Blue Cross Blue Shield of New Mexico & Addiction Rehab Coverage

Blue Cross and Blue Shield of New Mexico—a division of Health Care Service Corporation, an Independent Licensee of the Blue Cross and Blue Shield Association—represents the healthcare needs of almost 630,000 New Mexicans, including behavioral health in general and substance abuse treatment in particular.

Last Edited:

02/09/2022

How much of that treatment is covered varies by state and plan. New Mexico requires that insurance plans cover more than most.

Affordable Care Act

Behavioral health wasn’t always covered well or at all until the Patient Protection and Affordable Care Act (ACA), also known as ObamaCare, declared that mental health and substance use disorder services are essential health benefits.

That meant that plans for individuals, families, small groups, and on the Health Insurance Marketplace need to cover behavioral health the same as medical and surgical benefits. Access to mental health and substance use services cannot be more restricted by:

  • Higher deductibles or copays or out-of-pocket costs.
  • Allowing fewer days of treatment or physician visits to be covered
  • Making treatment authorization harder to get

ACA does not require the same parity from self-insured and large-group plans, but most do, according to a 2019 survey.

Does Blue Cross Blue Shield of New Mexico Cover Drug and Alcohol Rehab?

The ACA applies to Blue Cross Blue Shield of New Mexico, so rehab treatment for alcohol and drug use disorders is covered, at least partially. How much depends on the type and level of the plan.

The two main types of plans are:

  • Health Maintenance Organization (HMO) plans:
    • Require a Primary Care Physician (PCP)
    • Requires a referral from a PCP for any specialist services
    • Only pays for in-network medical visits.
    • Some services are only paid for after the client has already spent a certain sum of money on their healthcare in the current year (a deductible)
  • Preferred Provider Organization (PPO) plans:

There also are up to four metal levels of care, determining what percentage of costs the client pays. When the client pays a greater percentage, the premiums are lower but the deductible is higher; when they pay less, the premiums are higher but the deductible is lower.

In general, with the various metal plans, the share of health care costs the client must pay is:

  • Bronze: 40%
  • Silver: 30%
  • Gold: 20%

With platinum plans, where they are available, the client usually pays 10%. Although there are Marketplace platinum plans available in New Mexico, Blue Cross Blue Shield of New Mexico does not currently seem to offer any platinum plans.

Before treatment begins, individuals may need to undergo detoxification, a period of abstinence during which their bodies complete physical withdrawal from drug use.

A detox may be accomplished:

  • Cold turkey: Abruptly stopping the substance use. The physical withdrawal symptoms usually stop within two weeks.
  • Tapering off: The use of medication-assisted treatment (MAT) drugs, such as Suboxone, to gradually ease off of drug use. This is preferred in severe cases of addiction involving alcohol and benzodiazepines when withdrawal can be life-threatening.

Does Blue Cross Blue Shield of New Mexico Cover Suboxone?

Medication-assisted treatment (MAT) isn’t just for detox. It can be used to control cravings and prevent alcohol or opioid withdrawal to help individuals begin and stick with treatment. It may continue post-rehab into aftercare programs.

Because MAT may continue long after rehab, many—including medical professionals—call it trading one addiction for another. That’s not true unless people with high blood pressure or diabetes are addicted to the drugs they use to control their condition.

MAT, properly prescribed and used, does not cause euphoria. The only medications approved as MAT for opioids are Suboxone (buprenorphine plus naloxone), methadone, and naltrexone.

Naltrexone is different from the other two because:

  • It is not an opioid
  • It doesn’t prevent withdrawal, only euphoria from opioids.

Suboxone and methadone are opioids. If taken off prescription by people without an existing opioid use disorder, they may cause euphoria. For existing addicts, however, they will only ease the craving, reduce the withdrawal symptoms, because:

They don’t provide the intense rush of heroin, fentanyl, or OxyContin, and other prescription opioids. The effects are gradual and plateau but last longer. This makes them ideal for MAT but a poor choice for getting high.

