Blue Cross Blue Shield of Michigan & Addiction Rehab Coverage

Blue Cross Blue Shield of Michigan (BCBSM) is a nonprofit mutual insurance company and the most significant health insurer in the state. Formed in 1975, though its roots go back to 1939, BCBSM insures 4.5 million in the state—and another 1.6 million in other states—with HMO, PPO, Medicare, and Medicaid plans.

Last Edited:

02/09/2022

That insurance also covers treatment for substance use disorders and other mental health or behavioral health problems with inpatient, outpatient, and partial hospitalization plans.

While how much and what specific types of treatments BCBSM covers depends on the individual’s specific insurance policy, some level of coverage for mental health and substance use disorders is mandated by the Affordable Care Act (ACA).

Affordable Care Act

The ACA—its full name is the Patient Protection and Affordable Care Act (ACA), though it’s also known as ObamaCare—requires that services listed as essential health benefits, including mental health disorders in general and substance use disorders in particular, must be covered at least as much as medical and surgical services.

This requirement applies to all Health Insurance Marketplace plans, plus most private insurance plans: individual, family, and small group plans.

In addition to requiring coverage, accessing those benefits cannot be made more difficult by:

  • Requiring higher deductibles, copayments, or out-of-pocket costs
  • Limiting the number of times services can be used
  • Requiring authorization more often than for other services

In practice, even plans that aren’t required to provide these essential health benefits (self-insured or large-group plans) usually do.

Does Blue Cross Blue Shield of Michigan Cover Drug and Alcohol Rehab?

All health insurance plans offered by Blue Cross Blue Shield of Michigan cover drug and alcohol rehab as essential health benefits. How much and what is covered depends on the individual’s insurance plan.

On its website, BCBSM states that the best way to determine this is to check your member handbook, log on or create an account on the website or mobile app and look under My Coverage, or call the Customer Service number on the back of your membership card.

There you can learn about:

  • Any copay, coinsurance, and deductible (how much you must pay out-of-pocket before insurance kicks in) requirements
  • How many visits or days are covered and how much.
  • If authorization is required to access services.

Sometimes, individuals must first pay an out-of-pocket maximum and a deductible or are charged a coinsurance or copay fee.

Plans are often divided into metal tiers: bronze, silver, gold, and sometimes platinum. The more precious the metal, the more expensive the plan and the better the coverage:

  • Bronze plans: Insurer pays 60%, insured pays 40%
  • Silver plans: Insurer, 70%; insured, 30%
  • Gold plans: Insurer, 80%; insured, 20%.
  • Platinum: Insurer, 90%; insured, 10%.

In addition, there are two basic types of plans: HMO and PPO:

  • Health maintenance organizations (HMO). Individuals choose an in-network primary care physician (PCP) who must authorize any visits to a specialist. This means less paperwork and lower costs but less freedom. Out-of-network services usually aren’t covered.
  • Preferred provider organizations (PPO). Individuals can go to any physician or specialist they like (though in-network is usually cheaper).
  • Medicaid. Managed care health plan for Medicaid members, available in 32 Michigan counties through Blue Cross Complete of Michigan.
  • Medicare. BCBSM has an all-in-one, supplemental, and Part D prescription drug plan, some with no monthly premium.

Unless it’s an emergency, always check your coverage before agreeing to treatment. Blue Cross Blue Shield of Michigan members can call the number on the back of their member ID card or visit the BCBSM website.

What You Can Expect from Blue Cross Blue Shield of Michigan In Rehab

Rehab is a multistage process that begins with the intake interview, the initial assessment of the individual’s disorders, and rehab needs. The type of services varies from individual to individual.

Blue Cross Blue Shield of Michigan covers many of them.

Dual diagnosis

Roughly half of all people with a substance use disorder also have a mental health disorder, known as co-occurring disorders or dual diagnosis:

  • Some develop a mental health disorder because of their substance use.
  • Some start using substances in an attempt, conscious or not, to control their mental health disorder but then develop an SUD.
  • Sometimes which disorder is the cause can not be determined.

No matter which disorder came first, both need treatment.

Detox

Other people are not ready for rehab because they are still using the substance when they arrive at intake or have not yet gone through withdrawal. These individuals need to complete detoxification, the natural process by which the abused substances leave the body.

