Blue Cross Blue Shield of Illinois Addiction Rehab Coverage

Blue Cross and Blue Shield of Ilinois (BCBSIL) has been serving the people of Illinois since 1936. Currently, it provides coverage to more than 8.1 million members, making it the largest health insurance company in the state.

When a person is looking for addiction treatment, the two most pressing questions they have tend to concern the cost of treatment and whether insurance will cover it.

Affordable Care Act

The good news is the Affordable Care Act (aka Obamacare) designated substance use disorder and mental health services as essential benefits, so everyone should have some degree of coverage. Exactly how much and where a person can seek treatment will depend on the individual plan.

It’s always a good idea to contact the insurance provider to determine what exactly is covered and what the costs will be.

BCBSIL Levels of Care

Like many health care plans on the Health Insurance Marketplace, BCBSIL has three levels of plans: Bronze, Silver, and Gold.

• A Bronze plan usually pays 60% of costs while the patient is responsible for 40%. Monthly premiums tend to be lowest here. Preventive care and other essential health benefits are included, but these plans are more manageable for people who don’t need to see their doctor more than a couple of times a year, who have no ongoing health issues, or for those who don’t have any regular prescriptions.
• A Silver plan pays 70% of costs, and the patient handles the remaining 30%. Silver has lower out-of-pocket costs than Bronze. Depending on a person’s income they may qualify for a subsidy or tax credit to drive down costs.
• A Gold plan covers 80% of costs, and the patient pays 20%. These tend to be more affordable for people who need to visit the doctor regularly or who have ongoing health conditions. That will keep out-of-pocket costs down.

Some things to consider when shopping for plans include:

• How often might need to see your primary care physician (PCP)
• How often do you see specialists
• If you have regular prescriptions
• If you have surgeries or other procedures planned
• Whether you’ll need more or less care in the coming benefit year

Drug and Alcohol Rehab

Does Blue Cross Blue Shield of Illinois cover drug and alcohol rehab? Like all plans available on the marketplace addiction treatment is covered. Rehab can include detox, an inpatient stay, and counseling or therapies. Medical screenings and medications may be necessary to manage withdrawal and underlying conditions.

How much insurance will pay for will depend on the type of plan. A Bronze plan would have a higher deductible and a higher coinsurance. Copays would be higher for Bronze plan holders than Silver or Gold. Inpatient hospitalization services (which could include detoxification and rehab) would vary, but the patient will be accountable for a higher amount with a Bronze plan, and a lower amount with a Gold plan.

Gold plans, in contrast, would have a much lower deductible, co-pay, and coinsurance.

Prices can vary even among the various metal plans.

Going in-network can save patients a considerable amount of money. Out-of-network care sometimes will not be covered at all.

Length of Treatment

The length of treatment Blue Cross Blue Shield of Illinois covers may vary. The National Institute on Drug Abuse suggests treatment should vary depending on what kind of substances the patient is dependent on as well as the patient’s unique needs. The most effective treatments consider the patient’s abuse and whether they have any medical, psychological, or other issues. Gender, ethnicity, culture, and age are also important to consider. Staying in treatment a longer amount of time — three months, at least — tends to be most effective.

The length of time a rehab recommends depends on the patient’s needs. Someone with a milder problem might not need so much time on an inpatient basis, but usually, the longer a patient stays, the better the outcome.

Rehabs also have to work with insurance companies, too. Some providers may approve hospitalization until the patient is detoxed and stable. Others may approve a set length of stay and the rehab will request more days for the patient to recover on site.

Mental Health

Does Blue Cross Blue Shield of Illinois also cover mental health? According to the ACA, mental health is an essential service, so Blue Cross Blue Shield of Illinois behavioral health insurance would include treatment for mental health conditions, especially since mental health and substance use disorders often do co-occur.

Mental health care can take on many forms, including specialist and mental illness office visits,  inpatient and outpatient hospital services, and prescription medications to manage conditions.

Inpatient Rehab

Blue Cross Blue Shield of Illinois inpatient rehab, like most residential stays for addiction treatment, involves the patient checking into a facility and residing onsite for 30 or more days. There, they’ll receive care and treatment for their substance use disorder and/or mental health issues. Inpatient rehab usually occurs in several stages:

• Assessment: Center staff will examine the patient to get a full mental and physical picture of their health. That information is used to develop a treatment plan.
• Detoxification: Most patients need to undergo detox before they begin counseling and therapy. That’s when the body rids itself of drugs. Medication may be administered to manage the side effects in safety and comfort.
• Treatment: Here the patient goes to behavioral therapy (cognitive-behavioral therapy is a commonly used and effective approach) to address underlying causes of their addiction and to learn healthier ways to cope and manage stress. They might also attend support group sessions and take classes to develop life skills.
• Aftercare: The patient is prepared for life after rehab. That might include making plans to touch base with the rehab regularly as well as attend counseling and go to support groups closer to home. The goal is to prevent relapse.

Those stages make up much of what you can expect from Blue Cross Blue Shield of Illinois in rehab. The exact details will vary by plan and facility.

Outpatient Services

Blue Cross Blue Shield of Illinois outpatient services can occur separately from inpatient care or as an extension of it.

It can be more intensive, where a patient may visit the rehab several days a week, often for several hours at a time (hence it being called intensive outpatient). They’ll receive therapy and work on solidifying their abstinence. In some cases, a patient might live at a sober living facility and regularly attend intensive outpatient care.

Outpatient care can also be periodic, where a patient attends weekly (it will vary) for counseling. At other times a patient may visit the facility or an office for regularly scheduled counseling sessions.

Suboxone Treatment

Suboxone is the brand name for the combination of buprenorphine and naloxone. It’s often used as part of medication-assisted treatment, which is a blend of counseling, behavioral therapies, and medication to treat addiction. Buprenorphine-naloxone is specifically used to treat opioid use disorder. It has some of the effects of opioids but produces less of a high. It also reduces withdrawal symptoms, making it easier for some patients to avoid relapse.

Does Blue Cross Blue Shield of Illinois cover suboxone treatment? Many plans don’t cover suboxone as part of their prescription coverage, but most include the buprenorphine-naloxone generic option. The exact strength and specific formulation, as well as the copay, will vary by plan.

Methadone Treatment

Methadone is also used as part of medication-assisted treatment (MAT), specifically for opioid use disorders. It also pairs best with counseling to manage cravings and learn new coping mechanisms.

Methadone is in the same family as opioids, it has a longer half-life, or its effects last longer. Because of that, the patient takes it on a schedule (once daily, for example) so they are less likely to have withdrawal cravings and relapse.

Does Blue Cross Blue Shield of Illinois cover methadone treatment? Methadone is one of the approved drugs on BCBSIL’s list. The exact formulation and out-of-pocket cost will vary by plan.

Paying for Rehab

Rehab isn’t inexpensive, and that can make some people nervous about even considering it. Considering it as an investment in one’s longevity and good health can make it easier to decide, however.

When paying for services that are not covered by Blue Cross Blue Shield of Illinois’ insurance policy, including deductibles or copays, is proving difficult, there are ways to make it more doable. Some patients can opt to pay their bills monthly. Sometimes rehabs can make arrangements with the patients or financing may be available.