Using Blue Cross Blue Shield of TX to Pay for Treatment


Blue Cross Blue Shield of Texas (BCBS TX) is the state’s largest health insurer and has been doing business in Texas for more than 90 years.1 BCBS TX boasts a large network of providers (both HMO and PPO), and now Greenhouse Treatment Center is part of that network.

Mental health care is considered an “essential health benefit,” which means that if you hold a BCBS TX plan, you should have some degree of coverage for substance abuse treatment.

Which BCBS TX Plans Does Greenhouse Accept?

Nurse handing insurance card to patient

Greenhouse is now in-network (INN) with the following 6 BCBS TX plans:

  • Blue EssentialsSM HMO Provider Network.
  • Blue PremierSM HMO Provider Network
  • Blue High Performance Network
  • Blue AdvantageHMOSM Provider Network
  • MyBlue Health HMOSM Provider Network
  • Blue Choice PPOSM Provider Network (Inclusive of Blue Precision/Blue Options)

Each plan will have different requirements (e.g., some may require a referral from your primary care physician) and levels of coverage.

You can check your benefits below for free to see if your plan covers your treatment with us. The benefits verification form is free, quick, and completely confidential.

What Forms of Treatment Are Available?

We are proud to be INN with BCBS TX for all levels of care offered at our facility, including:

  • Medical detox. This is generally the first step in treatment for anyone who is physically dependent on a substance and needs help through the withdrawal process. Inpatient medical detox is generally recommended for substances like alcohol, opioids (heroin, painkillers), and benzodiazepines.2
  • Residential treatment. This live-in level of care provides a safe, supervised, and drug-free environment combined with structured days consisting of therapy groups, classes, counseling, and recreational time.
  • Partial hospitalization program. This level of care is a step down in intensity from a residential treatment program but still offers therapy for the majority of the day, most days of the week. The patient returns home in the evenings.
  • Outpatient treatment. The least intensive level of care offered at Greenhouse, this involves a minimum amount of therapy hours and is a good step down for someone who has completed a more intensive program.

Blue Cross Blue Shield of Texas Mental Health Coverage

Blue Cross Blue Shield explains that when you hold an insurance plan with them, you’ll have:3

  • Your choice of in-network care providers.
  • Coverage for mental health substance use disorder treatment.
  • Prescription medication benefits.
  • Coverage for preventive services, including annual exams.

When you need care for a substance abuse issue and/or mental health treatment, you can it with your BCBS TX plan. You’ll need to choose an in-network provider to get the best coverage. If you go out of your network, you may be required to pay for a hefty portion of the cost or even the full cost of your treatment. Each plan will have its own network. The plans for which Greenhouse Treatment Center is in-network are listed above.

For some plans (e.g., HMO plans), you will need a referral from your primary care physician (PCP) to access mental health or substance abuse services.

Insurance Terms to Know

Couple meeting with insurance provider

When you’re attempting to understand your Blue Cross Blue Shield rehabilitation coverage, there are some key terms you need to know. These include:4,5

  • Premium: What you pay for your insurance coverage. You will pay your premium regardless of whether you use your benefits for care.
  • Benefits: The services your insurance plan will cover.
  • Covered person or service: The people or services that your insurance will provide benefits to or for.
  • Group: A set of people covered under the same health plan such as the employees of an organization.
  • Deductible: How much you’ll be required to pay for healthcare services before your benefits kick in. If, for example, your yearly deductible is $500 for your plan, you’ll have to pay that before your health insurance begins paying for your treatment costs in that yearly period. Certain services like annual physicals may be covered before you’ve met your deductible.
  • Copay: This is a specific amount that is required when you visit a doctor or other treatment provider or when you pick up a prescription.
  • Coinsurance: This is the portion of the treatment cost you’ll pay after you’ve met your deductible. For example, if your plan pays 80% of the cost for an inpatient rehab program, and you’ve already met your yearly deductible, you’ll pay 20% of the cost. If you haven’t met your deductible, you’ll pay 100% until you’ve met the deductible and then pay 20% of the remaining cost.
  • Out-of-pocket maximum: This is the annual limit on how much you’ll have to pay in healthcare costs. If you’ve met your deductible and you have additional treatment costs, you’ll pay the coinsurance until you’ve met this annual limit.
  • Annual limit: A cap on the dollar amount your plan may pay for a certain type of treatment in a given year, or the cap on all benefits in that year.
  • In-network: Providers and services that have a contractual agreement with the insurance provider so that benefits are paid out at a higher level. You’ll get the most coverage with in-network providers.
  • Out of network: Healthcare providers and services that do not have a contract with the insurance company.
  • Primary care physician: This is the doctor you choose as your main source for healthcare and who will refer you out to other providers as necessary. Not all plan types require you to have a primary care physician.

How Much Will I Have to Pay for Rehab?

BCBS substance abuse treatment plans will provide different coverage options. Your cost will also be influenced by a variety of factors including (but not limited to):

  • The treatment services you need. For example, if you need medical detox and inpatient rehab, you may pay more than if you elect to participate in a partial hospitalization program or outpatient treatment. Longer treatment durations will also tend to increase the cost.
  • The specific plan type you hold. Certain plans will provide richer benefits than others. Plans with lower premiums tend to provide lower coverage levels.
  • Your annual deductible and how much of it you’ve met. If you haven’t yet met your deductible, you’ll have to meet it before your insurance begins kicking in for treatment.
  • Your coinsurance rate for the services you need. If, for example, your plan pays for 70% of a rehab stay, you’ll be responsible for 30% after you’ve met your deductible.
  • Whether you’re using an in-network or out-of-network treatment provider. Staying in your network will reduce your costs.

Getting Started

Insurance can be a confusing and sometimes overwhelming topic. That’s why we’re here to answer any questions you may have about how your plan can help you pay for treatment at Greenhouse and how to start the process today. Give us a call at 972-848-0221 now for help.

References:

  1. Blue Cross Blue Shield of Texas. (n.d.). Who We Are.
  2. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
  3. Blue Cross Blue Shield of Texas. (n.d.). Understand Health Care Plans.
  4. Blue Cross Blue Shield of Texas. (n.d.). Health Insurance Costs.
  5. Blue Cross Blue Shield of Texas. (n.d.). Glossary of Health Care Terms.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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