Does Blue Cross Blue Shield Pay for Treatment?

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A lack of health insurance was once common. Now, it’s unusual. According to the United States Census Bureau, less than 9 percent of Americans didn’t have health insurance in 2017. Most of us had some form of coverage.

If you have health insurance or you’ve shopped for coverage lately, you’ve probably heard of Blue Cross Blue Shield (BCBS). This is one of the largest health insurance companies selling products in the United States today.

And if you have coverage, you may be wondering if the company will pay for the addiction care you need. The answer to that question is “yes,” although you’ll need to scrutinize your benefits package and complete a few crucial paperwork steps before you enroll.

insurance concept

BCBS Coverage Options

Most insurance companies form relationships with doctors, hospitals, and other health care providers. Blue Cross Blue Shield promises to send patients to their partners, and the companies agree to hold down prices.

The bigger the health insurance company, the more partners it tends to have. Since BCBS is so large, it has many connections. And that could help you as you shop for addiction care.

There are many different types of places that offer addiction treatment. You could go to the following:

  • Inpatient treatment facilities
  • Hospitals
  • Outpatient treatment providers
  • Therapists
  • Doctors

BCBS says it has contracts with 90 percent of doctors and hospitals worldwide. That means the company could, in theory, connect with almost any person or organization you might consider an addiction treatment partner. 

BCBS is particularly prominent in two states.

  • Florida: In the individual market, BCBS had a 41 percent market share in 2015, experts say. More than 7 million Floridians have coverage through this company in all of the plans it offers in the sunshine state, BCBS says.
  • Pennsylvania: Estimating enrollment is tough, as many different companies provide care under the BCBS header in this state. But some of these companies, including Highmark, cover thousands of people.

If you live in one of these states and you have BCBS coverage, you’ll need to take a few steps before you tap into your benefits to pay for addiction treatment.

woman receiving help while climbing

How Does BCBS Cover Addiction?

Most Blue Cross Blue Shield plans include coverage for addiction treatment. But because of the way the company is structured, it’s almost impossible to make blanket statements about how plans work and what is or is not covered.

Every BCBS outpost is locally owned and operated. That’s why they can compete against one another in states like Pennsylvania. They don’t need to share resources or overhead. They’re completely different entities.

That means each company can make its own choices about what to cover and what rules to apply before members can use their benefits. Under some plans, you could get care with no hassles at all and see full reimbursement for charges. In others, you’ll need to get preauthorization before accepting any kind of care, and you’ll face a penalty if you work with a provider that does not have a special BCBS contract.

No companies, including Blue Cross Blue Shield, can eliminate all coverage for addiction care. Laws ensure that companies provide the same level of coverage for mental health services that they do for physical services.

But that doesn’t mean companies are required to pay for all of your care, no matter where you go, with no hassles. You’ll need to follow the rules of your company and your plan to save the most money.

Contacting BCBS

When you enroll, you’re given an identification card. That piece of plastic contains almost all the information you’ll need to understand how your benefits work and where to go to access them.

Your BCBS identification card has your:

  • Customer service phone number. On the back of your card, you’ll find phone information for the BCBS company that offers your care.
  • Identification number. This set of digits helps BCBS employees find you in their system.
  • Plan details. Do you have an HMO plan or a PPO plan? It’s not alphabet soup. These different products come with their own rules and regulations. Your plan type is listed on your card.
  • Copayment details. You’ll find out how much you’ll have to pay for common appointment types. This isn’t an exhaustive list, but it can help you understand a few basic details.

Call the customer service number, provide your identification number, and ask about your coverage for addiction care. Ask about:

  • Referrals. Does your doctor need to write an authorization slip before you get help?
  • Copayments. How much will you pay for the care you’re getting? Are some treatment options cheaper for you than others?
  • Facilities. Are you required to get care from organizations with a BCBS contract? Which places can you use?
  • Length. How long can you stay in a program? Are there limits?

If you’ve lost your identification card, you can still get help. The BCBS member services department has a handy online form. Click on the button that says, “I don’t have my ID card.” Fill in your zip code, and you’ll find out the name and contact information for the BCBS company in your area.

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