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Important Details on Blue Cross Blue Shield PPO Insurance for Rehab

Many drug addicts and alcoholics need exceptional healthcare coverage in order to successfully kick their habits. With Blue Cross Blue Shield PPO insurance for rehab, substance abuse and mental health patients can get full coverage on the full range of detox and rehabilitative services. Thanks to the Mental Health Parity and Addiction Equity Act that went into affect in 2010, insurers like Blue Cross Blue Shield are treating substance abuse coverage equal to everyday medical and surgical benefits. But there are still many things to think about when choosing the PPO that’s right for you.

How Far Does a PPO Go?

A PPO — preferred provider organization — is a network of physicians, specialists, pharmacies and facilities that provide a service similar to that of an HMO (health maintenance organization), though a PPO doesn’t require you get a referral from a primary care physician before seeing a specialist. Many addicts will find this to be a benefit, as waiting for an appointment from your physician, then waiting for an appointment from a specialist, and finally waiting for care from a facility or clinic can take unbearably long.

However, depending on your plan details, your PPO might require that you see a primary care physician or get approval from another source before the insurer will pay for an expensive medical service.

PPOs do have a distinctive advantage over HMOs: out-of-network coverage. Most PPOs will reimburse your out-of-network visits once you’ve met the deductible for your plan. This is especially important for substance abuse or mental health patients, as the specialist you’re seeking may not be in your network. If you continue to see this particular specialist, you’ll begin seeing coverage after you’ve hit your deductible.

What Does Blue Cross/ Blue Shield Insurance Cover?

Since 2010, when the MHPAEA when into effect for U.S. healthcare insurers, Blue Cross Blue Shield has made a significant effort to include behavioral health in its coverage umbrella:
* Inpatient admissions to a full-service hospital or other healthcare facility;
* Intensive outpatient therapy;
* Partial hospitalization depending on detox needs;
* Residential care facilities.
For addicts and alcoholics, having access to these options can be a lifesaver. Especially in the case of inpatient admissions — often a detox or rehab program is most effective when the patient is admitted and cared for at all hours of the day.

For outpatient therapy, addicts can seek help from psychologists and psychiatrists, not just physical specialists and surgeons. The MHPAEA has made it clear that those suffering from substance abuse or mental health disorders must be given the same level of treatment as those who suffer from physical injuries like broken legs or influenza. However, self-funded private employers can choose to opt-out of providing behavioral therapy coverage, and so too can small businesses.

Where To Go From Here

Since Blue Cross Blue Shield PPO insurance for rehab varies depending on your specific plan details, contact your insurance sponsor to determine what you’re covered for. For more information, fill out the form to the right of this page to find out what coverage you have available right now.

About The Contributor
The editorial staff of Recovery First is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands... Read More