In 2020, around 91.4% of Americans had health insurance. Medical insurance is an excellent tool to cut health expenses and help you receive quality care.
A gray area for many individuals is whether their insurance provider covers addiction treatment. With recent changes from the Affordable Care Act, you may be surprised to find that many providers, like Blue Cross Blue Shield, offer coverage.
However, the next big hurdle is finding an in-network facility. Luckily, we have simplified the process for you. At Northstar Recovery Center, we understand how important it is for you to afford quality treatment when starting your road to recovery.
In our complete guide, we will review our recent changes with Blue Cross Blue Shield and how you can attend Northstar Recovery Center today. Keep reading on for more information!
Blue Cross Blue Shield Insurance Provider
Blue Cross Blue Shield (BCBS) is an umbrella term defining 36 independent insurance providers. Some advantages of BCBS are:
- Nationwide coverage
- Extensive physician network
- Various insurance options
Approximately one-third of Americans have a BCBS plan. They have contracts with about 90% of physicians and medical facilities.
Since they have several Medicare insurance plans, they are a well-known Medicare Advantage provider. Around 30% of the top-ranked Medicare Advantage plans fell under BCBS.
On the downside, BCBS’ plans vary by state and region. Your costs and coverage may differ significantly, and it is important you review your plan options and costs beforehand.
How Does BCBS Rank?
BCBS Medicare-Advantage plan rankings can give you a general idea of how BCBS fares. Medicare rankings for BCBS is 4.1, with several areas that scored at a 4.5 or higher. Some of the highest positive BCBS reviews were:
- Care for older adults
- Timely appeal decisions
- Reviewing appeals
- Reviewing complaints
Additionally, AM has ranked it as an A- in terms of financial strength. Ultimately, it can provide comprehensive coverage in several states without sacrificing affordability.
Does Insurance Cover Drug and Alcohol Rehab?
Before the Affordable Care Act (ACA), many Americans did not have treatment coverage for substance use disorders. In 2014, these changes were implemented, boosting insurance coverage from 77% the year previous to 100%.
By 2017, all group commercial insurance plans were grandfathered in. With this new coverage, the ACA aims to provide coverage for:
- Substance use
- Mental health
However, the extent of coverage can still vary amongst providers. Some of the general services and treatments covered by insurance are:
- Screening
- Medical interventions (e.g., inpatient and outpatient care)
- Detox
- Medical treatments
- Behavioral health care
Since ACA requires coverage for mental health illnesses, treating co-occurring disorders is also covered. Services that are not usually covered include:
- Holistic/alternative treatments
- Recreation programs
- Private treatments
- Additional non-medical amenities
You should also follow up with your BCBS plan regarding coverage for medication-assisted treatment, peer support, preventative counseling, and treatments. In-between plans like partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) can fluctuate on coverage.
What Is In Network Insurance?
Substance use disorder programs include various in-network providers. Essentially, this means that treatments offered at a facility are covered to an extent. The primary difference between choosing an in-network facility versus an out-of-network is discounted rates.
For example, if BCBS has contracted with a facility, they have both agreed to outlined rates. In some instances, you might not see any expenses on your hand. However, if you choose an out-of-network facility, you will assume the cost differences since there is no contract in place.
However, the specific contract, treatments, and individual plans will vary in their coverage. In-network insurance providers will typically cover substance use disorder treatment with two criteria:
- The facility is Medicare-approved
- It is medically necessary
Under Medicare, inpatient rehabilitation is covered by Medicare Part A. Outpatient treatments are under Medicare Part B guidelines.
Since coverage, deductibles, and out-of-pocket expenses can vary, it is essential you talk to an admissions specialist. They can review your specific insurance plan and help you determine expenses.
How To Find a BCBS In-Network Rehab
One of the quickest ways to find a BCBS in-network rehab is to contact the facility you have an interest in. Sometimes, rehab facilities offer online insurance verification forms online. These are easy to fill out and help you find insurance eligibility.
Another avenue is contacting your insurance provider or agent. By visiting the BCBS website, you may be able to pull up information on your health coverage and search for in-network providers and facilities.
Medically Necessary Coverage
Since BCBS is so expansive, there are several physicians and offices that have contracts with them. This makes the process easier to contact and schedule an appointment with your in-network primary care physician. Before attending an inpatient or outpatient rehab, you must have physician approval.
Essentially, Medicare and other insurance providers will only cover treatment and interventions if “medically necessary.” The term medically necessary is when a doctor determines that your substance use disorder requires expert medical care for your health. They can also help you locate and start the process of entering a drug and alcohol addiction center.
Addiction Treatment in MA
Northstar Recovery Center has partnered with BCBS to offer in-network coverage. What does this mean for you or a loved one? First, you can rest assured that if you have BCBS, you can access high-quality addiction treatment at Northstar Recovery.
Second, you have options for attending flexible treatment programs. Northstar Recovery focuses on two primary rehabilitation programs:
Additionally, in these programs, you work with qualified healthcare professionals. They help facilitate evidence-based practices and treatments that help your sobriety journey.
Partial Hospitalization Guide
What is partial hospitalization, and how does it differ from inpatient programs? A PHP is a step down from an inpatient center and does not require overnight stays. One of the big challenges with insurance coverage is finding providers that will cover flexible programs.
BCBS and Northstar Recovery Center work hand-in-hand to offer intense addiction recovery therapy without being away from your family for weeks or months. There are two reasons you may choose a PHP:
- You did not qualify for inpatient rehab
- You require less-intense rehabilitation
Typically, PHP is ideal for individuals who have already completed the detox process. At this point, if you are not in danger of harming yourself or others, you could qualify for a PHP.
