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Alcohol and Drug Rehab Coverage with Empire Blue Cross Blue Shield 

Alcohol and Drug Rehab Coverage with Empire Blue Cross Blue Shield 

Overview of Empire Blue Cross Blue Shield Insurance

Empire Blue Cross Blue Shield (Empire BCBS) is a reputable health insurance company with a long history of providing quality healthcare coverage throughout the state of New York. They have been around since 1934 and currently serve over 4 million New Yorkers. 

Empire BCBS offers a variety of health insurance plans to individuals, families and businesses, including HMO, PPO, EPO and POS plans that cover a wide range of healthcare services, including preventive care, hospitalization, prescription drugs and mental health care.

In addition to traditional health insurance plans, Empire BCBS also offers Medicare Advantage plans, which provide additional benefits to Medicare beneficiaries and Medicaid managed care plans for eligible individuals.

Empire BCBS has a large network of healthcare providers in New York and out of state. Members can use the company’s online tools to find in-network providers and manage their accounts.

Is it Important to Have Insurance Coverage for Rehab?

Health insurance is crucial for people struggling with mental health, drug and alcohol addiction issues because out of pocket treatment costs are expensive and many people cannot afford it.

Insurance can help to alleviate the financial burden by covering a portion or all of the costs of treatment, including detox, inpatient and outpatient treatment, counseling and medications.

Without insurance, people needing treatment may be forced to choose between going into debt  or foregoing treatment altogether which has devastating consequences, as untreated addiction leads to a wide range of negative outcomes, including job loss, legal issues, health problems and even death.

Being able to access treatment helps to remove barriers and encourages individuals in need to seek the life-saving services they need to overcome addiction, for their own sake and that of their families.

Types of Health Insurance Plans Offered by Empire BCBS 

Empire BCBS offers a range of plans, including:

  1. Health Maintenance Organization (HMO) Plans: requires you to choose a primary care physician (PCP) from a network of healthcare providers. Your PCP will coordinate your medical care and refer you to specialists within the network.
  2. Preferred Provider Organization (PPO) Plans: allows you to see any healthcare provider, but you will save money by using providers within the network.
  3. Exclusive Provider Organization (EPO) Plans: requires you to use healthcare providers within the network except in emergency situations.
  4. Point of Service (POS) Plans: combines features of the HMO and PPO plans. You choose a PCP from a network of providers, but you can also see providers outside the network for an additional cost.
  5. High Deductible Health Plans (HDHP): have lower monthly premiums but higher deductibles. You will pay out of pocket for most medical expenses until you reach your deductible, after which coverage will kick in.
  6. Catastrophic Plans: have very low monthly premiums but high deductibles. They are designed to cover major medical expenses in case of a serious illness or injury.

Empire may also offer additional plan options, depending on your location and specific needs. It’s important to carefully review the details of each plan before making a decision as to what is best for you and your family.

Benefits of Choosing Empire BCBS for Alcohol and Drug Rehab Programs

Empire is one of the top insurance providers in the United States, offering coverage for drug and alcohol rehab centers. Here are some of the benefits of choosing Empire Insurance for addiction treatment:

  • Comprehensive coverage: Empire offers comprehensive coverage for mental health and addiction services and treatment programs, including inpatient and outpatient rehab, detox and medication-assisted treatment.
  • Access to high-quality care: works with a large network of treatment centers who offer high-quality drug and alcohol programs. 
  • Affordable costs: offers competitive rates for drug and alcohol rehab coverage.
  • Easy to use: their easy-to-use website and customer service team can help you find a provider, understand your coverage and file claims.
  • Confidentiality: Empire is committed to protecting your privacy and confidentiality. You can trust that your personal information and health records will be kept secure.

Inpatient vs. Outpatient Rehab Center Coverage for Substance Abuse Treatment

Inpatient treatment programs involve living in a residential facility for a period of time, typically between 30 and 90 days, while outpatient treatment programs allow you to attend therapy and counseling sessions on a regular basis while continuing to live at home.

In terms of coverage, many plans will provide coverage for both inpatient and outpatient addiction treatment but the specifics will depends on your plan.

