Will Blue Shield Blue Cross Help Cover Rehab?


Blue Cross Blue Shield (BCBS) is one of the United States’ largest private insurance companies and offers many policies that can help you pay for substance abuse treatment. Some of these policies may even cover the majority of your rehab expenses. Of course different policies will provide different amounts of coverage, and no one should be surprised by the cost of rehab when they get a bill.

If you have a policy with Blue Cross Blue Shield and would like to know exactly what your treatment will cost, call us at 503-850-2474. With your permission, we will run a free, confidential, and quick verification of your benefits. This means we will contact your insurance, learn about your coverage, and give you precise numbers instead of our best estimate. 

Ready to take your life back?

Call (503) 850-2474

About Blue Cross Blue Shield:

Blue Shield Blue Cross Association is a combination of 36 smaller companies. These companies were once owned by two different corporations; Blue Shield formed in 1939 and Blue Cross established in 1929. In 1982, these two corporations merged to form Blue Shield Blue Cross Association. Today, BCBSA is one of America’s largest insurance companies and has well over 106 million policyholders spanning 50 states, Puerto Rico, The District of Columbia, and 170 foreign countries. They also run a nationwide network of high quality healthcare coverage for members of the United States Federal Government. 

Federal Blue Cross Blue Shield Rehab Coverage:

As the name implies, the Blue Cross Blue Shield Federal Employee program is only available to people employed by the US Government (and their family members). It is one of the best insurance policies in the United States and offers high amounts of coverage for substance abuse treatment. If you are a member of BCBS Federal Network, there’s a chance it could pay for most or even all of your treatment expenses.  

Blue Cross Blue Shield Excellus:

Excellus is a New York based BlueCross BlueShield subsidiary that provides benefits such as coverage for substance abuse treatment to 1.5 million New Yorkers

Blue Cross Blue Shield Premera:

Premera is one of the subsidiaries of BCBS headquartered in Washington state. They provide access to BCBS’s vast network of treatment providers, including rehab centers, to over 2 million residents of Washington and Alaska. 

Blue Cross Blue Shield HighMark:

HighMark is one of the subsidiaries of BCBS headquartered in Pennsylvania. They provide access to BCBS’s network of treatment services, including rehab for addiction, to over 5.6 million residents of Pennsylvania, Delaware, and West Virginia.

Addictions that Blue Shield Blue Cross May Cover:

Your coverage with BCBS depends on the type of plan you have. But since rehab is classified as an essential form of care, every policy on the market must provide some form of coverage for: 

  • Heroin Addiction
  • Fentanyl Addiction
  • Cocaine Addiction
  • Alcohol Abuse
  • Addiction to Prescription Pain Pills like Vicodin or Oxycontin
  • Crack Addiction 
  • Methamphetamine Addiction
  • Abuse of stimulants like Ritalin or Adderall 
  • Addiction to anti-anxiety medications (Benzodiazepines) like Xanax or Valium 

Will I get the same coverage for any kind of addiction?

The short answer is no. The reason is that rehab for certain substances will require higher levels of care which costs more. For instance, It can be dangerous to quit alcohol cold-turkey, so your policy is more likely to cover more expensive higher levels of care. Your policy may still offer coverage for substances with less dangerous withdrawals, but it may be more difficult to get coverage if you want a higher level of care.

Ready to take your life back?

Call (503) 850-2474


How Does BCBS Help Me Pay For Treatment?

Blue Shield Blue Cross helps save you money on healthcare in one of two ways depending on what type of plan you have. Plans like HMOs work by making sure you are charged less if you go to one of BCBS’s in-network facilities. PPO plans cover a set amount or a set percent of your costs even if the facility isn’t in-network. Here’s how it works:

  1. BCBS makes contracts with doctors, hospitals, and clinics all over the US. BCBS will encourage its members to get treatment at these places, if their members get the same care for lower prices. 
  2. You become a member of BCBS and must pay a certain amount every month (called a premium) in exchange for access to BCBS benefits. This amount differs depending on your policy. 
  3. You go to a doctor and pay a certain amount of money completely out of pocket (called a deductible) before BCBS starts saving you money. 
  4. Once you’ve met your deductible, BCBS may pay for a certain amount or percent of your healthcare expenses if you have a PPO or you may be charged less at in-network facilities if you have an HMO. 