Daily time commitments are approximately six hours. You will attend a PHP five days a week in a safe environment. When you start your sobriety journey, it can seem scary to dive back into the real world.
PHP offers a great balance between rehabilitation and building life skills. You will also access mental health professionals. They can help with co-occurring disorders, such as substance use disorder and depression or anxiety.
Other treatments offered in a PHP are individual and group therapy. Peer supports groups are established and can be a lifeline for you down the road.
Intensive Outpatient Program Guide
An IOP is a step down from a PHP. It offers less intense and time-consuming therapy. When is an IOP appropriate?
- You are not at high risk of relapse
- You are not at risk of harming yourself or others
- You want to transition from an inpatient program or PHP
- You have a less severe substance use disorder
Substance use disorders follow a ranking of mild to severe. Mild diagnoses may not require a detox or inpatient program. However, it is still likely in the best interest of the person to attend therapy and seek professional help.
Rather than visiting an outpatient center once or twice a week, an IOP is slightly more intensive. It allows people to hold part-time or full-time jobs and does not require 24/7 overnight stays. IOPs usually have longer durations than other outpatient programs.
This helps clients develop coping skills and peer support groups to help long-term success. Additionally, IOPs have a higher retention rate than traditional outpatient programs. Clients are usually more invested and have greater time commitments, which leads to better outcomes.
Although it requires more accountability than other outpatient programs, it is more cost-friendly and opportunistic than inpatient rehab. At Northstar Recovery, an IOP requires three to five days of therapy weekly for up to five hours. Like PHPs, you will participate in individual and group therapy, including support groups.
Is a Virtual IOP or PHP Covered by BCBS?
Virtual healthcare services are increasing in popularity and insurance coverage. Since the COVID-19 pandemic, telehealth services have been critical in helping people safely receive medical guidance.
Addiction recovery centers were no exception. As of October 2021, approximately 42 states required insurance providers to reimburse telemedicine. Many private and federal insurances will offer some telehealth coverage.
Since Northstar Recovery has a contract with BCBS as an in-network provider, you can ask about your comprehensive virtual IOP coverage. As the name sounds, a virtual IOP or PHP allows you to attend rehab from home.
The time commitments and therapies are the same. You may lose some of the personal in-person connections, but you gain greater flexibility. Here are some of the key components of virtual IOPs and PHPs, such as:
- Group meetings
- Individual and group counseling
- Evidence-based practices (e.g., cognitive-behavioral therapy and dialectical behavioral therapy)
- Mental health counseling
- Support groups
- Holistic advice
Virtual centers are useful for individuals who are not a high safety risk. Yet, they may need additional support to withdraw and remain off drugs or alcohol.
Do You Need Addiction Treatment?
Substance use disorders are mental health conditions that require professional guidance in many situations. When drugs or alcohol are misused, your brain starts rewiring its reward centers. Over time, the brain relies on these external sources for chemical releases, creating a higher dependence on substances and greater difficulties in withdrawing.
It is not simply a means of quitting. It takes months to years of hard work to achieve sobriety. Afterward, it is an ongoing battle for many Americans, but the reward is worth it!
Addiction treatment also helps with relapses, which are highly prevalent during recovery. In fact, as many as 50% of individuals suffering from a substance use disorder experience relapses. While this isn’t a sign of failure, having reliable resources on hand can reduce the risks of relapse.
This may require starting therapy again or switching to a different program. It might also be part of the process, and your therapist or healthcare professional can give you the tools to get back on your feet. Lastly, addiction treatment centers are helpful.
People who seek addiction recovery at a younger age have a better chance of success. Yet, one of the most significant statistic is that approximately three-quarters of individuals with a substance use disorder recover. The key is attending or seeking recovery help.
For example, in this study, the researchers also found that it took more than one attempt. The average number of attempts was around five. Maintaining a positive attitude and following counseling can make a tremendous difference in your recovery and quality of life.
Eighty percent of people who recovered from a substance use disorder had one major life accomplishment. This shows the good that people can continue pursuing after attending a drug and alcohol treatment center.
Start Getting Help Today
Blue Cross Blue Shield is a prevalent insurance provider. It covers many states, providers, and hospitals. Coverage for substance use disorders has also expanded significantly in the past decade.
If you or a loved one is dealing with a substance use disorder, you may need qualified professional help. Northstar Recovery Center specializes in flexible treatment programs that fit your lifestyle and needs.
We have also partnered with BCBS, and they are now an in-network provider. Are you ready to get started? Fill out our insurance verification form today!
Day Treatment Program in MA
The Day Treatment in Massachusetts, also referred to as PHP (Partial Hospitalization Program) or IOP (Intensive Outpatient Program), is the highest level of care offered at Northstar Recovery Center. This addiction treatment option encompasses comprehensive clinical care and behavioral therapies. In the initial stages of recovery from addiction, it's crucial to have robust support to navigate both physical and emotional challenges. Our dedicated team at Northstar Recovery Center, located in Southborough, MA, and West Springfield, MA, is committed to assisting you in establishing a solid foundation for a lifelong recovery from addiction to drugs and alcohol. Clients typically visit our addiction treatment center in Massachusetts each weekday for several hours, engaging in counseling sessions and other necessary interventions. This approach ensures a balanced and effective recovery process, tailored to individual needs within the framework of Day Treatment.
Individual, Group, and Family Counseling in Massachusetts
Addiction thrives in isolation, which is why group counseling sessions are a foundational part of our addiction treatment plans. In group sessions, you’ll gain perspective on your struggles with substance abuse and can connect with others who understand your experiences. Family counseling can help your loved ones understand the disease of addiction, navigate conflict and build healthier relationships. In individual counseling sessions, you’ll be able to work through personal issues like past trauma with the help of an experienced therapist.