/ Addiction Information / Insurance / Blue Cross Blue Shield

Some health insurance-specific verbiage is crucial to grasp to understand the various coverage options available through BCBS:

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Premium

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Policyholders make regular (mostly monthly) payments to keep their insurance plan active.

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Deductible

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To reduce your premium, health insurance plans often include a deductible you must meet before the insurance company pays any of the costs associated with your treatment. It is the yearly amount you are responsible for paying for medical treatment before your medical insurance kicks in.

Preferred Provider Organization (PPO) vs. Health Maintenance Organization (HMO)

You may only use coverage under an HMO plan at affiliated service providers. It is common practice for a person to choose a primary care physician to act as their primary care provider. Unless it's an absolute need, services rendered outside the plan are not covered. Most HMO plans have larger deductibles but cheaper monthly premiums.

PPO plans allow you the freedom to see any doctor, not just those in the insurer's network. You are free to seek treatment from any doctor, facility, or specialist clinic. Premiums for PPO plans are much more costly than those for HMO plans, but the deductibles for PPO policies are often substantially lower.

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Out-of-Pocket Cost

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Out-of-pocket expenditures are any medical expenses incurred by a policyholder not covered by their insurance plan and for which the policyholder is personally responsible.

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Out-of-Pocket Maximum

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A policyholder must shoulder the maximum annual out-of-pocket expense before an insurance provider begins making payments.

What Will BCBS Cover?

Blue Cross Blue Shield Insurance might pay for all or a large chunk of your drug treatment expenses, depending on your policy. The rehabilitation care levels that your plan may cover include the following:

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Inpatient Treatment Programs

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Participating in an inpatient rehab program entails living at the institution full-time for weeks or months. You will work through feelings, establish healthy routines, and get used to a life without drugs or alcohol. This may be viable if you need medical attention all day and night.

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Outpatient Programs

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Outpatient programs are a good option if you need to maintain other responsibilities, such as those at home, work, or school, while receiving treatment. You may continue living at home while committing several hours each week to therapy. Outpatient programs are often a transitional step for patients after completing inpatient care.

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Intensive Outpatient Programs (IOPs)

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Intensive outpatient programs are designed for people who can live at home but need more support than a standard outpatient program. Since an IOP takes place during the day, you may spend your nights at home after each session.

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Partial Hospitalization Programs (PHPs)

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Patients who need full-time medical attention during the day but can go home at night may be good candidates for partial hospitalization programs. Generally, you'll have to come in for therapy up to at least five days per week, and each session will last for several hours.

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Aftercare

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The improvements you've made throughout therapy have a better chance of sticking around with the aid of aftercare services. You will get the necessary assistance to continue your new lifestyle and behaviors free of alcohol and other addictive substances.

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Treatment Facilitated by Medication (MAT)

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Medication-assisted therapy (MAT) combines traditional behavioral treatments with FDA-approved medications to treat substance use disorders from a more "whole-patient" perspective.