Blue Shield of California Insurance Coverage
Stairway Resource Center treats adults who are seeking treatment for both addiction and co-occurring mental health conditions. We accept Blue Shield of California insurance. Blue Shield of California covers various levels of care, including our outpatient program (OP), intensive outpatient programs (IOP), and sober living homes (SLH) in Southern California.
Blue Shield of California Insurance for Addiction Treatment in Southern California
Finding coverage for both substance use disorders and co-occurring disorders can be challenging. However, take comfort in knowing that insurance providers are required by law to cover addiction treatment. The Affordable Care Act mandates that your insurance provider cover addiction treatment. Although Medicaid and Medicare can provide some coverage, Blue Shield of California is one of California’s largest health insurance providers.
As a result, there are over 4.7 million Blue Shield of San Diego, 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. We are in-network; therefore, if you are facing a dual diagnosis or issues with chronic relapse, you will receive Blue Shield of California Insurance coverage at Stairway Resource Center. You will gain long-term structure and evidence-based care in our IOP, OP, and sober living programs. For example, you may work with many recovery professionals in our treatment space, including an in-house psychiatrist, MD, or a set of recovery clinicians. Our clinicians take on a 12-step approach, focus on a community-driven model, and support spiritual recovery. You can expect to receive individualized care from 3 months to 2 years in the Woodland Hills/ Los Angeles area.
In addition, Blue Shield of CA healthcare operates the Blue Distinction Treatment Network, which specifically designates nationally accredited treatment programs. Please reach out to our staff to understand how much coverage you’ll get for substance abuse programs, and where you or a loved one can go to navigate your recovery journey for insurance verification support regarding transitional living for addiction recovery. 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.
In addition, Blue Shield of CA healthcare operates the Blue Distinction Treatment Network, which specifically designates nationally accredited treatment programs. Please reach out to our staff to understand how much coverage you’ll get for substance abuse programs, and where you or a loved one can go to navigate your recovery journey for insurance verification support regarding transitional living for addiction recovery. 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.
Drug and Alcohol Rehab
Blue Shield offers up to 60% coverage on inpatient stays, which is high compared to most competitors. That makes alcohol and drug 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 whether they are state-funded or whether they offer payment plans, government assistance, or reduced-cost options to help reduce anxiety.
What Types of Addiction Treatment Does Blue Cross Blue Shield of California Cover? (Treatment Plans)
Blue Shield of CA offers coverage for most treatment options. It also doesn’t require you to go to an in-network provider. Therefore, as long as you have pre-approval, Blue Shield of California covers almost every form of addiction treatment.
Partial Hospitalization Programs (PHP)
Even if our partial hospitalization program is not the primary offering, this level of care is generally covered, so you or your loved one can receive day treatment in a hospital setting without an overnight hospital stay.
Aftercare & Sober Living Support
Once an addiction treatment program has been completed, aftercare planning can ensure a more positive recovery outcome. Thankfully, Blue Shield of California also covers aftercare programs, depending on approval. This means follow-up counseling and sober living to promote long-term recovery.
Residential Treatment & Inpatient Rehab Programs
Blue Shield of CA supports inpatient or residential treatment. You’ll get lower coverage than with an outpatient program. Blue Shield of CA offers better coverage than most competitors, including Medicaid and Medicare. Therefore, Stairway may refer out when needed with coverage of up to 60%,
Medical Detox Coverage (When Required)
Drug and alcohol withdrawal symptoms can be life-threatening. Medical detox includes 24/7 monitored detox and withdrawal from substance use disorders. However, medical detoxification is covered by insurance but not provided on-site. Blue Shield of CA behavioral health does cover any medications or medication-assisted treatment necessary for recovery support.
Does Blue Shield of California Cover Sober Living Homes?
Once an addiction treatment program has been completed, aftercare planning can ensure a more positive recovery outcome. You may be wondering, “Does the Blue Shield of California insurance company cover transitional housing such as sober living homes?” 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.
An SLH is very different from a halfway house. A 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 to benefit each resident. They are also more flexible, less structured, and have minimal requirements.
Fortunately, depending on approval, Blue Shield of California will cover 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. However, your insurance coverage varies by plan. Their sober living environments can provide the support needed for life skills training and personal growth. You or your loved one may also benefit from participating in community-driven support groups or Alcoholics Anonymous (AA) outside of their sober living home. Doing so enhances your ability to achieve long-term recovery.
Fortunately, depending on approval, Blue Shield of California will cover 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. However, your insurance coverage varies by plan. Their sober living environments can provide the support needed for life skills training and personal growth. You or your loved one may also benefit from participating in community-driven support groups or Alcoholics Anonymous (AA) outside of their sober living home. Doing so enhances your ability to achieve long-term recovery.
