When it comes to addiction treatment and behavioral health services, finding the right care is key to recovery. However, navigating insurance for rehab can be confusing.
Many people are unsure if their insurance will cover out-of-network rehab services especially if they have a BCBS plan which covers many forms of addiction treatment including alcohol addiction.
If you're wondering about your BCBS out-of-network rehab coverage you're not alone. This blog for LivePositively readers will break down the details of BCBS coverage so you can make more informed decisions when seeking treatment.
What is Blue Cross Blue Shield?
A Blue Cross Blue Shield Overview
Blue Cross Blue Shield (BCBS) is a large health insurance company that offers a wide range of plans for individuals, families, and employers. With over 100 million members BCBS is one of the largest health insurance companies in the US.
Their plans are designed to be affordable and comprehensive covering medical, surgical and hospital expenses. Whether you need routine medical care or specialized treatment for drug and alcohol rehab BCBS can provide the support through their network of providers.
Blue Cross Blue Shield Plans
BCBS offers different plans to fit different healthcare needs and budgets. These plans include individual and family plans, group plans and Medicare plans each with different coverage, deductibles, copays and coinsurance.
Here's a breakdown of some of the popular BCBS plans:
- Bronze Plans: Lower premiums but higher deductibles and out of pocket costs. Good for people who don't need much medical care.
- Silver Plans: Moderate premiums and deductibles. Good for people who need regular medical care but not too much.
- Gold Plans: Higher premiums but lower deductibles and out of pocket costs. Good for people who will need a lot of medical care.
- Platinum Plans: Highest premiums but lowest deductibles and out of pocket costs. Good for people who need comprehensive care and want to minimize out of pocket expenses.
What is Out of Network?
Before we get into Blue Cross Blue Shield coverage let's define what out of network means. In the health insurance world in-network providers are those who have an agreement with your insurance company to provide services at a discounted rate.
Out of network providers are those who don't have an agreement. When you use out of network providers you pay more for their services and your insurance may not pay at all or pay at a lower rate.
This is especially important when it comes to rehab centers as many of the best or highest rated facilities may not be in your insurance network.
If you're considering a facility out of network you need to understand the coverage and costs involved to make the best decision especially when seeking treatment for substance abuse.
Does Blue Cross Blue Shield Cover Out of Network Substance Abuse Treatment?
Yes—Blue Cross Blue Shield does cover out of network rehab for various addictions including drug and alcohol addiction. But the extent of the coverage depends on the plan you have. BCBS has different plans with different levels of coverage and the rules vary if you have an individual or group plan and if it's an HMO, PPO or other type of plan.
For example PPO (Preferred Provider Organization) plans offer more flexibility in choosing out of network providers compared to HMO (Health Maintenance Organization) plans which require you to use in network providers except in emergencies.
If you're in a PPO plan you'll get some level of reimbursement for out of network rehab treatment but your out of pocket costs will be higher if you go out of network.
Check Your Blue Cross Blue Shield Coverage
How to Check Your Insurance
Checking your Blue Cross Blue Shield insurance coverage is important so you don't get surprised with extra costs. Here's a step by step guide to help you check your coverage:
- Check Your Insurance Card: Your BCBS insurance card has the policy number, group number and other important details. This is your first stop.
- Log in to Your Online Account: Log in to your BCBS online account to see your policy details including coverage and claims history. This online portal is a great tool to manage your health insurance.
- Call BCBS Customer Service: If you have questions or need more information about your coverage call BCBS customer service. They can give you more details and answer your questions.
- Review Your Policy Documents: Your policy documents will outline your coverage including deductibles, copays and coinsurance. Review these documents to get a clear understanding of what's covered under your plan.
- Ask Your Doctor: Your doctor can also help verify your coverage. They can check your insurance and help you understand what's covered and what you'll pay.
By following these steps to check your BCBS insurance coverage you can get the medical care you need whether it's for routine check ups or specialized addiction treatment services without the surprise bills.
How Much Will I Pay Out of Network?
Blue Cross Blue Shield does cover out of network rehab treatment but the costs can vary depending on your plan and the type of addiction treatment (drug or alcohol addiction). Here are the typical costs when you use out of network services:
Higher Deductibles and Co-pays
Out of network providers for inpatient treatment will have higher deductibles and co-pays so you'll pay more upfront before your insurance kicks in.
Limited Coverage
BCBS may cover a smaller percentage of out of network residential treatment. For example if your plan covers 70% of in network rehab services it may cover 50% or less of out of network services and you'll have to pay the difference.
Balance Billing
Out of network providers will also bill you for the difference between what BCBS covers and the total amount charged for services, known as balance billing. This can result to surprise bills if you're not aware.
Out of Pocket Maximums
Some BCBS plans offer out of network services but only until you reach a certain out of pocket maximum. Once you hit that limit the insurance plan may cover 100% of the care but until then you'll pay a larger share.
How Can I Get the Most Out of My Out of Network Benefits?
If you're going out of network for rehab preauthorization can help get coverage for medication assisted treatment. Here are ways to get the most out of your Blue Cross Blue Shield:
Preauthorization
Before treatment reach out to BCBS to preauthorize the rehab services you're considering especially for services related to a mental health disorder. Some plans require approval before covering out of network services. Getting this approval will help ensure your rehab treatment is covered as much as possible.
Request an Explanation of Benefits (EOB)
After treatment make sure to request an EOB from BCBS. This document will show you the costs and what was covered by the insurance so you'll know exactly what you owe.
Requesting an EOB will help you understand coverage for services recommended by the mental health services administration. If there are errors you can challenge them by contacting your insurance provider.
Negotiate with the Rehab
If you're getting treatment at an out of network facility don't hesitate to talk to them. Some rehab centers may be willing to negotiate rates or offer financial assistance especially if you're facing high out of pocket costs.
Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA)
If you have an HSA or FSA you can use these accounts to pay for out of network services. This is a great way to offset the cost of treatment.
Why Go Out of Network?
There are many reasons why someone would go out of network for rehab services including specialized drug and alcohol treatment that's only offered at a certain facility. Some may be looking for a specialized program that's only offered at a certain facility. Others may prioritize a center with a higher success rate or better reviews even if the facility is not in network with their insurance.
While out of network rehab comes with higher costs the benefits of finding the right treatment center for you might be worth it.
Using Blue Cross Blue Shield Out of Network Health Insurance Coverage for Treatment is Possible
If you're going to rehab at an out of network facility and you're insured by Blue Cross Blue Shield make sure you understand your coverage. Out of network rehab is covered but you'll face higher costs and more paperwork like preauthorization and balance billing.
Always contact your insurance provider to get a clear understanding of your benefits and costs before you commit to a program.
But finding the right care for your recovery can be worth it even if it means going out of network, so be sure to use your resources to attain the best possible care for yourself or a loved one.
