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Capital BlueCross Insurance Coverage for Drug and Alcohol Treatment

Capital BlueCross has been serving clients for more than 80 years. With a variety of technology solutions and other services available to customers this company offers more than just health insurance. The company’s goal is to not only offer support for medical expenses, but also to promote wellness and peace of mind among members.

Capital BlueCross is part of the BlueCross BlueShield Association. The company is currently headquartered in Harrisburg, Pennsylvania. Capital BlueCross offers individual health plans, employer-sponsored coverage, Medicare plans and more.

Where Is Capital BlueCross Accepted?

Capital BlueCross is accepted by a large number of doctors, specialists, hospitals and other facilities. When looking for addiction treatment, members have plenty of options. However, it is important to note that the exact options you will have depend on the specifics of your plan. While some plans offer access to the entire Capital BlueCross network, others offer more limited options. Before choosing an addiction treatment program, reviewing the options available under your specific plan is highly recommended.

Exploring Policy Options from Capital BlueCross

Capital BlueCross offers a wide variety of different plan options. While some plans are available only to employers, others are available to individuals as well. In addition, Capital BlueCross’ policy options may vary based on other factors, such as an employer’s size or eligibility for Medicare. However, general policy types available include:

Capital BlueCross PPO Plans

Capital BlueCross Preferred Provider Organization plans are one of the most flexible options available from this company. With this type of plan, you won’t need to get a referral for treatment from a specialist, including behavioral health professionals. In addition, you will be able to choose your own providers. However, it is important to remember that you will spend more if you select a treatment program outside of your plan’s network.

Capital BlueCross PPO Choice Plans

Capital BlueCross also offers Preferred Provider Organization Choice plans to employers who have employees in York, Lancaster, Berks and Adams counties. These plans divide in-network providers into three different tiers based on expense and quality of care. Members can choose providers from the first tier to minimize their out-of-pocket expenses, with providers in the middle and third tiers requiring a higher financial commitment from the patient.

Capital BlueCross Health Reimbursement Arrangement

Capital BlueCross HRA plans are medical plans funded by an employer-sponsored reimbursement account designed to help with employee’s medical expenses. The funds from these accounts can pay for employee deductibles, as well as healthcare claims.

Capital BlueCross IRS-Qualified High Deductible Health Plan

Capital BlueCross offers QHDHP plans that can be paired with tax-free health savings accounts, or HSA. In the case of employer-sponsored plans, the HSA accounts associated with these plans can be funded by employers and/or employees. This type of policy offers lower premiums than other policies, but you may be required to pay a greater amount of your own addiction treatment expenses because of the high deductible.

Capital BlueCross Valley Advantage Exclusive Provider Organization

The Valley Advantage EPO is similar to a PPO, in that it allows members to choose their own providers and visit specialists without getting a referral from a primary care physician. However, the network associated with this plan is much smaller and includes only those doctors and facilities within St. Luke’s University Health Network. This plan is available only in Lehigh and Northampton Counties. When seeking addiction treatment, your choices may be more limited if you have this type of coverage.

Each of the plans listed here offers different advantages and disadvantages. In addition, the coverage you will receive when undergoing addiction treatment will vary considerably based on the specifics of your plan. Within each plan category, additional options are available, making it even more complicated to understand how your coverage will apply when you enroll in rehab. However, you can get clear answers by speaking with representatives from Capital BlueCross.

Will My Capital BlueCross Plan Cover Rehab Programs?

Generally, an insurance plan from Capital BlueCross will cover addiction treatment. However, the specifics of this coverage vary widely. Some of the factors that will impact your coverage for addiction treatment include:

  • Your plan structure
  • Your deductible and coinsurance
  • The treatment program you choose
  • The length of time you spend in treatment

In addition, you may also need to take certain steps to maximize your coverage. For example, if your health insurance plan includes a network of preferred providers, you can lower your expenses by selecting a provider from within this network. In some cases, a referral from your primary care provider and/or preauthorization from Capital BlueCross may also be necessary to ensure that your treatment program is fully covered.

Will Preauthorization or Precertification Be Required?

Before you enroll in an addiction treatment program, you may need to obtain precertification or preauthorization from Capital BlueCross. This simply means that you must apply for permission to receive the treatment, showing evidence that the program is medically necessary. In most cases, your physician will be able to provide Capital BlueCross with the information they need to approve the treatment.

If preauthorization or precertification for addiction treatment is required but you fail to obtain it, you may be forced to pay unexpected bills out-of-pocket. For this reason, contacting Capital BlueCross to learn about your insurance policy’s specific requirements is highly recommended.

Calculating Your Out-of-Pocket Costs

Before beginning any rehab program, it is always a good idea to find out how much you can expect to pay out-of-pocket. In fact, many patients decide to make these calculations before selecting a treatment program. Unfortunately, the numerous factors involved in determining the cost of treatment can make it difficult to estimate these expenses accurately. For a better idea of how much your rehab may cost based on the specifics of your insurance plan, check out our addiction coverage tool!

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