Premera BlueCross is a leading health insurance company serving over 2 million members in the Pacific Northwest [1]. Premera operates as an independent licensee of the BlueCross BlueShield Association, offering healthcare coverage that includes evidence-based treatment for substance use and mental health disorders.

Premera BlueCross drug rehab covers most of the costs of addiction and mental health treatment after deductibles are met. Members are liable only for co-payments or co-insurance.

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Premera Blue Cross Overview

Premera Blue Cross has 2.6 million members in Washington State and Alaska. Operating as a non-profit BlueCross BlueShield healthcare organization, Premera plans cover a variety of services, from addiction and mental health treatment to medical care, dental services, and workplace wellness programs.

Premera has access to an extensive network of accredited healthcare providers and works with hospitals, physicians, and specialized treatment facilities. This network enables plan members to receive top-notch care for specialties that include addiction treatment and behavioral health services.

The main plan categories offering Premera BlueCross rehab coverage include:

1. HDHP (high deductible health plan) – This plan has high deductibles but low monthly premiums.
2. PPO (preferred provider organization) plan – PPO plans offer Premera BlueCross rehab services either in-network or out-of-network.
3. EPO (exclusive provider organization) plan – These plans deliver in-network treatment through the coordination of primary care.

Does Premera Blue Cross Cover Alcohol and Drug Rehab?

Premera Blue Cross drug rehab coverage is available for drug and alcohol rehabs as part of the organization’s commitment to comprehensive healthcare. The ACA (Affordable Care Act) and MHPAEA (Mental Health Parity and Addiction Equity Act) are federal laws that mandate health insurers to provide the same benefits for drug and alcohol addiction treatment as those offered for medical or surgical care [2].

The scope of Premera BlueCross rehab benefits varies based on the plan type, deductible amount, co-payment structure, and requirements of network providers. Most plans include robust coverage for evidence-based therapies, with benefit levels differing by coverage tier.

All treatment programs and services deemed medically necessary by qualified healthcare professionals are eligible for coverage. The appropriate level of care is determined by initial evaluations before treatment begins.

The most favorable Premera BlueCross rehab coverage is available through in-network providers. In-network treatment reduces out-of-pocket expenses thanks to pre-agreed rates that these facilities negotiate with Premera.

What Types of Treatment Does Premera Blue Cross Cover for Rehab?

Premera Blue Cross rehab treatment is available across the continuum of care, depending on the severity of the addiction and individual needs.

• Supervised medical detox is the first step in the recovery process. It addresses physical dependence on drugs, alcohol, or prescription medications, and prepares individuals for ongoing treatment [3]. Premera coverage includes 24-hour medical monitoring, withdrawal symptom management, and a range of supportive care treatments.
• Inpatient treatment, also known as residential rehab, involves individuals staying at a treatment facility for 30, 60, or 90 days while receiving intensive, highly structured care. Treatments covered include individual, group, and family therapy, psychotherapies, and educational classes.
• PHPs (partial hospitalization programs), the most intensive form of outpatient treatment, involve up to 30 hours of weekly therapy without overnight stays. Covered services include therapeutic interventions, psychiatric services, and relapse prevention strategies.
• IOPs (intensive outpatient programs) offer structured support with even more flexibility, delivering up to 15 hours of therapy sessions per week. These include individual and group counseling, as well as educational sessions.
• Standard outpatient therapy involves weekly therapy sessions, consultations, and ongoing support for lasting recovery.
• MAT (medication-assisted treatment) is available with Premera BlueCross drug rehab coverage when indicated as clinically necessary. Coverage includes prescription medications approved by the FDA and psychotherapy to help people tackle opioid and alcohol addictions [4].

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How Long Will Premera Blue Cross Insurance Cover Drug and Alcohol Rehab?

The duration of treatment covered varies according to the specifics of your Premera plan and determinations of medical necessity. Most plans focus on covering therapies needed to support sustained recovery instead of setting time limits.

The process begins with an initial assessment and treatment planning based on the results. Healthcare professionals submit recommendations for treatment to Premera, highlighting the expected duration of therapy and the interventions to be used.

Periodic reviews evaluating treatment progress and the ongoing need for engagement help ensure the continuation of coverage with medically appropriate interventions. Extended coverage may be granted for complex cases and for individuals with co-occurring mental health disorders.

How to Use Premera Blue Cross for Addiction Treatment & Rehab

To use your Premera Blue Cross rehab benefits, you’ll need to follow some simple steps to streamline the coordination of care and maximize your benefits: 

1. Call customer service at Premera – Call Premera’s customer care division using the number listed on your insurance card. Check your benefits and deductible, and find out which treatment providers in your area are part of the BlueCross BlueShield network.
2. Get recommendations for treatment – Arrange an initial assessment with a qualified healthcare provider to establish the most appropriate level of care and specific therapeutic interventions for your needs. This will provide you with the documentation you need to activate your Premera Blue Cross rehab coverage.
3. Verify the provider’s network status – Confirm that your preferred drug or alcohol rehab is part of the provider network to minimize your out-of-pocket expenses.
4. Obtain prior authorization if needed – Contact your chosen treatment provider if prior approval is required for more intensive treatment. They will submit clinical recommendations and documentation to Premera.
5. Clarify your financial obligations – Review your deductible, co-insurance, and co-payment obligations before initiating treatment.

Premera Blue Cross Coverage for Co-Occurring Disorder Treatment

Co-occurring disorder treatment is typically available with Premera BlueCross rehab coverage when it’s deemed clinically necessary. Almost half of those battling addictions also have mental health disorders.

Treatment for co-occurring disorders addresses both conditions simultaneously, improving treatment outcomes and reducing the risk of relapse. Integrated dual diagnosis treatment is more effective than addressing each condition separately [5].

Covered services include:

• Psychiatric assessments.
• Medication management.
• CBT (cognitive behavioral therapy).
• DBT (dialectical behavior therapy).
• Trauma-informed therapies.
• Counseling.

Start Your Recovery with Health Insurance–Covered Treatment at Gratitude Lodge

If you need help getting back on track from addiction to drugs, alcohol, or prescription medications, reach out to Gratitude Lodge.

We offer detox services to streamline the withdrawal process, inpatient programs to provide immersive, trigger-free environments for recovery, and dual diagnosis treatment for those with co-occurring mental health conditions.

All addictions are unique, so all Gratitude Lodge treatment plans are customized to reflect this. Therapies include:

• Medication management.
• Individual counseling.
• Group therapy.
• Family therapy.
• Psychotherapy.
• Motivational therapy.
• Holistic interventions.
• Aftercare planning.

To verify your health insurance benefits and kickstart your recovery, call admissions at 844-576-0144. 

Sources

[1] https://www.premera.com/visitor

[2] https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity

[3] https://www.ncbi.nlm.nih.gov/books/NBK64119

[4] https://library.samhsa.gov/sites/default/files/pep19-matbriefcjs_0.pdf

[5] https://pubmed.ncbi.nlm.nih.gov/30352668/