platinum insurance plan. The individual is responsible for paying $20 per office visit for individual and group counseling and therapy.

Sober Living Homes

Continuing treatment at a sober living home may be covered by the CareFirst BlueChoice HMO Standard Platinum health insurance plan for individuals who are at an increased risk of experiencing a relapse while they adjust to life in sobriety. However, specific coverage amounts and copays should be discussed with CareFirst as well as the sober living home.

Is Mental Health Care Covered by CareFirst?

If you have an HMO or a POS (Point of Service: a hybrid of HMO and PPO) plan, you will receive in-network coverage for mental health and substance abuse office visits only when you see a doctor affiliated with the network. Out-of-network coverage is available with POS plans. If you have a PPO plan, make sure the mental health provider you want to see is part of our PPO network.

Every insurance plan is different, so the amount your insurer is willing to cover will vary depending on your provider. There may be a limit on how much is covered, and certain therapies may be excluded. We will verify your insurance at no cost, and are happy to discuss your payment needs with you.