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What is Blue Cross Blue Shield Health Insurance?
Blue Cross started in 1929 to make healthcare affordable for patients at Baylor University Hospital. Blue Shield offered similar health services to workers for monthly payments. Because of the rapid spread of these plans, the two companies merged in the 1940s.
Blue Cross Blue Shield is a parent company to a group of companies that provide health insurance to over 100 million people. Their network is vast, covering 9 out of 10 doctors and hospitals in America.
In fact, most government workers have health insurance through Blue Cross Blue Shield. Coverage comes with many benefits and perks. But is Blue Cross Blue Shield rehab coverage a benefit?
Yes, many policies provide various coverage for addiction treatment. However, these benefits may vary depending on where you live.
Some possible treatment options with Blue Cross Blue Shield rehab coverage include:
- Medical detox
- Inpatient or residential treatment
- Outpatient treatment programs
- Sober living homes
- Telemedicine
- Medication-Assisted Treatment (MAT)
If you are not sure what Blue Cross Blue Shield rehab coverage you have, call your health insurance representative or Live Free Recovery Services.
How Does Blue Cross Blue Shield Rehab Coverage Increase Recovery?
Blue Cross Blue Shield rehab coverage depends on factors such as the state you live in, the type of insurance plan, and your addiction rehab needs. For example, if you need detox services, insurance may cover part or all of the costs if it is deemed necessary.
Federal mandates such as the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA) guarantee most insurance companies in New Hampshire and throughout the U.S. cover some or all addiction rehab needs. The coverage has to be equal to medical and surgical coverage.
Blue Cross Blue Shield developed The Substance Use Resource Center to support lasting recovery to ensure members receive quality addiction and mental health treatment.
What are the Blue Cross Blue Shield Rehab Coverage Plan Levels?
Like most plans, Blue Cross Blue Shield rehab coverage has different levels. Each level has specific monthly premiums and deductibles. Deductibles are the amount of money you pay before insurance starts paying.
Insurance plan levels include:
- Bronze – Typically, these plans have low monthly premiums and cover about 60 percent. But, they have high deductibles.
- Silver – These plans typically cover about 70 percent. While deductibles are lower, monthly premiums are higher than bronze plans.
- Gold – These plans have lower deductibles and higher monthly premiums than silver plans and cover around 80 percent.
- Platinum – Not all states offer platinum plans, but they cover about 90 percent. Platinum plans have very high monthly premiums and low deductibles compared to the other plans.
Besides the Blue Cross Blue Shield rehab coverage plan, your monthly premiums and deductibles depend on whether you choose to stay as an HMO plan or a PPO plan.
HMO Plans vs. PPO Plans for Blue Cross Blue Shield Rehab Coverage
When looking for Blue Cross Blue Shield rehab coverage, it is crucial to understand the basics and differences of each plan.
HMO Plans
An HMO, or Health Maintenance Organization, offers its members care with specific networks of doctors, hospitals, and other medical providers known as in-network providers. Blue Cross Blue Shield and in-network providers have agreed on costs for services that keep monthly premiums and deductibles low.
Members who see out-of-network providers have to pay 100 percent of costs with HMO plans. The only exception is an emergency. To ensure members get their full coverage, primary care doctors provide referrals for specialists.
PPO Plans
IN a PPO, or Preferred Provider Organization, members have more flexibility in where they seek care. For instance, members can use out-of-network providers and see specialists without a referral.
However, when members use in-network providers, they pay less. Members using out-of-network providers have higher out-of-pocket expenses. At the same time, some doctor visits may not be covered at all.
Like HMOs, PPOs have contracts with in-network providers to pay a specific fee for each service. PPOs also have set prices for out-of-network providers. As a result, members pay the difference when charges exceed the contracted fee.
What Are the Key Differences between HMOs and PPOs?
The two main differences between an HMO and a PPO are affordability and flexibility.
- Cost – HMOs are more cost-friendly than PPOs. HMOs have lower monthly premiums, and while both may have deductibles, HMOs typically don’t. PPOs have higher monthly premiums but allow members to see out-of-network providers. HMOs only cover emergency out-of-network visits.
- Flexibility – PPOs offer members more flexibility than HMOs. With PPOs, members choose which doctors to see, whether in-network or not. You also do not need referrals from your primary care doctor. This is beneficial because you won’t have to change providers if your primary doctor is no longer in-network.
