Blue Shield of CA Insurance for Drug & Alcohol Rehab

Blue Shield of California is one of California’s largest providers of health insurance. In addition, as a nonprofit, the organization is focused around ensuring that its members receive the best possible healthcare they can. 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.

If you’re looking for drug or alcohol addiction treatment, BSCA has a lot to offer. As part of the Blue Shield Network, you get coverage for treatment. In addition, Blue Cross Blue Shield 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, and where you can go.

Does Blue Shield of CA Cover Addiction Treatment?

Yes. Blue Shield of CA covers drug and alcohol rehab. However, the percentage of coverage you get will depend on which provider you go to and which plan you have. 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 can vary drastically from plan to plan. Blue Shield covers drug and alcohol use treatment. It also has a custom program to ensure that you can get approved treatment. 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.

Finally, Blue Shield offers up to 60% coverage on inpatient stays – which is high compared to most competitors. That makes this a good choice if you’re going for a residential treatment plan.

What Types of Drug and Alcohol Treatment Does Blue Shield 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. Therefore, so long as you have pre-approval, Blue Shield of California technically covers almost every form of treatment.

However, it explicitly covers:

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 very easily seek out treatment with the provider without incurring extra costs. However, if you do go to an out of network provider, costs will be higher.

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 $500 of extra deductible for prescription medication. You’ll also have an out-of-pocket limit of $8,200 not including copayments, premiums, etc. You’ll 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 $300 of 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 Platinum 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 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 the treatment, that the treatment is medically necessary, and that you’re seeking treatment from a reputable rehab center.

Checking Coverage

Either call your treatment center 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. Here, you’ll want to call 800) 468-9935 or have your doctor send an electronic preauthorization request to Blue Shield on your behalf.