East Coast Recovery is a BSBC Massachusetts rehab center. Contact us today or verify your insurance online to check your benefits.
Finding affordable outpatient care can seem out of reach for many people, but with BCBS, many benefits can be applied to the overall costs of outpatient treatment with East Coast Recovery Center.
BCBS covers outpatient care including full day, partial day, and traditional outpatient programs. The company also provides benefits that extend to treatment for co-occurring mental health disorders or medication assisted treatment using FDA approved prescriptions.
If you’re in the process of considering addiction treatment options, understanding what your insurance does and does not cover can help you choose the best course of action. Substance use disorders (SUDs) are serious medical conditions that can take a toll on your physical, mental, and emotional well-being. Most insurance plans offer at least partial coverage for things like detox, psychotherapy, and prescription medications that can help you make progress in your recovery. Here are some of the benefits of using your insurance policy to help cover the costs of care:
At East Coast Recovery, we work with BCBS to make insurance affordable. Policyholders can access our evidence-based outpatient programs including our day and partial day programs, or our MAT or dual diagnosis care. Applying benefits from a BCBS policy means reducing or eliminating out of pocket costs while still getting the help you need.
Our Day Treatment (Day Treatment Program) is the most Partial Day option, offering 6 clinical hours of therapeutic service per day. This is best for those clients who need comprehensive treatment for substance use and co-occurring mental health disorders while still residing at home.
Our Partial Day Treatment (Partial Day Treatment Program) is a highly flexible outpatient program which is the next level down. It meets roughly half the time, but still gives clients intensive therapeutic groups and individual counseling.
With both programs, there are options for Medication-Assisted Treatment (MAT), dual diagnosis care, and aftercare support.
BCBS will cover at least some part of outpatient drug rehab services, but the exact coverage amount, deductible, and length of coverage is based on your specific regional plan (e.g., Anthem, CareFirst, Excellus) and tier level (Bronze, Silver, Gold, Platinum).
BCBS is legally required to cover substance use disorder (SUD) treatment at the same level as standard medical care which means benefits can be applied to the programs offered at East Coast Recovery.
Under most BCBS plans, outpatient coverage includes a broad range of evidence-based treatments.
The first is our Day Treatment program or full day program which offers a highly intensive level of full-time care at several hours per day, every day of the week over the span of a few weeks.
The second is an Partial Day program or our partial day program which offers continued structured care around 3 hours per day for a few days per week.
BCBS also covers MAT for those who need FDA approved medications as part of their treatment plan and ongoing outpatient care including individual therapy and group therapy typically with coverage limited to around one or two times per week depending on your plan.
To that end, what coverage is applied and when is contingent on whether you work with an in-network or out of network provider, and what deductibles, copays, or coinsurance requirements you have.
In-network providers will have significantly higher coverage compared to an out of network provider. If you go with someone out of network with, for example, a PPO plan you might only get up to 50% reimbursement and with an HMO plan, zero reimbursement.
There are also deductibles that have to be met every year before coverage kicks in entirely. Once you meet your deductible which is based on the plan you have, you typically have to pay a fixed copay for every therapy session which might be something around $40 per session, or a coinsurance percentage which might be 20% of the total cost while BCBS covers the other 80%.
It’s also important to know that many policies with BCBS have an annual out-of-pocket maximum which means that once you reach that figure based on your deductible and your coinsurance spending, BCBS will cover 100% of any subsequent services during the calendar year.
One of the most important aspects to determining coverage with BCBS and East Coast Recovery is recognizing whether you have a Blue Cross Blue Shield (BCBS) PPO or HMO plan.
Both plans give you benefits and coverage, but the rules over referrals and provider networks are different.
If you have a PPO (Preferred Provider Organization) then you don’t need to remain in-network. You can still, of course, choose East Coast Recovery as an in-network provider to help keep your costs low, but you have the flexibility to travel if you don’t already live in Massachusetts.
If you have a HMO (Health Maintenance Organization) then your coverage is restricted to healthcare providers who contract directly with your local HMO network. Care is often limited to your area, and if you go out-of-network then you can’t apply benefits to the costs.
Clients with PPO plans don’t need to go to their primary care physician first. If you have a BCBS PPO plan you can contact our admissions team directly and we will initiate your intake process and send pertinent documents to your insurance provider.
If you have an HMO plan, you will need to coordinate your care by getting a clinical referral from your primary care provider first, something that can be shared with us when you call.
Typically, clients with a PPO will have larger annual deductions which means you will be responsible for a portion of your bill up front before the insurance kicks in. By comparison, with an HMO, there might be lower deductibles and fixed co-pays but you have a tightly controlled pre-authorization process that’s required before you transition from one level of care or one type of program to the next.
Navigating all of these requirements can be difficult if you don’t know exactly what type of plan you have. That is why at East Coast Recovery our team is ready to help you verify your benefits, figure out the type of plan you have with BCBS, and explain exactly what you can expect for things like deductibles, coinsurance requirements, or copays.
Call our admissions team to get started.
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