Tennessee Blue Cross Blue Shield Addiction Treatment Coverage | PAX Memphis TN

Substance Addiction Treatment Coverage

Blue Cross Blue Shield insurance is one of the largest providers of health insurance in the U.S. The company states it covers over 100 million people with plans available nationwide – that’s about one in every three people. Blue Cross Blue Shield represents 36 local and independently owned companies, operated under various plan names.

This type of health insurance is available to individuals through the Healthcare Marketplace. However, Blue Cross Blue Shield also offers a ton of employer group coverage plans – both for-profit and nonprofit organizations.


Blue Cross Blue Shield Policy Coverage for Substance Abuse

Alcoholism was labeled as a disease by the American Medical Association in 1956, and 30 years later, addiction followed. In 2010, the Affordable Care Act — Obamacare — expanded the scope of behavioral health requiring benefits to cover substance abuse treatment as well. Officially defined as a disease, addiction cannot be defined as a  pre-existing condition. In other words, substance abuse disorder cannot be denied and plans on the Health Insurance Marketplace are now required to cover at least a portion of addiction treatment. This means that providers like Blue Cross Blue Shield of Tennessee, are required by law to apply the premiums of its policy holders toward addiction treatment services.

Blue Cross Blue Shield offers several types of coverage plans. Health Maintenance Organizations, or HMOs, require the policy holder to remain in-network when receiving care. This means the policy holder must choose from the available providers “in network” to receive financial compensation for coverage. Most HMOs also require a referral from a primary care doctor to see a specialist.

Blue Cross also offers Preferred Provider Organizations or PPO. This type of coverage provides more flexibility when choosing a provider. These specific plans cover specialists (usually with a requirement for a referral) even if they are not within the network.

When looking over your coverage, it is important to pay attention to what coverage your plan offers. Here are a few of the common Blue Cross Blue Shield plans:

  • Bronze Coverage – Premiums under this specific plan are typically the lowest. However, Bronze coverage includes high deductibles which must be met before coverage is provided. Typically coverage for this type of plan ranges but it typically around 60% of the overall medical bill.
  • Silver Coverage – Blue Cross silver coverage offers a slightly higher premium but tends to offer more coverage for medical services after the deductible is met. This policy commonly covers 70% of your medical bill.
  • Gold Coverage – Deductibles on this specific plan are generally more affordable. Benefits are typically the same, however, the premiums on Gold policies are much higher. This plan is most commonly used due to the 80% coverage of medical bills.
  • Gold Coverage – Deductibles on this specific plan are generally more affordable. Benefits are typically the same, however, the premiums on Gold policies are much higher. This plan is most commonly used due to the 80% coverage of medical bills.

It is important to remember that each policy typically includes co-pays as well as different benefits varying from each tier. You may also find varying partial hospitalization, detoxification, and hospital benefits with each plan.

Levels of Care Available With Blue Cross Blue Shield

The Affordable Care Act (ACA) requires insurance companies to provide services and benefits to those struggling with substance abuse/mental health disorders. This legislation ensures that individuals receive the same level and type of coverage for mental health services just as they would for any medical need. Take a look at some of the most common services necessary for substance abuse treatment and coverage for drug/alcohol rehabilitation.

  • Drug/Alcohol Detoxification – Many addicts require assistance with the detoxification process. This process includes managing the phases of acute withdrawal symptoms while ensuring the safety and comfortability of the individual recovering from substance abuse disorder. This level of care may require professional personnel and emergency facilities of a hospital or a rehab facility. PAX Memphis is able to coordinate detoxification level of care for individuals requiring a full drug and/or alcohol detoxification.
  • Medication-Assisted Treatment (MAT)– Many Blue Cross plans cover medication-assisted treatment programs for those struggling with substance abuse. This may include treatment plans including the use of products such as Suboxone or Methadone. Your doctor will need to provide information about this specific necessary treatment to your insurance provider in order to obtain coverage.
  • Inpatient Rehabilitation – This specific level of care at PAX is typically offered to individuals after coordinated care for detoxification. Blue Cross Blue Shield coverage for residential treatment at PAX Memphis in Memphis Tennessee for substance abuse disorder when individual members experience extreme impairment and the inability to function in the community with only outpatient treatment and services. PAX Memphis residential treatment typically includes a structured, therapeutic environment offering 24-hour services.
  • Intensive Outpatient Program (IOP) – Blue Cross offers coverage for intensive outpatient program for individuals suffering from substance abuse disorder that may require further assistance with stabilization, symptom reduction, or relapse prevention services. Typically, clients at PAX Memphis will transition from a higher level of care to IOP.

Pax Memphis is proud to accept Blue Cross Blue Shield health insurance. We cannot guarantee that every type of Blue Cross policy will cover your treatment at PAX, but our team is here to help make this process easy for you. When you call us, we can provide a confidential and free insurance verification of benefits for you. You can also verify your benefits online today!

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