Understanding Blue Shield of California Insurance Plans & Out-of-Pocket Costs
Blue Shield has over 250 in-network rehab partners in California. This means you can easily seek treatment with the provider without incurring extra costs. However, if you see an out-of-network provider, costs will be higher.
Depending on the facility chosen, addiction rehab can be expensive. However, you can expect the following out-of-pocket expenses when you seek rehab through Blue Shield of CA. If you’d like more information, you can always call Blue Shield of CA.
Depending on the facility chosen, addiction rehab can be expensive. However, you can expect the following out-of-pocket expenses when you seek rehab through Blue Shield of CA. If you’d like more information, you can always call 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. So, you can also expect to 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 has a deductible of $1,950 per individual, with an additional $300 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, up to $350 per day for outpatient treatment and $2,000 per day for inpatient treatment.
Gold: The Gold plan drops the deductible 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 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.
In-Network vs. Out-of-Network Providers
In-network providers have contracts with your insurance, so services typically cost less out-of-pocket, and claims are billed directly, while out-of-network providers may lead to higher copays, balance billing, and the need to file claims yourself. Choosing in-network usually means smoother coverage and lower costs, whereas out-of-network can offer more provider choice or specialized care at potentially higher expense.
Deductibles, Copays, and Coinsurance
A deductible is the amount of money you have to spend before insurance covers your care. Your copayment is a fee charged before a service is provided. However, out-of-pocket costs are fees that are not covered by insurance.
HMO vs. PPO
Plans
HMOs typically have lower costs, as you must stay in-network with a referral from your primary doctor. Whereas, PPO plans generally come with higher costs, but you have the freedom to see any doctor without the need for a referral. However, our admissions team is available to help answer all your questions regarding HMO and PPO plans.
What Impacts Your Insurance Coverage for our Rehab Facility?
Your specific benefits and provider network will determine which addiction treatment plans are covered. For example, your rehab insurance coverage is based on medical necessity, preauthorization, and plan type.
How to Use Blue Shield of California Insurance for Rehab Services
Blue Shield of California covers almost all drug and alcohol rehab services in California. However, you will want to verify that the treatment is medically necessary. You’ll want to seek treatment from a reputable rehab program.
Verify Your Insurance Benefits
Feel free to call Stairway Resources Center at the provided phone number or Blue Shield of CA to verify that your chosen rehab programs are covered.
Preauthorization & Medical Necessity
To start, you’ll want to call or have your doctor send an electronic preauthorization request to Blue Shield on your behalf. However, if you’re receiving addiction treatment at a doctor’s office, a preauthorization is not required.
Starting Treatment at an In-Network Provider
Once you get preauthorization, you can go to a rehab center, and Blue Shield will treat your medical bill just as they would for any other medical treatment.
If you’re struggling with alcohol or drug addiction, you or a loved one must get help. Blue Shield of California offers significant coverage, including a high limit and a large network of treatment centers. This means you can likely get rehab treatment in California with this provider.
If you’re struggling with alcohol or drug addiction, you or a loved one must get help. Blue Shield of California offers significant coverage, including a high limit and a large network of treatment centers. This means you can likely get rehab treatment in California with this provider.
When to Seek Help for Substance Use or Mental Health Conditions
It is common to miss the warning signs of substance use or co-occurring disorders. As a result, many people don’t seek support until they feel they’ve hit rock bottom. However, early intervention and community support can help you recognize the lead-up to severe addiction.
Warning signs of SUD include:
Warning signs of SUD include:
- Increased substance use
- Mental health decline
- Failed attempts to quit
- Isolation or instability
- Legal/work/family consequences
Frequently Asked Questions
Is Stairway Resource Center an in-network provider with Blue Shield of California?
Yes, we are in-network. When you contact admissions, our team will help you verify insurance and understand your BCBS coverage for substance use and any co-occurring mental health disorders. This process helps us provide an overview of your coverage, options, and financial responsibilities so that we may move forward with choosing the right addiction and mental health treatment program that best suits your needs.
Does Blue Shield cover dual diagnosis treatment?
For the Dual diagnosis: Yes, BCBS generally covers dual diagnosis treatment, which addresses co-occurring mental health and substance use disorders — you can add to contact SRC for additional details on this.
How long will insurance cover addiction treatment?
There is no limit; BCBS coverage is based on progress and medical necessity.
Can I get treatment without preauthorization?
No, your doctor should send an electronic preauthorization request to Blue Shield on your behalf. However, if you’re receiving addiction treatment at a doctor’s office, a preauthorization is not required.
How do I verify my Blue Shield of California insurance coverage?
You are welcome to contact our admissions team at Stairway Resource Center in Orange County. Our team would be happy to walk you through the verification process for support.
