Finding BCBS In-Network Rehabs [Guide]

Health insurance can be a complicated issue. If you use Blue Cross Blue Shield, you may well be wondering, does BCBS cover rehab at all? Fortunately, the answer is yes. As we discuss BCBS in-network rehabs, we’ll take a basic look at how insurance companies work with rehab facilities to help patients get the rehab they need. These are just the basics, so your particular situation may be different. If you have questions about how your insurance can help you get treatment, please contact us at 912-214-3867.

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Click on a section to read more about BCBS in-network rehabs and how insurance can help you find substance abuse treatment.

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Sorting Out Providers

The rehab treatment centers we refer people to are part of the Blue Cross Blue Shield (BCBS) network of centers. Those centers are called “in-network providers” because they have a contract with BCBS which states that the centers meet their standards for care and accept payments from them. Other treatment centers that do not have such a contract would be called “out-of-network providers.” That doesn’t necessarily mean that the insurance company will not pay them. It just means that the payment plans would be different, usually resulting in higher rates of payment for the patient. When getting any kind of medical treatment, it is best to look for an in-network provider to keep things relatively simple and affordable. The good news is, BCBS in-network rehabs can provide you with all the help you need to claim victory over your addiction.

Pick your Plans and Payments

How does a person get health insurance? Many people are able to get health insurance through their workplace. The insurance companies make a deal with each employer to provide health care plans for their workers. But the deal doesn’t mean that the insurance company pays for all of the workers’ healthcare. In most cases, each worker must be prepared to pay for co-payments and deductibles.

A deductible is the set amount you pay out-of-pocket each year before your insurance plan starts paying for covered services. However, in-network preventive services are covered before the deductible is met. These services could include annual dental check-ups or flu shots, which are usually fully covered by insurance with no deductible payments necessary.

If someone has a serious medical emergency, they would have to pay all of the deductible amounts before the insurance company would begin to pay. This is called your out-of-pocket limit. Once that amount is paid for, the insurance company takes care of the rest for the remainder of the year. But patients also need to keep co-payments in mind. A copay is a fixed fee that you pay out-of-pocket for each visit to an in-network health care provider. For example, a visit to the doctor may involve a $20 co-payment which would be paid for by the patient. “Coinsurance” is a term for the amount you pay for covered health care services. It’s a percentage of the cost of services after the deductible has been paid. 

Coverage During Unemployment

What happens to insurance coverage if someone loses their job? Most employers can direct their employees to COBRA care providers. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees to continue their health benefits after they lose their job. The employee will have to pay a set amount to their COBRA provider each month. COBRA coverage continues for several months after a job is lost, in the hope that the worker will find another job with health benefits within that time.

It is also possible to get affordable health care coverage outside of the workplace. The Affordable Care Act, or ACA, is designed to help ensure that all Americans have access to affordable health insurance. ACA plans can be sold on or off the health insurance exchange. Your ACA payment amounts will depend on your financial circumstances. They are usually based on how much money you earn (or would have earned) for the year. If you lose your job, it is wise to compare your COBRA rates with the ACA rates to see which plan would be better for you.

How to Reward Good Care?

How do insurance companies know that patients are getting the best rehab care possible? That’s a question that Anthem BCBS substance abuse treatment providers asked themselves in the course of developing a plan. They wanted to reward facilities and medical professionals that demonstrate expertise in helping people recover from their addictions.

The Anthem Behavioral Health Provider Collaboration aims to recognize—through reimbursement incentives—health care professionals and facilities that offer improved treatment outcomes and quality clinical care. These incentives help to ensure that patients at the facilities continue to get the best possible results.

There are three kinds of facilities that are recognized under this program. They are the substance use disorder (SUD)/behavioral health facilities, behavioral health outpatient providers and medical/behavioral health integration providers. Each will use one of three service models—fully integrated, co-located or coordinated. All of these BCBS in-network rehab facilities put their focus on trying to help addicts get back in control of their lives.

The payment program utilizes the Healthcare Effectiveness Data and Information Set (HEDIS) to measure the quality of care that patients receive. You can visit the HEDIS website to learn more about the guidelines. 

HMOs and PPOs: The Facts

There are two basic kinds of health care systems that employers can provide for their workers: HMOs and PPOs. A Health Maintenance Organization (HMO) is a health care system that assumes or shares both the financial costs and the delivery costs associated with providing medical services. A Preferred Provider Organization (PPO) is an arrangement designed to supply health care services at a discounted cost by providing incentives for members to use health providers who contract with the PPO. A PPO also covers services provided by health care workers who are not part of the PPO network.

Most employers can offer their employees both HMO and PPO plans. The following are some examples of different health care plans provided by BCBS. The exact plan that you need will depend on many factors, including how many people in your family will be covered. BCBS plans include Anthem Enhanced Choice, National PPO (BlueCard PPO), Pathway Guided Access HMO Products, Pathway X Guided Access HMO and Pathway X HMO (on Exchange).

If you need immediate guidance on how you can pay for rehab with insurance, please contact us directly to ask specific questions about BCBS in-network rehabs.

Focus On Your Health

Though insurance is important, it shouldn’t have to be the main focus of each recovering addict. The focus of each patient in rehab must be on getting well. Insurance hassles can be troubling, but they shouldn’t divert your attention from this goal. Thankfully, it is possible to focus on recovery instead of insurance costs. The many insurance options available ensure that anyone who needs rehab help can get it.

BCBS in-network rehabs play a vital role every day in providing coverage for patients. With COBRA and ACA coverage, insurance help is available even for those who may not be currently employed.

Each person is different, so each patient at a rehab facility will require a slightly different treatment plan. The length of the treatment plan will vary as well. But the important thing to remember is that BCBS will be able to cover all kinds of treatment plans, regardless of how long they last or what resources you may need. Do not let concerns about insurance coverage prevent you from asking for help. There are ways to solve the issue just as there are many ways to overcome an addiction.

Whether through a BCBS in-network alcohol rehab or a center specializing in other drugs, the help you need is available and so is the insurance coverage you need to access it. Please contact us today for more information about how you or a loved one can start a new, addiction-free life. We can refer you to rehab facilities that can work with your own insurance plan. You can reach us at 912-214-3867. Don’t hesitate to call if you have any questions about breaking an addiction.

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