The detox process is sometimes conducted at a separate site where withdrawal can be medically monitored because, like substance use, withdrawal can be life-threatening. Quitting abruptly, cold turkey, particularly with addictions to alcohol and benzodiazepines, can be fatal if medical assistance is not available.

A gradual taper—reducing the amount of alcohol consumed—or the use of safer opioid replacements—such as methadone or buprenorphine (Suboxone)—can reduce the risks but takes more time.

Behavioral therapies

Substance use disorders are caused by genetics and behavior. Unfortunately, you can’t change your genetics, but you can change your behaviors, so behavioral therapies are the top tool used in rehabs for substance use disorders.

Behavioral therapies are psychotherapies or talk therapies that help you recognize and change negative thoughts that may be causing or contributing to your substance use disorder. Most are variations of cognitive-behavioral therapy (CBT), a short-term (usually 20 sessions or less) goal-oriented therapeutic approach.

Aftercare

Because formal rehab will eventually end, but relapse for SUDs remains a lifelong risk, from day one, your rehab counselors should be working on your aftercare, an individualized plan to help prevent relapse.

Often this includes a peer support group—such as Alcoholics Anonymous or SMART Recovery—meetings with other people in recovery who provide moral support and practical tips on how they are keeping sober. Because AA—the best known such group—uses a tool called the Twelve Steps, when rehabs encourage participation in such groups, it’s known as 12 step facilitation.

Blue Cross Blue Shield of Michigan Outpatient Services

One of the first things decided by intake is how intensive the care needs to be. Some people need help but don’t need to be watched 24/7. They may only need outpatient services.

Outpatient rehab is when the individual visits the rehab center for services but does not live there. The benefits of outpatient treatment include:

  • Outpatient care is less disruptive. It may be possible to keep working or attending school during treatment.
  • Outpatient care is more like post-rehab life. After rehab, individuals will still have to take care of themselves and their responsibilities.
  • Outpatient care is less expensive. Because of the lower costs—you eat, sleep, and live at home without 24-hour supervision—up to twice as many days of outpatient care may be covered as for inpatient.

There are three levels of outpatient care:

  • Standard outpatient. Up to nine hours per week.
  • Intensive outpatient program (IOP). Between nine and 19 hours per week.
  • Partial hospitalization program (PHP). Also called Day Hospital. At least 20 hours per week.

Blue Cross Blue Shield of Michigan may cover outpatient care. For example, in its State Health Plan PPO, 90% (up to $3,500) of in-network care is covered; out-of-network, 50% or less.

The specifics of your plan’s coverage may vary.

Blue Cross Blue Shield of Michigan Inpatient Rehab

For some people, outpatient services aren’t enough. At least in the early days of rehab, they do need to be watched 24/7 to avoid relapse. They need residential or inpatient treatment.

One reason people who want to stop their substance use disorders relapse are triggers: people, places, and situations that they associate with past substance use. With inpatient rehab, these triggers are more easily avoided.

During inpatient treatment, the individuals not only get therapy at the center but also live there. They:

  • Wake up in the rehab center.
  • Eat meals at the rehab center.
  • Attend therapy, counseling, and educational classes at the rehab center.
  • Engage in recreation at the rehab center.
  • Go to sleep at the rehab center.

Inpatient rehab is more expensive, however. Many insurance plans, including some of those offered by BCBSM, will not cover inpatient rehab as long as outpatient services.

Length of Addiction Treatment Blue Cross Blue Shield of Michigan Covers

While substance use disorders (SUD) are now considered a disease or illness, they’re not the type that goes away or is cured with a round of antibiotics. They are chronic conditions such as hypertension, diabetes, and asthma that develop because of a combination of genes, environment, and behavior.

There is likely no cure once an SUD is established, only management. People with SUD not only have to stop using the substance; they have to learn not to use the substance, to avoid situations where they might be tempted to use it, and to find new ways to cope with problems without using it. That takes time.

How much time varies. Withdrawal, the physical symptoms someone with SUD experiences after stopping substance use, usually ends in a week or two. Psychological withdrawal can last much longer. Without additional therapy and treatment, the substance use is much more likely to resume.

Although the National Institute on Drug Abuse (NIDA) says 90 days should be the minimum, the default duration of substance abuse treatment—based on the Minnesota Model for treatment for alcohol use disorders and established in the 1950s—is 28 days.