In-Network Provider: A healthcare professional who Blue Shield Blue Cross has contracted with. If you have met your deductible, your costs will be reduced.

Out-of-Network Provider: A healthcare professional who does not have a contract with Blue Shield Blue Cross. However, depending on your policy, BCBS may still provide some coverage. 


PPO (Preferred Provider Organization): Unlike HMO’s, PPO policies may provide coverage if you choose a provider outside of the BCBS network. Once you have paid a certain amount of your own treatment expenses, BCBS will split the remaining cost with you. 

HMO (Health Maintenance Organization): HMOs work by reducing your total cost of treatment if you go to a provider inside the Blue Cross Blue Shield network. Like PPO’s you may need to pay for some treatment expenses before BCBS reduces your costs. 


Monthly Premium: The amount of money it costs each month to keep your policy with BCBS. The amount you pay in premiums differs depending on the policy. 

Deductible: The amount of money you must pay for your healthcare before your HMO or PPO policy helps you save money.


Co-Pay: The fixed amount of money you pay for treatment after meeting the deductible. For instance, paying $50 to see an in-network provider would be a co-pay. You could see that doctor again and the cost for the visit would still be $50. 

Co-Insurance: The fixed percentage of your treatment costs you must pay after BCBS contributes. For example if your policy pays for 40% of your costs then your co-insurance is the remaining 60%. 

Going to Out-of-Network Rehab:

If you have a PPO policy, it will likely offer some coverage for rehab at an out-of-network facility. However, if you have an HMO with BCBS, treatment outside of your network may cost more money up front, but you still have options:

  • Our staff can work out a payment plan with you to make the cost affordable.
  • We can try to make an agreement with BCBS to get you rehab at in-network prices. 
  • We can help you file a claim and recover some of your treatment costs.

Levels of Care that BSBC May Cover:

Sobriety gets easier as more time passes, which means you require less treatment or a lower level of care over time. All plans are different but usually the amount of coverage you get for rehab depends on your plan and the level of care you need. 

Detox: Detox is the highest and most expensive level of care. During detox, your body’s physical dependence to substances ends so that you can begin your recovery without the discomfort of physical withdrawal. The amount of coverage you get for detox might depend on your drug of choice. For example, quitting alcohol can be life threatening which will make it much easier to get a high amount of coverage for detox. 

Inpatient Rehab: Inpatient rehab is the second most extensive and expensive level of care. You stay overnight in a medical facility and participate in structured therapy, counseling, or other group activities during the day. Some people start with inpatient care, some use it as a step down from detox, however others skip it and go from detox to PHP.  

Partial Hospitalization (PHP): For some people, Partial Hospitalization (PHP) is a step down in care from Inpatient rehab, however some people start PHP immediately after detox. At Tree House Recovery, PHP is 5-6 hours a day for 5 days a week and includes evidence based programming that will: 

  • Help heal possible sources of addiction using guided stream-of-conscious writing with a trained therapist. 
  • Reduce and control cravings with cardiovascular training.
  • Teach coping skills for stress and anxiety.
  • Build connections with and support others. 
  • Create strong lifelong bonds with teammates who you can rely on after treatment.
  • Help you create a positive perspective and world outlook.  
  • Creates custom relapse prevention techniques. 
  • Help you practice new skills with teammates.

Intensive Outpatient (IOP): Depending on your needs you may begin Intensive Outpatient (IOP) after finishing detox. For others, it’s the next step after PHP. Tree House Recovery’s IOP is 3-5 hours per day for 5 days a week. It includes things learned in PHP as well as leadership, interview, and job-search training before graduating. 

Outpatient Rehab (Aftercare): Outpatient or aftercare is the lowest and least expensive level of care. Usually people in OP have already completed a rehab program. Tree House Aftercare is 3 one-hour therapy sessions a week (in the evenings to accommodate work schedules). 

 How To Get Started: 

The first step in getting treatment for addiction is verifying your Blue Cross Blue Shield benefits so we can help you understand what your plan will cover. You can do this by calling us any time at 503-850-2474 or by filling out the form below.

Ready to take your life back?

Call (503) 850-2474