Even if you’re an experienced researcher or very Web-savvy, in many cases you’ll only be guessing at what could be covered. Do you have Blue Cross, Blue Shield or Anthem Blue Cross or Blue Shield? It makes a difference. And did you know that Blue Shield’s California network is yet another entity, one that isn’t national? By placing a call and having your insurance card in hand, we can help you sort through the myriad options and tell you how each one affects your coverage.
Get help navigating the maze of insurance coverage when it comes to treatment for co-occurring disorders, substance abuse or alcohol addiction.
Determining Your Coverage
Fortunately, there is help to be had. When someone is in need of substance abuse treatment for drugs, alcohol or a co-occurring disorder, there are often concerns about how much it will cost and who will pay.
Calling the 24-hour toll-free number for Michael’s House is your best bet for finding out exactly what your options are. We can help you determine if residential treatment is the right option and what your policy covers – we can even recommend other programs if ours isn’t the best fit.
Some variations of insurance plans may work like HMOs, others like PPOs. Certain insurance companies may work only with their own providers or serve a large, less limited network. Certain providers reimburse the member instead of the provider and some get around the parity law through a loophole, but will pay for some “out of network” services.
- Am I “in network” or “out of network”?
- Is detox covered or not?
- How many days are covered for residential treatment?
- What’s the difference between Blue Shield in and out of California?
- Isn’t all Blue Cross Blue Shield coverage the same?
- What is Anthem and how is it linked to BCBS?
- What’s the parity act and how does it help me?*See this answer below
*Mental Health Parity and Addiction Equity Act
Built around the Mental Health Parity Act (MHPA) of 1996, the Mental Health Parity and Addiction Equity Act of 2008 requires insurance companies to provide an equal amount of coverage for mental health services as they do for general health services1. This includes substance abuse.
What this means:
Many individuals who have health insurance through their employers should now be eligible to receive mental health related coverage equal to that of their general health policy.
Who is not eligible to receive this coverage:
- Freelance workers and self-employed workers with their own insurance.
- Employers who don’t offer any substance abuse or mental health benefits.
- Employers with less than 50 employees.
Who can benefit from this law:
Group health plans that previously offered physical health and mental health coverage are required to treat both issues equally.
The following must be the same for both physical and mental health related coverage:
- Out-of-pocket costs
- Benefit limits
- Prior authorization
- Hospitalization costs