Does Blue Shield of California covers Opioid rehab?

Drugs like heroin, fentanyl, morphine, and oxycodone are all included in a class of highly addictive illegal and prescription drugs called opioids.^{1 what are opioids?} Opioids caused nearly 75% of drug overdoses in 2020 and continue to affect thousands of families nationwide.^{2 Intro} Similar to much of the U.S., California has seen a significant increase in opioid overdoses over the past 20 years.^{3 p.3 OVERVIEW AND STATUS OF CALIFORNIA COMMUNITIES)}

Many state and local organizations have taken the initiative to effectively address the opioid epidemic by building a comprehensive approach to monitoring opioid use and overdose.^{3 p.6} Blue Shield of California understands the importance of fighting the opioid crisis and treating opioid addiction by providing affordable, high-quality healthcare access. Blue Shield of California partners with healthcare providers and communities to develop tailored treatments focused on preventing opioid misuse and supporting the long-term recovery of those struggling with opioid addiction.⁴

If you or a loved one is ready to seek help for your addiction, affording treatment doesn’t have to be a hurdle. There are hundreds of in-network Blue Shield inpatient drug rehab centers in California. Many facilities provide various evidence-based treatment options like medical detox, inpatient rehab, outpatient rehab, behavioral interventions, and addiction aftercare.

What Does Blue Shield of California Insurance Cover for Opioid Treatment?

Various options for opioid treatment are available through Blue Shield California Healthcare plans. The cost for these treatments may be partially or completely covered, depending on your specific Blue Shield policy. Other factors that may affect coverage level include the services you need and the facility you choose to attend.

Even though everyone is different, treatment for opioid addiction commonly requires a blend of treatments, like behavioral interventions and medication-assisted therapy (MAT), to effectively overcome opioid addiction.^{5 Recovery is possible} Common options covered under most Blue Shield of California insurance plans include:

• Screenings and interventions: Drug screening tests and interventions are used to diagnose and assess addiction. A mental health provider performs different tests to better understand the severity of your addiction and recommend the best methods for effective treatment.^{6 How are behavioral therapies used to treat drug addiction?}
• Medical detox: The process of eliminating harmful substances, or detox, happens when a person stops using opioids. Detox is a necessary step in effectively treating opioid addiction. Many medications used to aid in treatment aren’t effective unless the person’s body is completely rid of opioids.^{6 opioids} Healthcare professionals help patients through detox by providing certain medications to aid in the withdrawal process and stop cravings.^{6 How are behavioral therapies used to treat drug addiction?}
• Inpatient and residential rehab: Inpatient and residential rehab can be particularly helpful for people with severe addictions. Many standard programs last between 30 and 90 days, but some offer longer stays. They provide a safe space for you to live while in recovery and separate from your everyday environment to focus on getting better. In inpatient rehab, you develop healthy coping skills to better handle stressful situations and promote long-term sobriety.^{6 How are behavioral therapies used to treat drug addiction?}
• Outpatient rehab: Many outpatient programs include similar treatments to inpatient rehabs and are a great choice for treating mild to moderate addictions. With care options like medical detox and behavioral therapies, you can still live at home while focusing on building coping skills to fight addiction triggers and prevent relapse.^{6 How are behavioral therapies used to treat drug addiction?}
• Behavioral therapies: Opioid addiction is commonly treated with a combination of behavioral interventions and medication.^{5 Recovery is possible} Cognitive-behavioral therapy (CBT) is effective in treating substance use disorder by helping patients understand what triggers drug use and change their behaviors.^{6 How are behavioral therapies used to treat drug addiction?}
• Treatment for co-occurring disorders: It’s common for someone to suffer from a mental health illness along with addiction. ^{7 intro} Dual diagnosis or a co-occurring disorder is thought to happen in 2 different ways. Substance abuse issues can develop from self-medication of mental health disorders with drugs and alcohol. Excessive, prolonged drug use can also cause a mental health disorder to arise over time. Mental health professionals recommend treatment in a mental health facility to tackle both issues simultaneously for the most efficient treatment.^{7 Does One Cause The Other? + What Should I Do?}

As a member of the Blue Cross Blue Shield Association, Blue Shield of California has developed strategies to aid in opioid addiction prevention and provide the best level of care for those struggling with addiction.⁴ By promoting best practices in prevention and treatment, Blue Cross Blue Shield has improved Prescription Drug Monitoring Programs (PDMP) to reduce the risk of excessive opioid use and increased access to MAT for those seeking treatment for opioid addiction.⁸ Hundreds of opioid rehab centers in California accept Blue Shield of California.

What Blue Shield of California does not cover for Opioid Treatment?

Blue Shield of California offers coverage for standard evidence-based treatments like psychotherapy and pharmacotherapy, but some additional non-medical amenities may not be covered. As with most insurance providers, Blue Shield of California limits the amount of coverage for services that aren’t essential for effective treatment.

Services like those offered in luxury and private rehabs often take a holistic approach to treatment, focusing on the person as a whole. Supplemental services and non-medical amenities, like holistic care, recreation programs, food delivery, private treatment services, and alternative therapy, can be very beneficial to many but likely won’t be covered under most Blue Shield California healthcare plans.

How Much Does Opioid Rehab Cost?

Many factors can affect the cost of rehab, such as your level of insurance coverage, the treatment services you choose, and the facility you choose to attend. Treatment in outpatient rehab is often more affordable than in inpatient or residential rehab. If you decide on a luxury or private rehab facility that offers exclusive amenities like spa treatments or a fitness center, you’ll likely pay more than the price of a standard residential rehab.

