Find Alcohol & Drug Rehabs that Accept CareFirst Insurance

CareFirst BlueCross BlueShield and CareFirst BlueChoice provide access to licensed clinicians, addiction specialists, and accredited treatment centers. 

This network aims to provide smooth transitions between detox, residential or inpatient programs, outpatient counseling, and follow-up care. Using in-network providers can help members lower out-of-pocket expenses and maintain continuity throughout their recovery journey.

Many CareFirst plans include coverage for substance use disorder (SUD) treatment when deemed medically necessary. Coverage may include outpatient counseling, intensive outpatient programs, partial hospitalization, residential treatment, and medication-assisted treatment (MAT). The exact benefits vary by plan type, state, and network.

Depending on your plan, coverage may include:

• Detox / Ambulatory Detox: Supervised withdrawal in a medical setting.
• Intensive Outpatient Programs (IOP): Therapy sessions multiple days per week, including individual, group, and family counseling.
• Partial Hospitalization Programs (PHP): Structured day programs providing therapeutic support while allowing members to return home.
• Residential or Inpatient Rehab: 24-hour care for more severe SUD cases.
• Outpatient Counseling: Flexible therapy sessions tailored to the member’s schedule.
• Medication-Assisted Treatment (MAT): Therapy combined with FDA-approved medications to support recovery.
• Dual Diagnosis / Co-occurring Disorders: Programs treating SUD alongside mental health conditions.

Coverage varies by plan type:

• HMO Plans: In-network only, primary care–coordinated.
• PPO Plans: Greater flexibility with some out-of-network options.
• Open Access / POS Plans: Hybrid options combining savings and choice.
• Individual & Family Marketplace Plans: Coverage differs by tier.
• Medicare Plans: May cover counseling, medications, and medically necessary services.
• Medicaid / State Plans: May provide detox, outpatient care, and support services based on state rules.

Health & Safety Criteria CareFirst Considers

CareFirst evaluates requests for treatment based on:

• Severity and frequency of substance use: Evaluating how often and how intensely substances are used to determine the appropriate level of care.
• Potential safety risks: Considering any immediate or ongoing risk to the member’s health, well-being, or the safety of others.
• Previous attempts to quit or reduce use: Reviewing past efforts to stop substance use to guide treatment planning and the level of support needed.
• Co-occurring mental or physical health conditions: Assessing additional medical or behavioral health needs that may affect recovery and require integrated care.
• Clinical documentation from your provider: Using medical records and assessments to confirm medical necessity and help identify the most suitable treatment program.

These criteria help ensure members receive the level of care that is safe, appropriate, and effective.

Pre-Treatment Approvals & Requirements

Before authorizing specific levels of addiction care, CareFirst may request the following:

• Outpatient therapy: Requests for routine outpatient counseling or therapy sessions may often be approved within 1–2 business days, allowing members to begin care promptly.
• Detox or inpatient programs: Higher-intensity services such as medically supervised detox or inpatient rehabilitation typically require a clinical review, which may take several days to ensure the level of care is medically necessary.
• Emergencies: In urgent cases, such as acute withdrawal or immediate health risks, requests may be expedited to provide faster access to critical treatment services.

In-network providers:

• Lower out-of-pocket costs: Members typically pay reduced deductibles, copays, and coinsurance when using in-network facilities.
• Contracted rates: Pre-negotiated pricing with CareFirst helps prevent unexpected or surprise medical bills.
• Streamlined approvals and coordination: Prior authorizations and care transitions are generally faster and simpler within the network.

Out-of-network providers (limited coverage in PPO plans):

• Higher out-of-pocket expenses: Deductibles and coinsurance are usually higher, which can increase overall treatment costs.
• Potential extra charges: Members may be responsible for amounts exceeding CareFirst’s allowable charges, depending on the plan.
• Additional documentation and approvals: Out-of-network care often requires more paperwork, prior authorization, and clinical review before coverage is confirmed.

Emergency or Urgent Addiction Care

CareFirst can expedite approval for urgent situations such as medical emergencies or acute withdrawal requiring immediate attention. Members should contact the CareFirst behavioral health line to ensure timely placement.

While CareFirst generally covers medically necessary addiction treatment, some services or features may not be included under standard plans:

• Luxury or comfort amenities: Features such as private suites, spa treatments, or massage services are typically considered non-clinical and may not be covered.
• Non-evidence-based programs: Programs that rely exclusively on holistic or alternative approaches without clinical support may not qualify for coverage.
• Out-of-network rehabilitation centers: Unless your plan specifically includes PPO out-of-network benefits, coverage for care outside the network may be limited or unavailable.
• Extended or long-term sober living: Supportive housing beyond standard treatment may only be covered when it is medically necessary and documented by a healthcare provider.

Knowing these limits helps members plan care aligned with their benefits.

If CareFirst does not approve your requested treatment, members have several options to explore:

• Speak with a CareFirst Behavioral Health Care Manager to evaluate alternative treatment options that may meet plan requirements.
• updated medical records or assessments to support medical necessity and strengthen your coverage request.
• Choosing a facility within CareFirst’s network can improve the likelihood of approval and reduce out-of-pocket expenses.
• If inpatient treatment is denied, Intensive Outpatient Programs (IOP) or Partial Hospitalization Programs (PHP) may still be covered and appropriate.
• Members can formally appeal or request a reconsideration of the decision to gain access to the care they need.

To verify your benefits:

• Call the number on your CareFirst ID card.
• Log in to your CareFirst member portal for behavioral health or SUD coverage details.
• Work with Better Addiction Care to confirm coverage, in-network options, and required authorizations.