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Horizon Blue Cross Blue Shield Of New Jersey Health Insurance Rehab Coverage

Horizon Blue Cross Blue Shield of New Jersey offers not only preventive care but also coverage for mental health and substance use disorders. Read on to learn what kinds of treatments and medications are covered and what may need prior authorization.

Horizon Blue Cross Blue Shield of New Jersey provides health insurance to approximately 3.7 million members in 21 New Jersey counties. Not only does that coverage include preventive care but also treatment for mental health and substance use disorders.

That can be comforting to know since many people, when considering treatment for substance use disorders, usually worry whether insurance will cover it and what the costs will be.

Exactly what will be covered will depend on many factors, including the type of insurance plan you have.

Horizon Blue Cross Blue Shield of New Jersey offers several levels of behavioral health coverage, including:

  • Doctors and therapists
  • Online wellness tools
  • Virtual visits
  • Crisis intervention
  • One-on-one and group counseling
  • Substance abuse treatment

Affordable Care Act

The Affordable Care Act named substance use and mental health care as essential benefits, so most people with health insurance can be treated. The type of plan they have will determine what the copay, deductible, and coinsurance amounts will be.

Whether a place offers luxury rehab or more standard care will play into costs, too.

To avoid surprises it’s a smart idea to research in advance. Your insurance provider will be able to answer questions about what is covered, what needs prior approval, and what amount you will be responsible for paying. Rehab centers can answer a lot of questions, too. They work closely with insurance companies and can explain the services they provide and their costs.

Receiving treatment from a doctor or center who is in a network’s plan can save a good deal of money, too.

Horizon Levels of Care

Not only does Horizon Blue Cross Blue Shield of New Jersey offer plans for individuals and families, but they also have Horizon NJ Health, which offers Medicaid Managed Care plans through the NJ FamilyCare program. It also has Medicare Advantage, supplement, and prescription plans.

Horizon also has several levels of care:

  • Gold plans have higher monthly premiums and lower deductibles and coinsurance charges.
  • Silver plans have lower premiums than Gold, but out-of-pocket costs run higher.
  • Bronze plans have the lowest premiums (with a qualifying subsidy, there’s a chance they could be zero dollars) but the highest copay and deductibles.
  • Catastrophic plans are one other option for those who qualify (low income, for example). With a subsidy the monthly premium may be very low or even zero. The deductible tends to be high, however.

When shopping for health insurance plans some things worth considering include:

  • How often you think you’ll need to see your primary care doctor
  • If you see specialists, and if so, how often
  • If you have any special procedures or surgeries planned
  • If you have regular prescriptions

If you need more medical care, a Silver or Gold plan might prove less hardship since they tend to have lower deductibles and lower coinsurance costs. Going in-network can save money, too. Some plans may cover treatment by out-of-network providers, but if they do the costs will be considerably higher, compared to network providers.

Drug and Alcohol Rehab

Does Horizon Blue Cross Blue Shield of New Jersey cover drug and alcohol rehab? Addiction treatment is covered. Often it’s under substance abuse treatment or behavioral health. It may include all or a combination of detoxification, emergency care, inpatient treatment, intensive outpatient treatment, partial hospitalization, therapy, and counseling. It will depend on the patient’s needs. Many procedures require prior authorization, however.

The type of plan you have as well as where you receive treatment will determine how much you will be responsible for. Gold plans mean smaller deductibles, while Bronze plans are the opposite. Coinsurance is something to consider, too, so knowing what your plan covers and what a facility charges for services can help predict costs.

Length of Treatment

The length of treatment Horizon Blue Cross Blue Shield of New Jersey permits may vary.

The National Institute on Drug Abuse (NIDA) recommends looking at a patient’s health (both mental and physical), how long they’ve used, and what they’ve used when shaping an addiction treatment plan. A person’s gender, culture, age, ethnicity, whether they’ve experienced trauma, and other details should be considered. A longer treatment stay (three months, at least) tends to result in better outcomes.

Rehabs work with insurance companies, too, to secure necessary care. Sometimes that means requesting more treatment time for the patient. Some patients may be making progress but need more work, and more therapy can prevent relapse. Sometimes the patient desires more time, too, because they feel they are not quite ready for returning to their pre-rehab world just yet.

Mental Health

Does Horizon Blue Cross Blue Shield of New Jersey also cover mental health? Mental health care is one of the ACA’s essential health benefits, so Horizon does cover treatment for mental health disorders. Mental health disorders and substance use disorders often overlap (co-occurring disorders), so treating both tends to produce better, more lasting outcomes.