Think of it this way, with HMOs, you pay less but have less flexibility in care. With a PPO, you pay more but have more options in care. To make sure you pick the right Blue Cross Blue Shield rehab coverage, there are terms you should know.
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Terms to Know for Blue Cross Blue Shield Rehab Coverage
Navigating insurance can be challenging, especially when trying to get addiction treatment. Knowing the following terms can help you get the most out of your calls with Blue Cross Blue Shield and your rehab center.
Deductible
Deductibles are the out-of-pocket expenses you must pay before insurance starts to cover rehab. For example, If Blue Cross Blue Shield rehab coverage has a $500 deductible, you must pay $500 out-of-pocket before insurance starts paying.
Out-of-Pocket Costs
Out-of-pocket costs are the money you pay out of pocket. This includes services not covered by your plan, out-of-network providers, and money paid toward your deductible and coinsurance.
Coinsurance
Coinsurance is the percentage of the total health care service cost you are responsible for. For example, a coinsurance of 30 percent means if medical detox costs $1000, then Blue Cross Blue Shield will pay $700, and you must pay $300.
Copays
Copays or copayments are the set amount you pay when seeing a health care provider. For example, your Blue Cross Blue Shield rehab coverage may have a $25 copay for each doctor visit and a $100 copay for hospital stays.
In-Network
Health insurance companies have contracts with health care providers to provide services for set amounts. Some Blue Cross Blue Shield rehab coverage only covers in-network services. These plans are the most cost-efficient.
Out-of-Network
If providers do not have a contract with Blue Cross Blue Shield, they are out-of-network providers. Seeing these providers will have higher out-of-pocket costs, so it’s crucial to know if you have coverage.
Types of Treatment With Blue Cross Blue Shield Rehab Coverage
In New Hampshire, there are a variety of drug and alcohol treatment centers. The first step right here in finding the right rehab is understanding your treatment needs. For example, severe addictions and addictions with co-occurring mental disorders need inpatient rehab. Others in the early stages of addiction often benefit from outpatient rehab programs.
Blue Cross Blue Shield rehab coverage may allow you to attend treatments such as:
- Medical detox
- Inpatient or residential treatment
- Outpatient rehab
- Partial Hospitalization Programs (PHP)
- Intensive Outpatient Programs (IOP)
- Medication-Assisted Treatment (MAT)
Your Blue Cross Blue Shield plan provides at least partial coverage for addiction treatment at in-network rehab centers. Your exact coverage depends on your specific insurance plan. Whatever your coverage, you will still be responsible for out-of-pocket costs such as copays and deductibles.
What If My Blue Cross Blue Shield Rehab Coverage Only Covers Part of Treatment?
Although Blue Cross Blue Shield rehab coverage varies, it will cover at least some of your rehab costs. The portion not covered by insurance is on top of copays and deductibles. These out-of-pocket expenses can deter people from entering treatment.
Fortunately, there are programs to assist in paying these costs not covered by insurance. Some rehab centers offer scholarships or payment plans if you can not make the full payment upfront.
Other ways to help pay for rehab include:
- Loans such as Healthcare loans
- Fundraising such as GoFundMe
- Borrowing money from friends and family
Although addiction rehab is expensive and Blue Cross Blue Shield rehab coverage may only cover a portion of treatment, it is crucial to attend treatment. The longer you wait to get addiction treatment, the higher your risk of overdosing and the risk of dying.
How Do You Check Your Blue Cross Blue Shield Rehab Coverage?
There are multiple ways to check your Blue Cross Blue Shield rehab coverage. The insurance paperwork you received when enrolling with Blue Cross Blue Shield will state your benefits. You can also call them directly or check their website.
At Live Free Recovery Services, we can also verify your Blue Cross Blue Shield rehab coverage. We offer various ways to verify your insurance coverage, such as visiting our website or calling one of our representatives.
Start Your Recovery Today With Live Free Recovery Services
Are you or someone you love struggling with an addiction to drugs or alcohol? Does it feel like the addiction wins no matter how hard you try? At Live Free Recovery Services, we focus on healing what is feeding your addiction and encouraging recovery. Contact us today to find out more.