The duration and intensity of the services you require also contribute to how much opioid rehab will cost. Since everyone has unique needs, mental health professionals recommend individualized treatments for the best treatment results. Specific treatments and treatment times will be recommended based on how far along you are in recovery and what would work best for your long-term sobriety. The longer you spend in treatment, the more treatment will often cost.

The following costs are estimated based on reported costs from different rehab programs and facilities. To find out specific costs, contact the rehab center you’re interested in.

Cost of Inpatient Opioid Rehab

The average cost of a standard 30-day inpatient opioid program is about $6,000. Well-renowned or luxury facilities can cost up to $20,000 for a 30-day program. Costs for longer stays of 60–90 days can vary widely from $12,000 to $60,000.^{9 p. 3.2 Cost band estimates table 2}

Cost of Outpatient Opioid Rehab

If you’re struggling with mild to moderate opioid addiction, outpatient rehab is often much cheaper than inpatient rehab and can be a great starting point. You can expect to pay about $5,000 for a standard, 3-month program. Some highly-acclaimed programs can cost up to $10,000. Price is also determined by how often you attend the facility and for how long.^{9 p. 3.2 Cost band estimates table 2}

Cost of Opioid Partial Hospitalization Programs (PHP)

Partial hospitalization programs (PHP), also called day treatment programs, are similar to inpatient programs, but you still live at home and attend treatment daily for multiple hours a day. The average opioid PHP costs between $375 and $500 per week, but prices vary based on the center you choose and how long you attend.^{10 results}

Cost of Medication-Assisted Treatment (MAT)

MAT is the top recommended treatment for opioid addiction in combination with behavioral interventions like cognitive-behavioral therapy.^{5 Recovery is possible} Different medications like methadone, naltrexone, and buprenorphine are administered to prevent withdrawal symptoms, normalize brain chemistry, and reduce opioid cravings.^{5 Recovery is possible} The average cost for MAT ranges between $6,000 to $15,000 a year, but costs differ based on the duration of your treatment and the type of medication you’re prescribed.¹¹

Opioid Rehab vs. the Cost of Opioid Addiction

Figuring out how to pay for opioid addiction treatment leaves many putting it off for another day. But the cost of opioid addiction will leave a greater impact on not only your finances but many significant aspects of your life. Leaving your opioid addiction untreated can cause more problems to arise over time. Addiction can cause you to destroy relationships with friends and family, deplete your finances, contract irreversible diseases and health problems, and put your life and the lives of others at risk.

When you compare the price of opioid addiction to the price of treatment, both are difficult to afford but seeking treatment is an investment in a healthier, happier life. Finances can cause a lot of anxiety for many, but understanding what is covered under your insurance gives you the peace of mind to choose the best treatment.

What Length of Opioid Rehab Does Blue Shield of California Cover?

Mental health professionals agree that although everyone is unique, longer treatment times are the most effective in promoting long-term recovery.^{6 Points to Remember} Spending as much time as you need to work through underlying issues contributing to your addiction sets you up for a successful recovery and lessens your chances of relapsing.^{6 Points to Remember}

Because there are so many different tiers of coverage and types of policies, the length of time covered by your Blue Shield of California insurance depends on your specific plan. If you want to know more about how much time in treatment your Blue Shield coverage in California will cover, it’s best to contact the specific rehab you’re interested in or call the number on the back of your insurance card. You can also reach out to American Addiction Centers (AAC) online or by phone for assistance verifying your insurance.

Choosing between Blue Shield of California Inpatient vs. Outpatient Opioid Rehab Centers

Choosing the best treatment option for you varies depending on your specific needs. Individualized treatment plans are often the most beneficial in promoting long-term recovery because they’re designed with you at the forefront.^{6 Points to Remember} Important factors like your lifestyle and the severity of your addiction are considered to create a plan that will benefit you the most.

If your addiction is mild to moderate, outpatient programs may be the best choice for you. For more severe addictions, treatment in inpatient rehab can be very beneficial. Inpatient rehab is particularly helpful for opioid addiction because you have 24/7 access to support from mental health professionals and peers, along with constant quality care.

The severe mental health effects and intensity of withdrawal symptoms common with opioid addiction can make it difficult to fight without medications and constant supervision.^{6 Points to Remember} Inpatient rehab provides a safe space to focus on getting better and building the skills for long-term recovery.

Specialized opioid programs where you can receive peer support from people going through similar experiences are also offered through many inpatient facilities. You’ll be able to foster relationships with people in recovery, celebrating wins together and holding each other accountable in hard times.

How to Use Blue Shield California Insurance for Opioid Rehab?

Ready to seek help for your opioid addiction? Contact your primary care physician for support in finding a suitable rehab program. Ask about how you can use your Blue Shield of California insurance to finance opioid rehab. To learn more about what’s covered under your specific plan, contact the rehab center you’re interested in, and they can verify your coverage for you.

How to Find Opioid Rehabs That Accept Blue Shield of California Insurance

AAC can also offer assistance to verify your insurance coverage. Contact us through online chat or by phone to receive help from one of our representatives. You can also speak directly with an agent who can check your benefits while you’re on the phone when you call our helpline. Hundreds of people are financed for opioid rehab yearly through Blue Shield of California healthcare plans.

AAC is home to some of the leading treatment facilities in the nation. Our top-notch California facility, Laguna Treatment Center, provides an exclusive treatment experience and high-quality addiction treatment plans. Located in Laguna Beach, this center provides outstanding accommodations and highly-acclaimed medical care while supporting guests through individualized services. Laguna Treatment Center offers different services like medical detox, inpatient residential treatment, addiction-focused healthcare, and addiction aftercare.

Opioid addiction may seem hard to overcome, but winning the battle against opioid abuse is very possible with the right support and resources. If you want to learn more about starting your journey to recovery, AAC is here to help.