Blue Cross Blue Shield of Michigan’s State Health Plan PPO (October 2020) covers 28 days of inpatient substance use disorder treatment, with a possible additional 28 days in the same calendar year after at least 60 days. Coverage is twice as long for intensive outpatient programs (IOP). Two IOP days equal one inpatient day.

Other employers’ plans may differ.

Does Blue Cross Blue Shield of Michigan Also Cover Mental Health?

Mental health treatment is another essential health benefit that BCBSM covers. The most common behavioral health conditions covered, besides substance use disorders, include:

  • Anxiety. Feeling afraid or worried out of proportion to the real dangers.
  • Depression. Persistent feelings of hopelessness (at least two weeks) that interfere with your ability to concentrate, sleep, eat, or function.
  • Attention-deficit hyperactivity disorder (ADHD).  An inability to concentrate on one thing, control impulses, or sit still, especially among younger people but also some adults.

Again, the extent of BCBSM’s coverage varies. Except in emergencies, check your coverage before seeking treatment.

Blue Cross Blue Shield of Michigan Behavioral Health Insurance

Blue Cross Blue Shield of Michigan’s behavioral health plans refer not only to substance use disorders and mental health disorders but also conditions such as autism spectrum disorders and others that affect emotional well-being, such as chronic pain, post-traumatic stress disorder, suicidal thoughts.

BCBSM’s behavioral health benefits may also apply to comorbid medical or substance use conditions—also known as co-occurring disorders or dual diagnosis—if they meet the necessary criteria.

Behavioral health insurance may not cover holistic treatments such as neurofeedback, art or music therapy, or hypnotherapy.

Does Blue Cross Blue Shield of Michigan Cover Suboxone?

Medication-assisted treatment (MAT) is an outpatient treatment that may be covered by your Blue Cross Blue Shield of Michigan health insurance plan.

Suboxone, a tamper-resistant formulation of buprenorphine and naloxone, is approved for MAT. Usually prescribed as a sublingual (under the tongue) pill or film, Suboxone is used in medication-assisted treatment (MAT).

Suboxone provides a low dose of opioids to prevent withdrawal symptoms and control cravings. Because it has a low plateau (the point at which more of the drug doesn’t increase its effects), people on Suboxone alone don’t get high. If they try, they risk overdose.

If the Suboxone is crushed or dissolved for snorting or intravenous use, the naloxone—an opioid antagonist also used solo as an overdose reversal drug—is activated and cancels out the buprenorphine’s effects.

Suboxone is federally approved and effective in conjunction with counseling and other therapies, such as cognitive-behavioral therapy, so BCBSM should cover it.

Does Blue Cross Blue Shield of Michigan Cover Methadone Treatment?

Another form of medication-assisted treatment is methadone. It has a bad reputation because some heroin addicts remain on methadone for years, prompting the claim that it just replaces one addiction for another.

It’s not, because while methadone use can continue for years—and at least 12 months, according to NIDA—it does not cause intoxication or euphoria by itself. To prevent diversion or misuse, people in methadone maintenance usually visit a doctor’s office or clinic for their daily dose.

BCBSM also may cover methadone maintenance treatment.

Paying for Services That Are Not Covered by Blue Cross Blue Shield of Michigan Insurance Policy?

Since few (if any) health insurers cover 100% of the cost for substance use disorders, and some services (such as neurofeedback and other holistic treatments) may not be covered at all, most people will have to pay for at least a portion of treatment out-of-pocket.

Financial assistance may be available.

The Advanced Premium Tax Credit may be available to those:

  • Who buy insurance (no employer-provided plans)
  • Whose employer-provided plan costs more than 9.5% of their income and covers less than 60% of health care costs
  • Whose income is less than four times the federal poverty level

The cost of health care plans in their area may also influence eligibility.

In Michigan, a cost-sharing reduction plan may cover up to 94% of all health care costs, including SUD treatment.

Some employers offer an employee assistance program (EAP) or provide some counseling services at no cost.

The federal government also has subsidies for qualified individuals and their families, including Medicaid and the Children’s Health Insurance Program (CHIP).

Other possible sources of financial assistance include:

  • Churches.
  • Charities.
  • Rehab centers (scholarships, a sliding-fee scale, or a time-payment plan).
  • Government grant.
  • A health savings account (HSA).
  • Individual savings account.
  • An individual retirement account (IRA), 401(k), or other retirement savings account.

Sources

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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