Mental health may include specialist visits to counselors and therapists, inpatient and outpatient hospital services, and medications to help manage one’s condition.

The cost of treatment and the number of options a person has will vary on their personal needs and what their plan allows/covers.

Inpatient Rehab

Horizon Blue Cross Blue Shield of New Jersey inpatient rehab involves being checked into an addiction rehab center for around-the-clock treatment. Inpatient rehab can last 30 days or go on for longer: as much as 60, 90, or more days. In rehab, the patient will be treated for their substance use disorder, any mental health issues (when they co-occur), and any other health complications.

Inpatient rehab involves several stages:

  • Assessment. The staff examines the patient. They’ll look at their physical and mental health. If any mental disorder like depression or schizophrenia is untreated, they’ll begin treating that. If any health complications have resulted from substance use, that will be addressed, too. The health picture is used to craft a treatment plan. If detox is needed, that begins right away.
  • Detoxification. Many patients need to detox when they check into rehab. Here, the body is rid of drugs or alcohol (or both). Medication may be administered to minimize the uncomfortable side effects like vomiting or anxiety. In some cases, medical oversight is necessary to keep the patient safe. (Severe alcohol addiction, as well as opioid or benzodiazepine use disorders, can be dangerous to quit cold turkey.)
  • Treatment. This includes behavioral therapies (like cognitive-behavioral therapy) to find potential causes of addictive behaviors. This can help patients develop healthier coping mechanisms and handle stress in more productive ways. Holistic treatments like yoga or meditation can also boost relaxation and ease anxiety. Support groups allow patients to meet others who are on the same journey as they share struggles and advice.
  • Aftercare. Staffers ready the patient for life after rehab. Regular check-ins may be scheduled to note progress. Challenges may be addressed. The patient might also be connected with support groups or counselors closer to home. The goal is to keep reinforcing one’s sobriety and prevent relapse.

Outpatient Services

Horizon Blue Cross Blue Shield of New Jersey outpatient services can sometimes take the place of inpatient care, but they also can serve as an extension of it.

For intensive outpatient programming (IOP), the patient might visit the rehab center a few times a week, often for several hours at a time. They’ll undergo therapy and focus on strengthening their sobriety. Some patients might go from inpatient care to a nearby sober living environment. IOP can help in that in-between time where the patient transitions from living at rehab to living on their own.

Outpatient care can also include behavioral therapies and counseling.

Suboxone Treatment

Suboxone is often used as part of a medication-assisted treatment (MAT) program, particularly to treat opioid use disorder. It contains two drugs, buprenorphine, and naloxone.

MAT blends behavioral therapies and medication to treat substance use disorders. Suboxone (or its generic equivalent of buprenorphine-naloxone) provides many of the effects of opioids, but at a lowered intensity. That combination has been found to help manage withdrawal symptoms and prevent relapse.

Does Horizon Blue Cross Blue Shield of New Jersey cover suboxone treatment? The generic version is covered. The cost will depend on what level of coverage one has. There usually are limits on quantities permitted, too.

Methadone Treatment

Methadone is another drug prescribed for opioid use disorders, also part of medication-assisted treatment (MAT).

Methadone is an opioid agonist with a long half-life. It helps by lowering opioid cravings and lessening withdrawal symptoms. A person prescribed methadone for their opioid addiction should experience less of the intense highs and painful lows that accompany some drug use. That can make it easier to stop using, and reduce the odds of relapse.

Does Horizon Blue Cross Blue Shield of New Jersey cover methadone treatment? It is one of the drugs on its list of approved medications. The exact cost will vary by one’s plan, and quantities may be limited.

Paying for Rehab

Addiction rehab, especially when it involves detoxification, hospitalization, and inpatient care, can be expensive. Fear of a big bill can make some people hesitate over seeking help. Insurance can help with costs, however. Coverage, prior authorization, and going in-network for care can reduce the bottom line significantly.

Deductibles and coinsurance responsibilities are a given. When researching treatment, it’s good to note what deductibles, co-insurance, medications, and co-pays will be.

Insurance companies can answer a lot of questions about costs and what rehabs are in-network. They’ll also tell you what needs authorization in advance.

Addiction centers also can provide answers.

For services not covered by Horizon Blue Cross Blue Shield of New Jersey, many rehabs can set up an installment plan so the financial obligation is more manageable. Financing can sometimes be an option, too.

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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