Excellus BlueCross BlueShield Health Insurance Plan Options for Substance Addiction and Mental Health Treatment

As a member of the Blue Cross Blue Shield Association, Excellus BlueCross BlueShield is a prominent health insurance provider within New York State. Insured members have access to a range of inpatient and outpatient care options because a broad range of mental rehabilitation programs accepts them.

Excellus BlueCross and BlueShield rehab coverage can be used for various behavioral health concerns, including mental health, substance abuse, and dual diagnosis concerns. While the extent of your coverage can vary, policyholders often receive coverage for therapy, counseling, support groups, and other treatment methods. Read more below for an introduction to commonly used Excellus BlueCross BlueShield rehab options.

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What Is Health Insurance Coverage from Excellus BlueCross BlueShield?

Excellus BlueCross BlueShield can trace its roots back to 1932 when it offered payment plans for hospitals located in Rochester and Syracuse, New York. In 1996, it was reorganized after regional mergers. Today, Excellus BCBS is an independent licensee offering healthcare policies for 31 counties located in Upstate New York.

Excellus BlueCross BlueShield is headquartered in Rochester, NY, and is proud to have an active presence within the local community. Popular plan options include individual, family, and employer-sponsored plans. Publicly funded programs like Medicaid, Medicare, and Child Health Plus are available for qualifying residents. Additionally, Excellus BCBS provides coverage options for dental, vision, telehealth services, and other wellness options.

Insurance policies with Excellus BCBS were determined by an actuary who evaluated the liability and risk associated with medical and behavioral health conditions with their corresponding treatment programs. From there, the underwriting process is used to create customized plans for insured members based on their health history, needs, and other factors. This accounts for the individualized nature found among individual health care plans and benefits. Insurance companies often have reinsurance to provide themselves with additional financial support when treatment costs for policyholders are higher than they expected.

The National Alliance on Mental Illness (NAMI) indicated that over 2.8 million adults are living with a mental illness in New York, a rate of about one in three adults. These conditions have been found to affect younger generations as well, with about 145,000 youth experiencing depressive symptoms.

New York State has just under 1,000 substance abuse treatment facilities that provide a range of treatment options across the state. Substance abuse concerns are a serious public health concern within the state, contributing to a drug-related overdose rate of 31.4 deaths per 100,000 residents. Access to appropriate treatment services can vary in different regions of the state, with rural areas often having limited access to mental health services. Treatment costs are an additional concern that can make it challenging for New Yorkers to access the care they need for their mental health concerns.

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Are Substance Misuse Treatments Included in Health Plans from Excellus BlueCross BlueShield Health Insurance?

Yes, Excellus BlueCross BlueShield rehab coverage can include various substance abuse treatment programs. This includes treatment for drug dependency, alcoholism, and polysubstance abuse. Depending on the severity of your symptoms and health risks, your policy may provide coverage for detoxification services, inpatient care, and outpatient treatment options.

Substance abuse treatment programs are designed to provide individualized support addressing triggers, underlying factors contributing to your abuse, and other health concerns you’re experiencing as a result of your addiction. Your treatment may incorporate dual diagnosis treatment, medication-assisted treatment services, and family therapy. Therapeutic approaches commonly used in recovery programs include cognitive-behavioral therapy, motivational interviewing, and holistic approaches. Your policy may require a referral or prior authorization before beginning treatment.

Are Alcohol/Drug Addiction Treatments Included in Excellus BlueCross BlueShield Health Insurance Plans?

Excellus BlueCross BlueShield drug and alcohol rehab coverage can include a range of treatment options. This allows those struggling with an addiction to access personalized care focused on developing the skills and knowledge needed for long-term sobriety. Treatment recommendations for alcoholism and drug dependency can vary based on the ways these substances affect the body.

Policyholders who receive substance abuse treatment may be responsible for out-of-pocket expenses like premiums, deductibles, and copayments. These costs are often required to process claims successfully. Verifying your insurance coverage can help you understand your treatment costs, decreasing unexpected fees and expenses.

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Is Dual-Diagnosis Treatment for Drug Addiction and Alcohol Addiction Covered by Excellus BlueCross BlueShield Health Insurance?

Yes, dual diagnosis treatment is commonly included in Excellus BlueCross BlueShield alcohol rehab coverage options. Dual diagnosis conditions are estimated to affect over 21 million adults in the United States. These conditions are often complex and require personalized treatment plans focused on your symptoms, triggers, and other challenges.

Common co-existing conditions among those struggling with substance abuse include anxiety, depression, bipolar disorder, Post Traumatic Stress Disorder (PTSD), ADHD, schizophrenia, and other trauma-related conditions. These mental health conditions have varying symptoms and benefit from different treatment approaches. Dual diagnosis care can include additional therapy, counseling, educational sessions, and psychiatric care.

