Blue Shield Mental Health and Substance Abuse Rehab
Nearly one in three Americans is covered by a Blue Cross or Blue Cross Blue Shield insurance option. That means it’s especially important that Blue and its licensed distributors offer full coverage for substance use disorder and mental health treatment. The good news is that they do. However, the exact rates, terms, and what you get will vary a great deal based on whether you use your Blue plan directly and which state you use your Blue plan from. For example, if you’re covered by Blue California, you’ll pay the same rates and deductibles for mental and behavioral health as you would for any other form of treatment.
Compassion Recovery is fully in-network with Blue Shield
Compassion Recovery is fully in-network with Blue Shield, meaning that you’ll get maximum coverage from your plan. However, coverage can vary a great deal based on your plan. You can contact us at 909-314-1097 for a consultation on what your insurance covers, or contact your provider directly via the number on your Membership ID Card.
What Does Blue Shield Cover?
Blue Shield covers mental health and substance use disorder services to the same extent that it covers physical health problems. In fact, in most cases, you’ll have the exact same rates for behavioral and physical health. That makes your rates easy to predict, because you likely already know what you pay for a visit to the hospital or your doctor’s office. Here, Blue Shield treats an outpatient visit like a doctor’s office and an inpatient visit like a hospital.
Substance Abuse Treatment and Rehab
Blue Shield offers substantial substance abuse and rehab treatment coverage. For most plans you need:
A reference from your doctor
The provider to be in-network
If both of those are true, then Blue Shield will offer coverage, to the maximum your plan allows.
This includes:
Medical Detox – Outpatient and inpatient detox services with prescription medication or medical monitoring.
Inpatient Treatment – You’ll get the same coverage for an inpatient rehab or mental health program as you would for checking into a hospital. That typically works out to $750 per admission plus your deductible, or coinsurance of 10-50%, with rates capped at $2,000 per day.
Outpatient Treatment – Outpatient, intensive outpatient, and partial outpatient are all treated as visits to a doctor’s office. This means you typically pay a fee of $40 per visit + your coinsurance, with rates capped at $350 per day.
Aftercare – You can attend follow-up counseling, group therapy, and have stays in aftercare covered by Blue Cross Blue Sheild, with a doctor’s recommendation. You’ll pay the standard coinsurance listed on your plan for behavioral healthcare, meaning 50-35% for most plans, with rates capped at $2,000 per day.
In most cases, if you can get your doctor to request your treatment as medically necessary, Blue Shield will approve it.
However, you do need pre-approval in order to get coverage.
Mental Health Services
Blue Cross Blue Shield offers comprehensive behavioral health treatment including coverage for inpatient, outpatient, and partial hospitalization programs. Like with substance abuse and rehab treatment, you only need a referral from your doctor and pre-approval. This includes treatments like:
Counseling
Behavioral therapy (CBT, DBT, EMDR, etc.)
ACT/Motivational Therapy
Group Therapy
Psychotherapy
Complementary Therapies
Here, you can go into intensive and emergency care stays at your clinic, attend remedial counseling, or go through a behavioral therapy course to improve your overall mental health. Blue Shield typically treats mental health as being equivalent to physical health, which means coverage is almost always there, providing your treatment center is in-network and you get pre-approval.
Our Program Defined
Dual Diagnosis Treatment
Dual Diagnosis treatment allows you to get treatment for both mental health problems and substance use disorder at the same time. This dual track program means you’ll receive a program that’s tailored to your needs and which tackles behavior and mental health in the order of most pressing, e.g.,, when something is getting in the way of therapy or posing a danger to you. It also means you get holistic care, with the intent to have therapy improve your quality of life as a whole, rather than helping you to resolve one problem.
Like with other forms of behavioral and mental health, Blue Shield offers coverage for dual diagnosis treatment. The only thing you’ll need is pre-approval and a recommendation from your primary healthcare provider.
What Are Your Costs with Blue Shield?
Blue Shield is one of the largest insurance providers in the nation. In fact, it divides services up across multiple licensed providers as well as individual state distributors. This means there’s a Blue Cross Blue Shield organization for every state in the nation.
If you live in California, you have Blue Shield California. If you’re coming to Compassion from another state, you’re more likely to have the Blue Cross Blue Shield option for that state.
The Blue California Access +HMO High Option offers:
Blue Shield specifically supports dual diagnosis treatment. In fact, Blue Shield will work with you during the diagnosis stage to ensure you get into a dual diagnosis program if you need it. Compassion Recovery offers a fully in-network dual diagnosis program, where you receive treatment for mental health and substance use disorders together, with a single trajectory.
$30 per visit for outpatient office visits.
$750 per admission for inpatient services
$250 calendar-year deductible for prescription medication
You can also expect rates like:
Bronze – $6,300 individual deductible + $500 deductible for medication. Coinsurance is 40% for inpatient and outpatient services and 50% for out of network providers. Day rates are capped at $350 for outpatient services and $2,000 for inpatient services. Your out-of-pocket limit is $8,200+ copayments.
Silver – Individuals pay a $1,950 deductible with a $300 deductible for prescription medication. Coinsurance drops to 35%. Otherwise, caps and your maximum out-of-pocket remain the same.
On the other hand, if you have Blue Shield of Texas, you can expect Bronze Plan rates to look more like:
$5,000-$6,500 deductible
0% coinsurance after deductible for most plans
40% coinsurance with the Blue Advantage Plus Bronze 104 plan
Out of pocket maximum of $6,500-$7,150
Therefore, your rates will vary depending on which specific plan you have. Make sure you contact Blue Shield to ask about rates and specific coverage. You can also call Compassion for custom advice and so we can check what your insurance covers.
Compassion Recovery is In-Network for Blue Shield
Compassion Recovery is in-network for Blue Shield of California, Blue Shield Licensees in California, and for most major insurance providers across the United States. That means you can book your rehab program with us to receive maximum coverage from your insurance provider. If you’re not sure, call us at 909-314-1097 and we’ll help you check to see what your coverage is and what your coinsurance is.
In most cases, you’ll be able to get full coverage for all of Compassion Recovery’s services including:
- Inpatient care
- Outpatient care
- Intensive Outpatient Care
- Counseling
- Complementary Therapy
- Outpatient Detox
- Dual Diagnosis Programs
If you have further questions, get in touch to ask us about what’s covered and what we offer.
Starting Rehab with Blue Shield
Blue Shield offers coverage for most behavioral health and treatment options. This means you’ll almost always be able to get treatment, providing you submit a request for pre-approval.
- Call your rehab or mental health center for a consultation
- Talk to your primary healthcare provider and ask for a referral.
- Have your doctor send an electronic preauthorization request to Blue Shield on your behalf or call Blue Shield at 800-468-9935
- Go to treatment
Blue Shield is one of the best insurance providers to have if you need mental health treatment or substance use disorder treatment. In fact, Blue Shield typically treats behavioral health as equivalent to physical health, so you won’t pay extra for behavioral health services. Providing you work with an in-network treatment center, you’ll be able to minimize total costs for care so you can more easily afford the treatment you need.
If you’re ready to get help, contact us at 909-314-1097.
