Blue Cross Blue Shield

Blue Cross Blue Shield Insurance Coverage for Drug and Alcohol Rehabilitation

Navigating the benefits of your BlueCross BlueShield insurance can be a little tricky. If you’re not familiar with all the terminology, you may find yourself even more lost. Here at Amethyst, we assure you that this process can be much smoother than you think. Our priority is to make the journey to recovery a fulfilling and smooth process. Keep reading to learn more about how we can help you go through your BlueCross BlueShield coverage. Let’s get you the treatment you need.

Does Your Policy Cover Rehab?

Trying to understand your BlueCross BlueShield policy and the cost of substance abuse treatment for you or a loved one can be a little overwhelming. Although it may seem complex at first, we’re here to make it as straightforward as possible for you. Fortunately, we have a team of specialists ready to walk you through every step of the way.

Our priority is to make sure you get the help you need and deserve. 

BlueCross BlueShield Insurance for Drug and Alcohol Treatment

BCBS insurance companies are sprawled all across the nation, providing insurance to nearly 105 million individuals and families. In other words, they cover almost one in every three people! Typical BCBS coverage includes taking care of some of the costs connected with the following levels of care:

  • Inpatient Hospitalization 
  • Residential Detox or Non-Medical Detox
  • Residential Treatment
  • Partial Hospitalization Treatment
  • Intensive Outpatient or Outpatient Treatment

Policy Coverage for Substance Abuse with BlueCross BlueShield Insurance

BlueCross BlueShield offers a variety of different plans depending on your location. Generally, it falls into either Bronze, Silver, Gold, or Platinum levels. The Bronze Plan is the lowest in coverage and has the lowest monthly premium and highest deductibles. The higher-level plans, like Platinum or Gold, are more costly, but they offer more inclusive coverage with lower deductibles.

If the policy is a Federal Employee Program policy, it generally holds two plan options. This includes the basic option or the standard option. The basic Federal employee plan option requires individuals to use providers within a preferred network. Continuing on, the standard plan allows its members to choose between preferred and non-preferred providers (also known as PPO). Policyholders may be held accountable for the difference in cost between the plan allowance and the billed amount by the provider if an out-of-network or non-preferred provider was used.

BS Policies Work for Addiction Treatment Centers

The majority of drug and alcohol treatment centers will accept BlueCross BlueShield insurance. Although, there are differences in policy rules within each state. For example, sometimes someone will have all their claims approved in one state and, in the neighboring state, have all of their claims rejected. 

In rare cases, we have seen really strong conditions on a policy. For example, such as no substance abuse or mental health benefits at all.

Due to the complex details of Blue Cross Blue Shield insurance coverage from state to state, we make sure we find you the highest level of care at the lowest cost possible. 

Furthermore, contacting BCBS directly may not guarantee the best options for you, as we base most of our referrals on the past experiences of actual clients who have gotten their alcohol and drug rehab treatment programs taken care of by insurance.

BlueCross BlueShield Covers Inpatient Treatment

To reiterate, a BlueCross BlueShield policy for inpatient drug treatment varies from state to state. Coverage is dependent upon each state’s specific laws and regulations.

It is also dependent upon the state and facility where the member receives care and treatment services. For example, coverage for an individual who receives treatment at a hospital may vary from coverage for a member who receives treatment at a residential (inpatient) addiction rehabilitation center. Also, the service given by a physician’s office will cover different amounts than a service provided at a hospital or treatment facility.

BlueCross BlueShield may also require precertification for those who are planning to enroll in an inpatient hospital or center for substance abuse treatment and services.

If your insurance policy takes care of addiction treatment, it will do so regardless of the type of substance abuse issues. In other words, your policy has you covered whether you’re struggling with an alcohol abuse issue or an opiate addiction.

Costs and Services at Inpatient Rehab

Inpatient programs provide the highest level of treatment care, with medically supervised detoxification and 24/7 supervision. Below are some of the typical terms used when becoming familiar with your health plan coverage:


A premium is a payment made monthly to a health insurance company by the policyholder to maintain coverage. In the majority of cases, patients are fortunate enough to have employer-provided insurance. That means that the company picks up all or part of the monthly premium cost.

Out-of-Pocket Maximum

This is the maximum amount of money you are obligated to pay for covered services within a  plan year. Once your out-of-pocket maximum amount is spent on deductibles, copayments and/or coinsurance fees, your health care plan will take cover 100 percent of any added costs of covered health care services.

Policy Effective Date

This is the day your insurance company starts to help you take care of your health care costs. Open enrollment period is typically a set amount of time that occurs once a year, or during a special enrollment period. Your policy effective date is agreed upon after you’ve enrolled, and generally takes place a few weeks or months after the date of your official enrollment. 


This is the amount you pay for covered health care services in a given plan year prior to when your insurance will start to pay for them. Let’s say you have a  $2,000 deductible. In this case, you pay the first $2,000 of covered services yourself. After you pay your deductible, your provider will typically pay for the remaining costs.


A copayment is a fixed amount you are required to pay for a covered health care service, such as a doctor’s office visit. Copayments take will take place either before or after your deductible is paid, which is reliant upon your health insurance plan. This information is not shown on our health insurance verification form.

Below are cost estimates for Inpatient Rehab with generally used plans with BlueCross BlueShield:

  • Bronze Plan – Holds the minimum deductible amount for in-network providers. Out-of-network Providers are generally not covered.
  • Silver Plan – Usually, a coinsurance percentage in addition to the deductible for in-network. Out-of-network is typically not covered.
  • Gold Plan – Theses plans call for a coinsurance percentage (generally this is a lesser amount than that of the lower level plans), as well as a deductible. Out-of-Network providers are also not covered.
  • Platinum Plans – Any in-network provider services will have one or the other- copay per day (with a maximum daily amount) or coinsurance percentage. There are instances that out-of-network services are covered. If out-of-network is covered, it will include a higher coinsurance percentage as well as the deductible.

BCBS Coverage for Mental Health Treatment

BlueCross BlueShield will also support you in the cost of care if you have a mental health condition. Behavioral and mental health disorders typically co-occur with addiction problems, which we call a dual diagnosis. In these cases, addiction and mental health care go hand in hand to help our patients with this challenge. 

Having said that, finding care for co-occurring disorders can be a little hard at times. However, it’s best to know which options are available and how your BCBS insurance policy can help you to get you the resources you need.  Insurance plans are expected to offer equal coverage for mental health concerns and issues with physical health. This means that an insurance plan that provides a certain amount of coverage for treatment for a physical injury or concern, must also provide that level of care for mental health treatment.

Common mental and behavioral health disorders may include:

  • Depression
  • Anxiety
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder

Walking You Through Your Blue Cross Blue Shield Benefits

Here are some other benefits as a BCBS policy holder with our facility:

  • We’ll do an in-depth review and take you through your Blue Cross Blue Shield health insurance plan.
  • We’ll help you determine if you are covered for substance abuse treatment.
  • We’ll help decide what kind of treatment and how much is covered.
  • Blue Cross Blue Shield health insurance is accepted by almost every treatment center in the U.S., so we’ll go through which ones will work best with your policy.

Amethyst Is Here for You

We want to make this process for you as smooth as possible, from beginning to end. Long-lasting sobriety and well-being are a priority at our facility. Don’t let your financial worries get in the way of a recovery that could change your life. Give us a call at 888.447.7724 or contact us here, and let us take the first step with you on the road to recovery. 


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