Detoxification services are typically included in Excellus BlueCross BlueShield drug rehab coverage. Detox programs provide medical supervision and treatment for those experiencing withdrawal symptoms when they stop using drugs and alcohol. Because of the impact substances have on your body’s functioning, you’re at risk for uncomfortable or even dangerous physical and psychological symptoms.

Detoxification programs tend to be short-term because they are focused on addressing the medical concerns that arise in early recovery. Detox programs may include support groups and educational services, though they commonly recommend aftercare after completing detox. Depending on the details of your policy, you may have limitations or exclusions for out-of-network or high-end detox programs. Verify your coverage with CheckMyInsurance.co to learn more about applicable restrictions for your coverage.

Medication-Assisted Treatment (MAT) is a treatment option commonly included in Excellus BCBS coverage options. MAT services are often used in detoxification programs, though they can also be used in inpatient care and various forms of outpatient treatment. MAT services can help reduce the intensity and risks associated with withdrawal symptoms and promote long-term recovery with some forms of addiction.

More specifically, individuals struggling with alcoholism or opioids like heroin, synthetic opioids, and prescription pain medications may continue receiving MAT services on a long-term basis. In these cases, it is often recommended that individuals engage in traditional addiction treatment programs for comprehensive care. Prescription drug coverage is often required to experience lower costs for prescriptions. If your policy has limitations or restrictions on name-brand medications, your prescribing healthcare provider may be able to provide generic options.

Which Substance Use Disorder and Mental Health Treatment Programs Are Offered in Upstate New York and Are Covered by Excellus BCBS?

Rehab centers that take Excellus BlueCross BlueShield insurance policies can offer a range of behavioral health services. Treatment programs can range from inpatient to outpatient care, focusing on mental health, substance abuse, and dual diagnosis concerns. While this is not an exhaustive list, it does elaborate on popular rehabilitation programs used within New York:

Residential and inpatient treatment programs provide around-the-clock support for individuals who struggle to manage their home environment independently. Treatment can incorporate therapy, counseling, educational sessions, and family therapy. MAT services, dual diagnosis care, and psychiatric treatment are commonly available when necessary.

Excellus BlueCross BlueShield covers inpatient rehab services and some residential treatment programs. Your Excellus BCBS policy may have exclusions for high-end and luxurious residential treatment programs, which can reduce the coverage you receive. Verifying your insurance policy helps you understand this and other essential details of your insurance policy.

Partial Hospitalization Programming (PHP) can provide you with a full day of therapeutic support if you find yourself struggling to manage symptoms throughout the day. PHPs can facilitate the growth of emotion regulation, distress tolerance, and relapse prevention skills that can then be implemented in real time. These programs often offer MAT, psychiatric, and dual diagnosis services when necessary.

Excellus BlueCross BlueShield does cover rehab services, like partial hospitalization programming. Your rehab coverage may require prior authorization for maximum coverage. This process is used to ensure that PHP is the appropriate treatment option for you.

Intensive Outpatient Programs (IOPs) are an intensive treatment option, including nine or more hours of treatment per week. IOPs have a strong focus on group therapy with options for individual therapy, psychiatric care, MAT services, and dual-diagnostic care. These programs often allow you to manage professional and personal responsibilities.

Excellus BCBS rehab coverage can include IOP services. These programs often require prior authorization or referrals for maximum coverage because they are a specialized treatment option. You may be responsible for out-of-pocket costs like deductibles and premiums.

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How Can I Verify the Details of My Excellus BlueCross BlueShield Health Insurance Plan?

Verifying your insurance coverage should be done with a trusted resource, such as CheckMyInsurance.co.  Our complimentary and reliable coverage checker tool can be used to highlight the details of your insurance policy that can affect the coverage that you receive.

This can include information like expected out-of-pocket costs, prior authorizations, necessary referrals, session limits, and provider exclusions. With this knowledge, you can find a treatment provider that allows you to receive maximum coverage.

Does Excellus BlueCross BlueShield Health Insurance Provide Health Plans for Retired Military Personnel and Veterans?

Yes, Veterans can often utilize Excellus. BCBS insurance policies. This can include individual and family plans, as well as publicly funded options for qualifying individuals. Veterans may choose to have additional coverage to broaden the scope of medical and behavioral health treatments they can choose from.

Veterans may qualify for benefits through the VA. These benefits are generally limited to VA-approved healthcare providers, which may be limited in some areas of New York. With additional coverage options, Veterans can access lowered costs for behavioral health services outside the VA healthcare system.

Best Steps to Take to Get Excellus BCBS Health Insurance to Pay for Mental Health, Drug Addiction, and Alcohol Addiction Treatments

When you’re ready to get help for your behavioral health concerns, we encourage you to begin by verifying your insurance coverage. This can inform you of the steps you need to take to maximize your coverage. You may need prior authorization, referrals, or to focus on in-network treatment providers.

Try to ensure coverage for specialized services you may need, like dual diagnosis care, psychiatric care, and MAT services. You can document your conversations with Excellus and your treatment providers for future reference. This can include authorization or approval numbers, dates, and other important information.

