Discovering the right treatment program for you can feel daunting and difficult. There are so many factors to consider. For example, you will need to decide if you want to enroll in an inpatient or outpatient treatment. Also, you’ll need to decide whether you want to travel for treatment or stay in your hometown.
Moreover, you need to decide the length of the treatment you’ll enroll in. Will you enroll in 30-day treatment, 60-day treatment, or 90-day treatment? Once you make all of these decisions, you will also have to decide how you will pay for addiction treatment. Will you pay for it out of pocket? Will you pay for it through private insurance? Or, will you pay for treatment through Medicare or Medicaid? Although we don’t know every personal circumstance, we do want to help you understand the basics. This page will help you understand what you need to know about Blue Cross Blue Shield Tennessee. If you would like more information about this or other insurance companies, please call us at 901-403-7925.
Blue Cross Blue Shield of Tennessee
Blue Cross Blue Shield of Tennessee (BCBS) is one insurance company that may be covering you at this time. BCBS prides itself on being a client-focused insurance company. Further, BCBS works closely with medical providers in the community. Since 1945, BCBS has served people in Tennessee. BCBS is a not-for-profit company. Therefore, BCBS’s priority is not to make money to pay shareholders. Ultimately, BCBS’s goal is to operate solely to provide services to its members.
At Blue Cross Blue Shield (BCBS), three plans are available. All services offer substance abuse treatment coverage but may require a copay or coinsurance and may require a deductible to be met. The three plans are Bronze, Silver, and Gold. First, the Bronze plan is good for infrequent care. However, care through the Bronze plan may have a high deductible. Second, the Silver plan has a lower deductible and offers more providers. Third, the Gold plan has the lowest deductible. However, the Gold plan usually comes with higher monthly premiums.
Medicare and Medicaid in Tennessee
In several cities in Tennessee, many treatment centers accept both Medicare and Medicaid. Medicare is the US federal healthcare plan for people who are ages 65 and older. Medicaid, however, is the US federal healthcare plan for those who are economically disadvantaged. Although Medicare and Medicaid aren’t for everyone, these options can help those who aren’t covered through private insurance.
Information on Medicare
Medicare, the federal health insurance program, serves the following people. Medicare serves those who are 65 or older, some younger people who have disabilities, and people who have End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure that requires dialysis or a transplant. Further, Medicare’s services come in four distinct parts. Here are the four parts:
- Hospital Insurance, Medicare Part A
- Medical Insurance, Medicare Part B
- Medicare Advantage, or all-in-one coverage, Medicare Part C
- Prescription drug coverage, Medicare Part D
To help you better understand Medicare, we will further explain these services.
Medicare Part A
Part A is hospital insurance. Therefore, Part A covers care in a skilled nurse facility (such as an assisted living center), hospice care, inpatient hospital visits, and home healthcare in some situations.
Medicare Part B
Part B is medical insurance. Consequently, Part B covers outpatient care, some doctors’ visits, medical supplies, preventative services, and some doctors’ services.
Medicare Part C
Part C is a combination of Part A, Part B, and (most of the time) Part D. This means that those covered by Part C have access to hospital care, medical care, and prescription services.
Medicare Part D
Part D covers prescription drug coverage. This means that those covered by Part D can receive their medications at a lower cost than they normally are.
Information on Medicaid
Through Medicaid, millions of Americans receive the healthcare they need. Medicare generally served economically disadvantaged people in the US. States administer Medicaid, and the program is funded by states and the federal government. Further, Medicaid covers pregnant women, children, people with disabilities, and adults. Ultimately, Medicaid provides care to those who would not otherwise have the means for health insurance.
Coverage of Inpatient, Outpatient, and Residential Treatment
Although there are no specific benefit categories for addiction treatment, Medicare covers those types of services when providers deem the services reasonable and necessary. Therefore, Medicare could potentially cover inpatient, outpatient, and residential treatment. Further, Tennessee’s Medicaid also covers addiction treatment for adults with alcohol or drug dependency. Medicaid’s coverage includes outpatient and residential services, among other treatments.
Here is some information about the difference between outpatient, inpatient, and residential treatment. Outpatient treatment is part-time, usually between 10 to 12 hours a week, meaning that the recovering user comes to the facility, but they do not stay in the facility. These programs usually run between three months to one year. Ultimately, outpatient treatment is right for those who have more mild addictions.
Inpatient treatment means the person stays at a facility for a period of time—usually between three weeks and six months. While staying at the facility, they undergo intensive treatment. Inpatient treatment has a higher success rate than outpatient treatment, but it is also more expensive. Further, inpatient treatment interrupts daily life. Ultimately, inpatient treatment is especially effective for those who have undergone serious addictions.
Residential treatment means that patients live in a residence with other patients. Treatment staff transports the patients to the treatment center each day. In this way, they experience the benefits of both inpatient and outpatient treatment. Residential treatment is best for those who want to keep their treatment and living areas separate, but they still want to separate themselves from their toxic environments.
How to Find Information
Substance abuse treatment options are commonly found in behavioral and mental health sections of insurance company websites. If you are looking for a specific facility, check your insurance company’s website to make sure the provider is covered by your plan. Many facilities in Tennessee offer payment assistance and/or offer their services on a sliding fee scale.
More Information About Blue Cross Blue Shield
Regardless of what kind of insurance you have, you can receive the treatment you need. Whether you have Medicare, Medicaid, or Blue Cross Blue Shield, there is treatment out there for you. To review, Blue Cross Blue offers several types of plans. For example, the company offers Gold, Silver, and Bronze plans. As with other insurance companies, Gold offers the most coverage. However, the Gold plan also comes with the highest monthly payments. The Silver plan offers average coverage with average monthly payments. Finally, the Bronze plan provides the lowest amount of coverage with the lowest monthly payment. Further, those who do not have insurance through Blue Cross Blue Shield can find help through either Medicare or Medicaid.
In summary, Medicare is federal healthcare. Further, Medicare covers those over the age of 65, as well as certain people who have disabilities. Also, Medicare covers those who have ESRD. Therefore, Medicare can be a good option for people who fall into those categories. Additionally, Medicaid is a federal program designed to serve people who are economically challenged. Therefore, people who have severe financial constraints may qualify for Medicaid.
HMO and PPO Plans
Another element of insurance to be aware of is the types of plans offered. Most insurance companies offer a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan. The difference between these two types of plans is the networks, costs, and copayments. For example, HMO offers coverage through specific in-network medical providers. However, PPOs offer more flexibility with who a person can receive care from.
Further, HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. However, PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of the network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan. Clearly, you have a lot of options when it comes to deciding which method of payment is right for you. If you would like more information about HMOs, PPOs, or Blue Cross Blue Shield insurance, please call us today. Contact us at 901-403-7925.