Addiction Treatment Covered by Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS) is one of the nation’s largest health insurance providers. Its 35 independent and locally operated companies deliver health insurance coverage to 1 in 3 Americans across all 50 states, as well as the District of Columbia and Puerto Rico.¹ The BCBS Federal Employee Program insures over 5 million federal employees, retirees, and their families throughout the country.¹

Blue Cross Blue Shield operates in the state of New Jersey and surrounding cities in the tristate region (including Anthem BCBS in New York, Connecticut, and Wisconsin). They are in-network with local rehab facilities in the New Jersey area, including Sunrise House Treatment Center in Lafayette, NJ.

In this article, we’ll go over some of the treatments for drug and alcohol addiction that may be covered by Blue Cross Blue Shield and what to expect when using health insurance to pay for rehab in the tristate area.

Does Blue Cross Blue Shield Cover Drug & Alcohol Rehab?

Yes. Blue Cross Blue Shield does cover addiction treatment. However, the extent of coverage will vary, depending on the plan you have.

Under the Affordable Care Act (ACA), Marketplace health insurance providers (including Blue Cross Blue Shield) are required to cover mental health and substance abuse services.² These are now considered essential benefits, and must be accessible to people with Marketplace health plans, as mandated by the ACA.²

In New Jersey, BCBS is operated through Horizon Blue Cross Blue Shield of New Jersey.³ The company has been providing insurance to local families and businesses for over 85 years.³ It is the only licensed BCBS affiliate in the state. However, BCBS is not the only health insurance carrier in the state. New Jersey’s Health Insurance Marketplace offers other qualified health plans via Get Covered NJ.

To learn more about BCBS coverage for addiction treatment, use our . Within minutes, you will have an email explaining what is covered by your insurance. This is an important first step toward getting the treatment and care you need.

You don’t have to figure out the insurance process alone. We are here and happy to help.

What Types of Rehab Are Covered by BCBS?

Blue Cross Blue Shield and Anthem BCBS members may use their insurance to cover some or all of the cost of rehab. Depending on the specific policy, BCBS coverage might include the following types of treatment for substance use disorders:⁵

• Withdrawal management/detox. Stop or slowly reduce use in a safe, supervised setting. This includes evaluation, stabilization, and preparation for entry into a rehab or recovery program.
• Interim care. Daily medication and emergency counseling are provided while waiting for a spot to open up at a rehab facility.
• Outpatient. Treatment and counseling for individuals that continue to live at home while seeking treatment.
• Inpatient. Around-the-clock clinical care for a set number of days or weeks. Individual and group therapy are integral parts of inpatient rehab.
• Residential. This where patients stay and live at the facility while in treatment.
• Telemedicine. Receiving treatment via video conference and/or telephone, which is particularly useful if local resources for inpatient or outpatient are unavailable.
• Medication-assisted treatment (MAT). The use of medications, along with counseling and behavioral therapies, to help those with substance use disorders get and stay sober.

Learn more about the different levels of rehab care that are offered at our facility in Lafayette, NJ. Remember—rehab is tailored to each individual, and the type of treatment you receive will be based on your needs.

How to Use BCBS to Cover Substance Abuse Treatment

As a Blue Cross Blue Shield  or Anthem BCBS member, your insurance provider will likely cover at least some of the cost of treatment. If you’re ready to enter rehab, you can check your insurance benefits to see what level of coverage your specific plan offers. Enter your plan information in our to get started.

Before you enter rehab, here are a few things you will need to do beforehand:

• Talk to your doctor. See your primary care physician or therapist and talk to them about your struggles with addiction. They can help you get the treatment you need and ensure continuity of care once you leave the treatment facility.
• Get pre-authorization for rehab coverage. Most insurance companies require pre-authorization before approving coverage for addiction treatment. This is essentially paperwork completed by your primary care physician that confirms rehab and treatment are medically necessary.
• Understand your benefits. Talk with a BCBS customer service agent, who can clarify exactly what services are covered and potential out-of-pocket expenses. Many insurance policies have deductibles that must be reached before coverage kicks in. Some plans also have copays for certain services (e.g., prescription medications), and then insurance covers the rest.
• Find an in-network treatment facility. Look for a quality facility that is in-network with BCBS, like Sunrise House Treatment Center. This means the facility has an agreement with the insurer to provide treatment at a discounted rate for BCBS members, which helps lower out-of-pocket expenses.

Paying for rehab can be overwhelming for many people. Fortunately, insurance may be able to help defray the cost, and there are additional payment options to assist with charges insurance does not cover.

Call us at to speak with an admissions navigator who can answer any questions you might have and help determine the appropriate next steps.

How Much Does Substance Abuse Treatment Cost with Blue Cross Blue Shield?

The cost of substance abuse treatment in New Jersey and surrounding states can vary widely. It depends on the individual’s medical and psychological needs, their specific insurance plan, history of addiction, and co-occurring conditions (e.g., depression or anxiety) that may also require treatment.

Horizon BCBS in New Jersey plans and Anthem BCBS plans in surrounding states will usually provide some coverage for most drug and alcohol addiction treatment, including inpatient and outpatient rehab.⁵ For immediate help, you can also call one of our trained admissions navigators at for free, confidential assistance. They are available 24/7 to answer any payment or care-related questions.

Benefits of BCBS Insurance Coverage for Rehab

Drug and alcohol addiction is a serious public health issue in the tristate area. In 2019, there were 98,628 individuals admitted to treatment in the state of New Jersey.⁶ Of those, 42% used heroin and 31% were addicted to alcohol.⁶

Addiction can destroy a person’s life, but it doesn’t have to be this way. Top-tier, evidence-based treatment centers, like Sunrise House, can help people find renewed hope and recovery. And using insurance can provide peace of mind and access to important medical care, including treatment for substance use disorders.

Fill out the form below to learn more about what your BCBS insurance plan may cover. Or call us at to speak with an admissions navigator who can help you begin the journey to lasting recovery today.