Insurance coverage with Excellus BCBS can vary, though some policies include annual session limits. Coverage is often based on medical necessity. You may be asked to submit documentation about your diagnosis, treatment plan, or treatment recommendations to demonstrate the need for treatment.

Session limits often apply to intensive programs like inpatient care, partial hospitalization programming, and intensive outpatient treatment. You can learn about applicable session limits when you verify your insurance policy with CheckMyInsurance.co.

Excellus BlueCross BlueShield rehab coverage may be available for individuals who have the BlueCard program. This program allows eligible members to access treatment providers across the nation and within Canada, Mexico, and over 200 countries with the Global Core. This allows members to access necessary care when they are away from home.

It is important to note that eligibility for this program varies, and that there may be limitations associated with HMO and EPO plans. PPO, POS, and indemnity plans provide in-network coverage for providers nationwide. You’re encouraged to verify your policy with CheckMyInsurance.co to learn about your out-of-state benefits.

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Five Well-Regarded Mental Health Treatment Centers Based in Upstate New York

  1. Genesee Valley Psychology: 1 Centennial Square, Rochester, NY 14623
  2. Clarity Advanced Mental Health Inpatient      Program: 950 Broadway (Suite 301), Saratoga Springs, NY 12866
  3. Sylvia Brafman Mental Health Center (telehealth services): Virtual (based in NY, treating Excellus patients statewide)
  4. Liberty Resources – Rochester Outpatient Clinic: 1500 Brighton-Henrietta Town Line Road, Rochester, NY 14623
  5. Unity Hospital – Rochester Regional Health Behavioral Health: 1555 Long Pond Road, Rochester, NY 14626

Five Well-Regarded Substance Use Disorder Treatment Centers Based in Upstate New York

  1. Unity Hospital – Rochester Regional Health (Chemical Dependency Program): 1555 Long Pond Road, Rochester, NY 14626
  2. BriteLife Recovery (Catskills residential): 5250 State Route 23, West Kill, NY 12492
  3. Twin Oaks: 75 Oak Street, Plattsburgh, NY 12901
  4. Clinton County Addiction Clinic (Community Services): 130 Arizona Avenue, Suite 1500, Plattsburgh, NY 12903
  5. Otsego County Addiction Services: 197 Main Street, Cooperstown, NY 13326

When Using Excellus BlueCross BlueShield Health Insurance, What’s the Cost of Substance Addiction and Mental Health Treatment in Upstate New York?

Individuals who are accessing behavioral health treatment with the use of Excellus BlueCross BlueShield rehab coverage can have varying treatment costs. Costs are dependent on things like the type of plan you have, coverage details, and required treatment services. You may be responsible for costs like premiums, deductibles, and copayments.

Additionally, the coverage you receive is dependent on your ability to abide by the details of your policy. Those who do not obtain the necessary authorizations or referrals may experience reduced coverage. Some policies have specific limitations for out-of-network treatment providers, which can lower the coverage you receive and potentially contribute to claim denials.

When Not Using Health Insurance, What’s the Cost of Substance Addiction and Mental Health Treatment in Upstate New York?

New York is the 22nd most affordable state for addiction rehabilitation programs. NY has the same average cost for traditional outpatient care as Pennsylvania, Arizona, Indiana, and Michigan. On average, NY residents pay about $56,653 for residential care and $1,706 for traditional outpatient care.

Behavioral health treatment costs can vary greatly because of the care you receive. In addition to the level of care you receive, treatment costs are influenced by the healthcare facility’s location, available amenities, the clinicians’ experience, and your use of specialized services. Those who have extended treatment durations often experience higher treatment costs. For a personalized treatment quote, we encourage you to contact treatment providers directly.

How Can I Check if A Treatment Center Is In-Network With Excellus BlueCross BlueShield Health Insurance Plans?

You can learn if a treatment provider is in-network by contacting Excellus BlueCross BlueShield by calling the number on your insurance ID card. Your representative should be able to verify local providers within your insurance network, and may even mention providers you were not considering.

Your insurance coverage is dependent on your policy, which you can learn about by verifying your coverage with CheckMyInsurance.co. Get started today to learn about your expected out-of-pocket costs, required authorizations, and other essential details of your policy.

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  • New York State has an estimated 998 substance abuse treatment programs. These rehabs provide inpatient care for over 113,000 residents annually, and over 104,000 adults engage in traditional outpatient care each year.
  • Approximately one in three adults in New York experiences anxiety and depressive symptoms, which is a higher prevalence than it was before the COVID-19 pandemic. 
  • New York State’s fatal drug overdose rate remained below the national average from 2011 to 2021.
  • Over 2.8 million adults in NY are living with a mental illness. Approximately 145,000 youth are experiencing depressive symptoms, many of whom do not receive mental health treatment.
  • The Centers for Disease Control and Prevention (CDC) indicated that the fatal overdose rate is 31.4 deaths per 100,000 residents.Â