Alcoholics and drug addicts across the country know the importance of quality health insurance. Thankfully, Blue Cross substance abuse insurance has that near-nationwide reach many patients need when attempting a recovery or rehabilitation from an addiction. Still, there is much to consider when choosing Blue Cross. For example, how do you know whether an HMO or a PPO plan is right for you?
First: Is Rehab and Detox Covered?
Blue Cross has a comprehensive network of physicians and facilities that provide behavioral therapy services. From full-service inpatient facilities like hospitals and rehabilitation care centers to intensive outpatient therapy, your detox effort can be covered by Blue Cross substance abuse insurance.
However, the relevant law that oversees mental health and substance abuse insurance regulation has left exemptions for some entities that could leave you without coverage at all. For example, if your employer fully funds its own healthcare plan, it can opt-out of the obligation to provide coverage for mental health services. Also, businesses that employ between 2 and 50 people can opt-out, even if they don’t fund their own plan. Also significant is those companies that would incur a 2% cost increase in the first year of providing this coverage.
Barring these exemptions, you are most likely eligible for coverage that is essentially equal to any other medical or surgical coverage, such as broken bones, concussions or eye surgery. That’s the crux of the Mental Health Parity and Addiction Equality Act that went into effect in 2010.
The Differences Between PPOs and HMOs
Fundamentally, a PPO and an HMO perform the same function: they provide a patient with a network of physicians, specialists, pharmacies and facilities that provide healthcare services. In both cases, the healthcare providers within these networks are the cheapest option, and if a patient chooses to receive care from someone outside the network, they will pay more.
An HMO is more restrictive in the sense that you will have to see a primary care physician and get a referral before you can see a specialist. This can have negative effects on addicts since this increases the wait time before you’ll be able to enter a rehab facility or detox program. However, if you need a service (i.e. a psychiatrist) that is provided by your HMO but is too far away for you to reach, your HMO will pay for you to see a closer out-of-network doctor.
A PPO does not usually require that you see a primary care physician before seeing a specialist (though there are exceptions, such as an inordinately expensive medical procedure), which makes it easier to get more advanced help more quickly. PPOs also allow you to seek out-of-network care, and once you’ve hit the deductible limit, you will be covered for a certain percentage of the cost.
Blue Cross substance abuse insurance is always a complicated issue, especially if you’re seeking a specific type of coverage. But there is help — fill out the form to the right of this page to check your insurance coverage for drug rehab right now.