Independence Blue Cross is a health insurance provider based in Pennsylvania and is the largest insurance provider in the Philadelphia area. They are one of many independent licensees of the Blue Cross Blue Shield Association (BCBSA) and offer individual, family, employer and Medicare plans for members in Pennsylvania.

No stranger to the opioid epidemic, Independence Blue Cross bragged in a recent whitepaper that they have reduced opioid scripts by 65% among their members between 2014 and 2020. 

Other Independence Blue Cross efforts to address addiction treatment needs in the Philadelphia area include maintaining almost 100 addiction treatment rehab centers and retaining over 5,000 behavioral health providers in-network. 

While Independence Blue Cross doesn’t require PAs for Vivitrol or Suboxone, they do require PAs - which they refer to a pre-certifications or “precerts” for many other types of behavioral healthcare services, including most inpatient and outpatient behavioral healthcare services. 

Here’s 4 quick tips for understanding addiction treatment discharges with Independence Blue Cross.

Discharge Planning at Independence Blue Cross is Handled by the Independence Care Management and Coordination Team 

Insurance providers are financially incentivized to make members’ stay at addiction treatment centers as short as possible. That’s why, as savvy addiction treatment billing department advocates, we spend a lot of time educating clients about how to maximize patients’ coverage and benefits to ensure that patients get the care that they deserve. 

When you’re working with Independence Blue Cross, it’s the Independence Care Management and Coordination team that will monitor the patient’s stay at any residential program. This team will conduct a concurrent review to ensure that the care being provided is medically necessary and that it does not conflict with Independence Blue Cross’ clinical practice guidelines. 

One of the main pieces of care that the Independence Care Management and Coordination Team focuses on is discharge planning. They want to ensure that the patient is discharged promptly and is not given more days of care than absolutely necessary, according to their review. 

The Care Management and Coordination Team at Independence Blue Cross also handles preauthorizations or precertifications. 

Discharges Nearly as Tough as Admissions: All Inpatient Addiction Treatment Services with Independence Blue Cross Require Precertification 

Independence Blue Cross’ website states that they require precertification for: 

• Inpatient addiction treatment programs 

• Partial hospitalization addiction treatment programs 

• Intensive outpatient SUD programs 

According to their Summary of Benefits and Coverage, Independence Blue Cross actually requires precertification for all “mental health, behavioral health, or substance abuse” outpatient and inpatient services:

Independence Blue Cross Members May Appeal a Care Management and Coordination Team Discharge Decision

If a member disagrees with the Care Management and Coordination Team’s discharge planning timeline, they may remain in the program but it is unlikely that they will receive coverage for their stay. They (or your billing department) can file an appeal with Independence Blue Cross using their grievance process. 

Inpatient Addiction Treatment Discharge Decisions with Independence Blue Cross are Based in Clinical Practice Guidelines 

All Independence Blue Cross discharge decisions are made using Independence Blue Cross’ clinical practice guidelines. It can be helpful to review these when understanding discharge planning with Independence Blue Cross.

Ready to Master Managing Addiction Treatment Discharges with Independence Blue Cross? We Can Help.

Addiction treatment providers and insurance companies rarely see eye to eye on the appropriate length of stay for residential SUD patients. Problems around discharge planning crop up frequently - but they don’t have to. 

BehaveHealth’s Revenue Cycle Management (RCM) service includes soup-to-nuts, hyper-detailed, hands-on attention to every single component of your addiction treatment billing needs. We have strong working relationships with every major insurance company in the United States. 

Even better, we’re not health care generalists.  We only work for behavioral health providers like you.

Let our team of specialists handle it all: 

• Verification of Benefits 

• Utilization Review 

• Billing and Collections 

• Patient Responsibility

• Denials and Appeals 

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.