In general, out-of-pocket costs for inpatient treatment will be higher, as these programs typically involve more intensive and specialized care. Outpatient treatment may have lower out-of-pocket costs, but may also have limitations on the amount of therapy and counseling sessions that are covered. Again, all of this depends on your specific plan.

It’s important to review your plan’s coverage for addiction treatment carefully and speak with your provider to understand your options and any out of pocket costs.

Some state and local government programs offer financial assistance for addiction treatment, so it may be worth exploring these resources as well.

Empire BCBS of New York Insurance – Pre-authorization for Alcohol & Drug Rehab Coverage

The pre-authorization process for drug and alcohol rehab will vary depending on your plan but generally speaking, pre-auth is a requirement for most plans.

Here are the steps for the pre-authorization process:

  1. Contact the member services number on the back of your insurance card 
  2. The treatment center will provide any required documentation of medical necessity, level of care, estimated length of stay and treatment planning.
  3. Empire will review the pre-authorization request and either approve or deny coverage. The timeframe for approval will vary.

Remember, pre-authorization is not a guarantee of coverage and you may still be responsible for copayments, deductibles and other out-of-pocket expenses. Be sure to review your plan details and coverage limits.

Finding a Listed Drug and Alcohol Treatment Center through Empire BCBS of New York

To find a listed addiction rehab facility with through your Empire BCBS plan, all you need to do is contact customer service and ask for a list of in-network facilities in your area and out of state. Now you can start researching facilities to find the one that best fits your needs. 

How to Find the Best Inpatient Alcohol and Drug Rehab for Your Needs?

Choosing a rehab will likely feel overwhelming and leave you wondering where to start. Addiction treatment centers vary in terms of the quality of care, types of services offered and more. It’s important to do your research and choose a facility that is not only reputable but one that meets your treatment needs.

The first thing to do is talk to your doctor, therapist and friends and check out any they recommend. Word of mouth is a powerful thing so talking to someone who has been there will be very helpful. Here are some of the things you will want to find out: 

  • what their treatment program entails
  • do they provide mental health treatment
  • accreditation & licensing
  • staff credentials
  • is there detox support onsite
  • what do the facilities look like
  • how many beds they have
  • look at online reviews

You can now reach out to the center to confirm that they accept Empire BCBS and there is availability. The admissions team will contact Empire to verify your benefits and obtain any pre-authorization or referral forms that are needed and get the ball rolling for your admission.

Empire BCBS Co-Payments & Deductibles 

The co-payments and deductibles for Empire plans will vary depending on what plan you have and can vary from a few hundred dollars to several thousands.

  • A co-payment is a fixed amount that you pay for services, such as a doctor’s visit or medications. 
  • A deductible is the amount you pay out of pocket before your insurance coverage kicks in and covers a portion to all of the costs. 

Out-of-Network Insurance Cover with Empire BCBS

Empire offers various plans that cover alcohol and drug treatment outside of their network and it should come as no surprise that the extent of coverage and costs will vary depending on your plan.

With out-of-network benefits, you’ll be covered for services from providers who are not part of the Empire network (in network providers). The downside is that the amount of coverage may be limited and leave you having to pay a higher percentage of the costs out of pocket.

Contact Empire’s customer service or check your plan documents to learn about your out-of-network coverage.

Coverage for Dual Diagnosis Treatment

Empire members who are struggling with both substance use disorder and mental health issues (co-occurring disorder) will be provided some form of coverage for:

  • inpatient treatment
  • detox
  • outpatient programs
  • individual counseling
  • group and family therapy
  • medication-assisted treatment (MAT)

Luxe Recovery Accepts Empire BCBS for Inpatient Alcohol & Drug Treatment

If you or a loved on are dealing with drug or alcohol addiction issues and you have Empire BCBS insurance, Luxe Recovery can help. The team at Luxe Recovery will help guide you through the admission process including communicating with Empire to verify your benefits, help with pre-authorization and submitting any required documentation throughout your treatment.

Luxe Recovery’s world class treatment will help you reach and maintain sobriety as the program is tailored for your unique needs.

The professional and caring team strives to provide clients with a seamless admission process and treatment and will work hard to maximize your benefits and keep you in treatment for as long as possible.

You can reach out to the admissions staff to learn more – they are always available to listen and are just a phone call away.

You can fill out this form or call us directly


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