Blue Shield Rehab Coverage in California

Blue Shield of California Insurance Coverage

Although Medicaid and Medicare can provide some coverage, Blue Shield of CA is one of California’s largest health insurance providers. In addition, as a nonprofit, the organization is focused on ensuring that its members receive the best possible health insurance coverage. As a result, there are over 4.7 million Blue Shield of California members in the state. That’s backed by a massive network of over 340 hospitals, meaning that over 97% of Blue Shield claims are in network.

It can be challenging to manage the effects of substance abuse. If you or a loved one is looking for a drug or alcohol addiction treatment program for improved mental health, understanding your health insurance plans can help. Insurance companies such as Blue Shield of California (BSCA) have a lot to offer. As part of the Blue Shield Network, you or a loved one gets coverage for addiction treatment facilities such as Stairway Resource Center. Be sure to reach out to inquire about their insurance policies for substance use disorder, including transitional living for addiction recovery.

In addition, Blue Shield of CA healthcare operates the Blue Distinction Treatment network, specifically designating nationally accredited treatment programs. However, there are considerations you’ll have to look into, like what your plan covers, how much coverage you’ll get for substance abuse programs, and where you or a loved one can go to navigate your recovery journey.

Does Blue Shield of CA Cover Addiction Treatment?

When choosing a substance abuse treatment center or on-site rehabilitation programs, it can be reassuring to inquire about alcohol or drug rehab with Blue Shield of CA for substance use disorders. Take comfort in knowing that Blue Shield of CA covers drug and alcohol rehab services. However, the percentage of coverage you get will depend on which provider you go to and which plan you or a loved one has. For example, insurance providers are required by law to offer coverage for addiction treatment. The Affordable Care Act mandates that your insurance provider cover addiction treatment.

However, the amount of coverage for drug rehab programs can vary drastically from plan to plan. Blue Shield of California covers drug and alcohol use treatment. It also has a custom program to ensure that you or a loved one can get approved treatment for their rehab facilities. In addition, you can always get coverage for out-of-network providers, although you will pay more, which means you have more freedom than with many alternatives.

Alcohol Rehab With Blue Shield of CA

Blue Shield offers up to 60% coverage on inpatient stays, which is high compared to most competitors. That makes alcohol rehab with Blue Shield of California a good choice if you’re going for a residential treatment plan. You may even benefit from asking your treatment facility if they are state-funded or considering payment options such as payment plans, government assistance, or financial assistance for reduced anxiety. 

What Types of Drug and Alcohol Treatment Does Blue Shield of CA Cover?

Blue Shield of CA offers coverage for most treatment options. It also doesn’t require you to go to an in-network provider, which means you can choose to get treatment almost anywhere you want. As long as you have pre-approval, Blue Shield of California covers almost every form of addiction treatment.

However, it explicitly covers:

Does Insurance Cover Sober Living Homes?

You may be wondering, “Does insurance cover sober living homes?” Once an addiction treatment program has been completed, aftercare planning can ensure a more positive recovery outcome. If you or a loved one is considering recovery residences, you may benefit from sober recovery housing options such as sober living facilities or sober living homes. A sober living house is much different than halfway houses. An sober living home is focused on transitional housing, whereas a halfway house is often mandated by the court system. Stairway Recovery Homes are 12-Step based, affordable, gender specific, and structured in a way that benefits each resident. They are also more flexible, less structured, and have minimal requirements. 

Fortunately, depending on approval, Blue Shield of California will cover the cost of sober living homes and other aftercare programs at treatment facilities. This way, you can transition from your formal treatment program and become eligible to receive follow-up counseling and sober living programs for long-term addiction recovery. Their sober living environments can provide the support needed for life skills training and personal growth. Clients also benefit from participating in support groups or Alcoholics Anonymous (AA) outside of their sober living home. 

What are Your Out-of-Pocket Expenses with Blue Shield of CA?

Blue Shield has over 250 in-network rehab partners in the state of California. This means you can easily seek treatment with the provider without incurring extra costs. However, if you do go to an out-of-network provider, costs will be higher.

Blue Shield Rehab Coverage

Depending on the facility chosen, addiction rehab can be expensive. In this case, you may be wondering about Blue Shield rehab coverage. Depending on your plan, you can expect the following out-of-pocket expenses when you seek out rehab with Blue Shield of CA.

• Bronze: Bronze plan holders have a deductible of $6,300 per individual with a $500 extra deductible for prescription medication. You’ll also have an out-of-pocket limit of $8,200, not including copayments, premiums, etc. Expect to also pay $65 per visit and 40% coinsurance for outpatient treatment and 40% coinsurance for inpatient treatment. In addition, if you choose an out-of-network provider, you will pay 50% coinsurance, for a maximum of $350 per day for outpatient stays and a maximum of $2,000 for residential care.
• Silver: The Silver plan uses a deductible of $1,950 per individual with a $300 extra deductible for prescription medication. You’ll have an out-of-pocket maximum of $8,200, which doesn’t include copayments, premiums, etc. In addition, you’ll pay $50 + 35% coinsurance for outpatient treatment and 35% coinsurance for inpatient treatment with a network provider. If you choose an outpatient provider, the cost is $50% coinsurance to a maximum of $350 per day for outpatient treatment and $2,000 per day for inpatient treatment.
• Gold: The Gold plan drops the deductible down to $1,000 per individual. It also drops payments down to 20% coinsurance for network providers and 40% coinsurance for out-of-network providers. Otherwise, costs are the same as the silver plan.
• Platinum: The platinum plan reduces your deductible down to $0 or $1,000 if you’re working with an out-of-network provider. You’ll also pay 10% coinsurance for in-network providers. However, you’ll pay 50% coinsurance for out-of-network providers, just like with the silver plan.

If you’re not sure, you can always call Blue Shield of CA.

How to Get Started With Addiction Treatment Services With Blue Shield of CA

Blue Shield of California offers coverage for almost all drug and alcohol rehab services in the State of California. However, it will want to verify that the treatment is medically necessary and that you’re seeking treatment from a reputable rehab center.

How to Check Coverage

Be sure to call your treatment center at the phone number provided or call Blue Shield of CA to verify that it covers your chosen rehab center.

Pre-Approval

You will need preauthorization to get treatment with Blue Shield of CA. However, if you’re getting treatment at a doctor’s office or opioid treatment at a doctor’s office (e.g., a methadone dose), you won’t need preauthorization. You’ll want to call this phone number (800) 468-9935 or have your doctor send an electronic preauthorization request to Blue Shield on your behalf.