Are you or a loved one suffering from addiction? Treatment could help you get on the path to lasting recovery. But you feel overwhelmed by choices, financial decisions and you’re wondering if insurance will help you with the bills.

You’re not alone.

Over 20 million Americans suffer from substance abuse disorder, according to SAMHSA, the government organization that tracks trends related to mental health and substance abuse. That’s 1 in every 12 adults.

Of those suffering with addiction only an estimated 7.6% get help each year. In some states the treatment rate is as low as 1% according to the same organization.

You’re very brave to seek out your options. The road ahead isn’t easy. But by becoming 1 of those 7% you can find lasting healing in your own life and the lives of those you love.

In this article, we’ll look at Health Care Service Corporation (HCSC), as we explore:

  • What addiction treatment services  are covered.
  • What, if any, restrictions there might be in regards to your treatment.

But first, we must mention that coverage varies based upon your individual plan. You will additionally need to refer to your plan to have a complete understanding of what you qualify for.

If you need assistance reviewing your individual coverage, working through financial barriers or finding respected and effective treatment options in your area, our compassionate team is ready to help when you call our free, confidential helpline.

Understanding Your Health Care Service Corporation Coverage

HMO – In this plan you have a primary care physician (PCP) who is probably your family doctor. All diagnosis and treatment begins with the PCP, who will then refer you to in-network specialists and facilities. If you have an HMO, staying within your network is important. Not getting a referral or not staying in-network could lead HCSC to not covering and paying for your treatments

PPO – PPO are a bit more flexible. You still have a network, but you have the option to go outside it. If you do go outside of your network, however, you will pay more for covered services.

HCSC offers coverage through Blue Cross Blue Shield, a large insurer that many of us are familiar with. This means that you have access to a broad network of doctors and facilities allowing you to get the best cost savings when you stay in-network.

Determining your Financial Responsibility

Your plan may have a deductible, co-pays, coinsurance and a maximum out of pocket expense level. Even if a service is covered you will still be required to pay these as part of your responsibility for your own care.

The deductible is an amount of money that you may have to pay before insurance will pick up part of the bill. It could be as little as $500 or as much as $10,000.

Copay/Coinsurance is a percentage or flat fee that you pay for each service. It could be $40 to see a specialist, $185/day for an inpatient drug rehab stay or perhaps insurance pays 70% of the cost of a service while you pay 30%.

This all sounds like a lot. Fortunately, you probably have a maximum out of pocket expense level that will help to curb some of these expenses as once you’ve paid a certain amount, insurance pays for 100% of all remaining services.

What’s Typically Covered by HCSC Insurance for Rehab?

Diagnosis – In this first phase of treatment a doctor or similar treatment provider will talk with you and run tests. Their goal is to determine the severity of the addiction and the best course of treatment. They’ll then write doctor’s orders for those treatments. This service is covered by HCSC.

Medical Detox – During this phase you’ll remain under medical observation for several days while the drug level breaks down in your system. You could experience dangerous withdrawals so 24/7 monitoring is necessary. HCSC typically covers medical detox, but they may limit the number of days based upon medical necessity.

Outpatient Rehab – Outpatient rehab can involve intensive outpatient care which is several days a week for several hours a day of counseling, classes, group therapy and other treatments. Outpatient rehab can also be done over a longer period of time with less intensity. HCSC covers various forms of outpatient rehabilitation. In fact, they require that most of those suffering from an addiction to drugs or alcohol first try outpatient treatment before seeking inpatient treatment.

Inpatient treatment can last 30, 60 or even 90 days in either a hospital-like setting or a facility that is intended to feel more like a home. Most plans will cover some inpatient drug rehab, although longer stays beyond which are deemed medically necessary may not be covered.

HCSC is not known for covering what they consider frivolous services such as luxury rehab or specialty treatments like private rooms, acupuncture, aroma therapy, saunas, etc. If you choose a facility that offers these amenities you may be paying for them yourself.

Relapse prevention is an important part of treatment. It will likely last months and possibly years. Visits with a relapse prevention therapist are typically covered under the mental health portion of HCSC’s plans. Look to your policy binder to determine how many visits you may be able to take part in annually as part of your relapse prevention and aftercare program–each policy is a bit different in coverage.

HCSC does not cover methadone maintenance during which a more manageable and less “harmful” drug is substituted for the opioid of choice. This treatment allows the substance abuser to remain dependent on the new substance rather than recovering, so HCSC chooses not to cover it.

All scheduled inpatient rehab and most outpatient services will require an authorization from HCSC prior to beginning treatment.

Answers to Your HCSC Insurance Questions

Adrugrehab.org is committed to changing the lives of those suffering from addiction and the lives of their families who are equally impacted by this disease. Our team of professionals work with you to find effective treatment options based upon your unique needs and to find lasting healing through recovery.