Suboxone has another built-in safety measure. In addition to the opioid buprenorphine, the Suboxone formulation also includes naloxone, the opioid antagonist found in the opioid overdose reversal drug Narcan.

When taken as prescribed—a pill or sublingual film, the naloxone remains inert. If the pill is crushed and snorted or dissolved for intravenous use, the naloxone is activated and cancels out the buprenorphine.

Because buprenorphine is sometimes diverted, politicians, law enforcement, and judges don’t always permit its use. Check with Blue Cross Blue Shield of New Mexico to see if it is covered.

Does Blue Cross Blue Shield of New Mexico Cover Methadone Treatment?

Methadone is another MAT that has a bad reputation it doesn’t deserve. One reason is that while there is no standard recommended duration for Suboxone MAT use, the National Institute on Drug Abuse (NIDA) says methadone should be used for at least 12 months, and sometimes years.

Methadone prevents the pains associated with opioid withdrawal, but it can’t cause euphoria. The risk of methadone abuse is that the people will take multiple doses in the attempt to get high that they overdose. To prevent this, methadone is usually dispensed one dose at a time in a doctor’s office or clinic.

Check with Blue Cross Blue Shield to find out if a plan covers methadone treatment.

Blue Cross Blue Shield of New Mexico Outpatient Services

There are two basic levels of care: outpatient and inpatient.

Outpatient treatment for substance use disorders and mental health issues is when individuals visit the treatment center but do not live there.

Outpatient treatment is closer to how life will be post-treatment. People still get therapy but have more freedom, independence, and the ability to keep their lives as close to normal as possible.

Outpatient clients are also exposed to the triggers (people, places, situations), temptations, and causes of addiction. It’s good practice if they can resist. If not, they may need inpatient treatment.

The three main degrees of outpatient treatment are:

  • Outpatient. Requires nine hours or less per week at the rehab center, spread out over about three days. Individuals in outpatient treatment can work a job, go to school, and hang out with friends and family.
  • Intensive outpatient programs (IOP). This requires a greater commitment of time, between nine and 19 hours weekly, usually five days a week. Employment, school, and leisure activities are still possible.
  • Partial hospitalization programs (PHP). This requires at least 20 hours weekly, spread out over five-to-seven days. There’s little time for anything but therapy-related activities. Also called Day Hospital.

Blue Cross Blue Shield of New Mexico Inpatient Rehab

Inpatient treatment or residential treatment is when individuals live at the treatment center. In addition to daily therapy and other treatments (groups, classes, activities), they also sleep and eat at the center. This is to allow as few opportunities or causes for relapse as possible.

Inpatient treatment is for more severe SUD. People in inpatient treatment need constant monitoring and for help to be available 24/7 if they are about to relapse.

Inpatient treatment is highly structured. Clients are told when to get up, when to eat, when to take medications (if any), and when to engage in therapeutic practices (classes, therapy, group therapy, holistic activities).

This is because inpatient rehab requires unlearning old habits, behaviors, and ways of thinking and learning new ones. Such learning after SUD changes the brain’s reward system requires constant activity and repetition.

Length of Addiction Treatment Blue Cross Blue Shield of New Mexico Covers

Just as no two substance use disorders are the same, and no treatment for SUD works for everyone, neither is there a standard length of time that always works.

Four weeks (28 days) or one month is a common length but it doesn’t seem to be based on science. Sometimes treatment lasts as little as seven days, though that may not even be long enough for the drugs to leave the body. Substance use often starts up again.

According to the former medical director of the US Air Forces’ first addiction treatment program, the 30-days length was based on bureaucracy: any longer, the individual would have to be reassigned.

In 2018, the National Institute on Drug Abuse (NIDA) said that rehab, inpatient and outpatient, needs to be at least three times as long (90 days)—and maybe much longer—or it isn’t likely to last. That’s because it takes the brain at least 90 days without alcohol or drugs to regain its normal decision-making.

One 2009 study found that 30% of people in SUD treatment drop out in the first month, and at least 50% have dropped out by the end of three months.

