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Does Blue Shield of California covers Alcohol and Drug rehab centers in California?

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Paying for Inpatient Alcohol and Drug Rehab Centers With Blue Shield of California

Blue Shield of California is a health insurance provider in the state of California. If you are a member of Blue Shield of California and are seeking treatment for substance use disorder in the state, your insurance plan should cover at least some of the costs of your treatment, including detox, inpatient or outpatient rehab, or long-term residential programs. Exactly what is covered and how much you will have to pay out-of-pocket depends on your plan.

You can check your coverage by calling the number on the back of your insurance card to speak with a Blue Shield of California customer service agent. Alternatively, you can contact the rehab center directly. An admissions navigator can verify your insurance with you while you’re on the phone, and help you navigate the next steps to help insurance coverage pay for rehab.

What is Blue Shield of California?

Blue Shield of California is a non-profit organization that provides health insurance to Californians at an affordable price. Founded in 1939, Blue Shield of California is an independent member of the Blue Shield Association.1 Over 4.5 million Californians are members of Blue Shield of California.1

Additional specialists are included in the Blue Shield of California network. Rehab centers must meet Blue Shield of California’s requirements to ensure members have access to a large number of doctors that are close to home.2

Blue Shield of California Treatment Plans

Blue Shield of California offers a variety of plans for its members. The selection allows members to choose the plan that fits their budget and suits their medical needs. The company offers individual and family plans, Medicare plans, Medicaid plans, and small business plans for employers.3 For individuals and families, health insurance plans are offered in 4 categories:4

  • Blue Shield Bronze. Bronze plans offer the lowest monthly premiums and are best for those who do not need a lot of medical care. With a high deductible, these plans are best for those who want coverage for medical emergencies and see the doctor infrequently. Bronze plans cover 60% of your healthcare costs once the deductible is met.
  • Blue Shield Silver. Silver plans offer average monthly premiums and lower deductibles. They are best for those who visit the doctor a couple of times a year. Silver plans cover 70% of healthcare costs once the deductible is met.
  • Blue Shield Gold. Gold plans have high monthly premiums and lower deductibles. These plans are ideal for those who see the doctor frequently, as all routine healthcare is covered by the plan. Gold plans cover 80% of all healthcare costs once the deductible is met.
  • Blue Shield Platinum. Platinum plans have the highest monthly premiums and lowest deductibles. These are ideal for individuals who require routine medical care and see the doctor frequently. Platinum plans cover 90% of healthcare costs once the deductible is met.

What Does Blue Shield of California Insurance Cover in Addiction Treatment?

If Blue Shield California is your health insurance provider, your policy will cover at least some of the costs of addiction treatment. Services covered by Blue Shield of California include (but are not limited to):5

  • Medical detox: Medical detox helps people withdraw safely from drugs and alcohol. With 24/7 medical supervision and the help of medications, individuals in detox will get sober safely and comfortably to prepare for their time in inpatient or outpatient rehab.
  • Inpatient or residential rehab: Inpatient residential facilities provide a safe place for people on the road to recovery. You will live in the facility for 1 to 6 weeks (or more), depending on your needs and the program you are enrolled in.
  • Partial hospitalization programs (PHPs): PHPs allow you to live at home while accessing treatment at a facility during the day. This is sometimes called “day treatment.”
  • Intensive outpatient programs (IOPs): IOPs allow you to live at home while attending treatment approximately 3 days a week. The commitment varies from 10-20 hours per week.
  • Outpatient treatment: Outpatient treatment takes place in hospital clinics, mental health clinics, counselors’ offices, or local health departments. You can live at home and work during the daytime and attend 1-3 treatment sessions a week, which may last up to a year or more.

Does Blue Shield of California Cover Mental Health & Co-Occurring Disorder Treatment?

Under the Affordable Care Act, mental health treatment must be covered by insurance providers.6 This includes treatment for co-occurring disorders—when someone has another mental health diagnosis (e.g., anxiety, depression, post-traumatic stress disorder) along with substance use disorder. The extent to which mental health treatments are covered and for how long depends on your insurance plan. Blue Shield of California can help coordinate care for you when you access mental health treatment. If you are a Blue Shield of California member and need to access mental health care and addiction treatment services, you can take comfort in knowing that the company is fully committed to caring for members with mental health conditions.5

The Mental Health Parity and Addiction Equity Act was a law enacted to ensure that mental health and addiction treatment coverage is provided by all healthcare insurance providers, including Blue Shield of California.7 Many treatment facilities offer treatments for mental health disorders along with substance use disorders. Taking care of your mental health is just as important as caring for physical health. You wouldn’t wait to get a broken wrist taken care of, so it’s important not to put addiction and other mental health conditions on the backburner to address at a later time. The law ensures that everyone who needs access to addiction and mental health services gets the care they need.

How Long Does Blue Shield of California Cover Inpatient Alcohol and Drug Rehab programs?

Blue Shield of California offers a wide range of policies and plans for its members, and each policy covers at least some of the cost of addiction treatment. The length of time coverage is provided varies, depending on your particular needs as well as the insurance plan you have. Research indicates that people with addictions have the best outcomes when they attend treatment for at least 3 months. The longer you stay in treatment, the higher the chance of getting and staying sober.8

You can look up your Blue Shield of California plan information on the member portal to learn how many days of treatment are covered in a calendar year by your plan. Or, you can call the number on the back of your insurance card to learn more about what your plan covers and how long you can stay in rehab with insurance coverage.

What if my Blue Shield of California Policy Does Not Cover an Inpatient Drug Rehab Program?

If your insurance policy does not cover all of your rehab expenses, there are other ways to pay, including:

  • Private loans and/or payment plans. Many financial institutions offer loans to help cover healthcare costs, including the expenses for rehab.
  • Payment plans: Most treatment facilities offer payment plans that allow you to pay back the cost of treatment over time.
  • Scholarships and grants. Some treatment facilities offer scholarships and grants who need financial support to cover the costs of rehab. Some states also offer scholarships and grants to low-income individuals who need help paying for treatment.
  • Fundraising & crowdfunding. Asking family and friends for support can help cover the out-of-pocket costs of treatment. It isn’t always easy to ask for help, but most people are happy to support those who are ready to seek treatment.

Getting the treatment you need now is crucial. While you may want to wait until a future point in time, there is no better time than now to get the help you need on your journey to recovery.

Blue Shield California In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

Blue Shield of California has an agreement with some treatment facilities in the state to offer treatment services at a lower rate than other providers. These rehab facilities are “in-network” with Blue Shield of California. This typically means lower out-of-pocket expenses for you. Rehab facilities that are out-of-network do not have an agreement with Blue Shield of California, and services and treatments are more expensive for members. If you choose an out-of-network facility, you may pay more for services and in some cases, the insurance company may not pay any expenses at all. Choosing an in-network rehab facility means that your costs are lower, and you will be required to fill out less paperwork for insurance purposes. This provides peace of mind, an easier process, and lower costs. You can easily find out if any provider is in-network by visiting the Blue Shield of California website or calling the number on the back of your insurance card.

How Can I Check My Blue Shield Coverage for Inpatient Drug Rehab Centers in California?

Insurance coverage for addiction treatment varies depending on your plan, which is why it’s so important to check with Blue Shield of California to determine what is covered by your policy. American Addiction Centers can verify your insurance benefits for you. Call the rehab facility you are considering to speak with an admissions navigator, who can check your insurance benefits for you while you’re on the phone.

American Addiction Center’s treatment center in California, Laguna Treatment Hospital, provides a high-quality program for people seeking addiction treatment. Visit the website to learn more about the services offered at the facility and how to get started.