That 90 days of treatment doesn’t necessarily have to be residential or inpatient. Thirty days of inpatient rehab followed by 60 days in an intensive outpatient program (IOP) might work.

Rehab length should be based on:

  • How long the client’s substance use has gone on
  • If the client has become dependent on or addicted to the substance used
  • The willingness and ability of the client to stop substance use
  • The type of treatment needed

Without mental health and substance use disorder health coverage, the ability to pay would be a greater factor. How much and for how long Blue Cross Blue Shield of New Mexico will cover depends on the specific plan: individual, family, Medicare, Medicaid. Contact them directly.

Does Blue Cross Blue Shield of New Mexico Also Cover Mental Health?

Treatment for mental health disorders is another essential health service required by the ACA. Mental health disorders include:

As with SUD, the level of benefits can vary.

Blue Cross Blue Shield of New Mexico Behavioral Health Insurance

BCBSNM lists which services are covered, including:

  • Residential treatment centers (authorization required)
  • Inpatient Psychiatric Hospital Services (authorization required)
  • Inpatient Professional Services
  • Outpatient Hospital Services
  • Intensive Outpatient for Substance Abuse and Co-occurring Disorders
  • Day Treatment Services
  • Evaluation
  • Psychological Testing
  • Counseling therapy (some may require authorization)
  • Pharmacy services (some may require authorization)
  • School-Based Counseling

Behavioral health includes not just mental health and substance use disorders but also dual diagnosis or co-occurring disorders. That’s when someone has a mental health problem and a SUD at the same time. Approximately 50% have both, and each disorder needs to be treated concurrently.

A new law in New Mexico that went into effect in January 2022 makes that treatment more affordable.

Under the legislation, Blue Cross Blue Shield of New Mexico and other insurers in the state can’t apply any cost-sharing measures—copays, coinsurance, deductibles, or premiums—for behavioral treatment services. It’s a five-year experiment to see if it will reduce substance abuse rates and lower overall healthcare costs.

What You Can Expect from Blue Cross Blue Shield of New Mexico In Rehab

Rehab consists of:

  • Intake. The initial interview and assessment upon entering rehab.
  • Detox. The elimination of substances from the body through abstinence or tapering, often in a medical facility.
  • Medication-assisted treatment (MAT). The use of approved drugs to taper off substance use or prevent withdrawal and relapse while SUD treatment begins. Also called narcotic replacement therapy (NRT),
  • Behavioral therapies. The use of psychotherapies, primarily cognitive-behavioral therapy (CBT), to retrain the brain to cope without substance use.
  • Twelve-step facilitation. To encourage participation in peer support fellowships—such as the 12-step groups Alcoholics Anonymous and Narcotics Anonymous or non-12-step alternatives such as SMART Recovery—during and after rehab.
  • Holistic therapies. The use of mindfulness exercises (meditation, yoga and other movement therapies, riding and caring for horses, and art or music therapies) to maintain abstinence.
  • Aftercare. A personalized plan to prevent relapse after rehab.

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

Even with the legislation, Blue Cross Blue Shield of New Mexico, like most health care plans, won’t pay all of the costs of alcohol, drug, and mental health treatment services. The only way to find out how much coverage people have is to contact their health insurer and ask.

With bronze plans, the insured pays 40% of the costs, silver 30%, gold 20%, and—if available—platinum 10%. The dollar amounts they must pay depend on factors such as:

  • Were detox services used?
  • Was the treatment facility inpatient or outpatient?
  • If inpatient, was it in a resort-like luxury rehab?
  • How long did the treatment last?
  • Was medication-assisted treatment used?

For those who need help paying health insurance costs, the federal government offers subsidies—including Medicaid, the Children’s Health Insurance Program (CHIP), and for those with qualifying household incomes

Help paying for health insurance may also be available from: :

  • Employers.
  • Churches and other charitable organizations.
  • Some rehabs through scholarships, a sliding-fee scale, or a time-payment plan.
  • Government grants.
  • A health savings account (HSA), an individual savings account, or a retirement account such as an IRA or 401(k).

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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