Harvard Pilgrim Health Care Coverage for Drug Rehab
Discover how Harvard Pilgrim Health Care covers addiction rehab and mental health services. Find the right plan for your needs today.
Harvard Pilgrim Health Care Coverage for Drug Rehab
Discover how Harvard Pilgrim Health Care covers addiction rehab and mental health services. Find the right plan for your needs today.
Harvard Pilgrim Health Care came into being after the merger of Harvard Community Health Plan and Pilgrim Health in 1994. They offer plans in Massachusetts, Maine and New Hampshire. You can get individual and family plans from Harvard Pilgrim directly or through your employer. They also have Medicare Advantage and Medicare Supplement plans for people who are eligible.
Does Harvard Pilgrim Health Care Cover Addiction Rehab?
Yes, may Harvard Pilgrim plans cover addiction rehab and the company has a number of treatment centers in their network. They also make it easy to find out what care providers they cover through their substance use services webpage. There are many levels of addiction treatment included in their network.
However, every insurance plan is different so be sure to verify your coverage details before you start treatment. You’ll want to get a treatment plan from your doctor as well because that will let you know what’s medically necessary in your case.
Spring Hill and its amazing staff has changed my life dramatically for the better. I learned more in 30 days here about addiction and recovery than the previous 5+ years of seeking help for alcoholism and depression. KEEP COMING BACK, IT WORKS IF YOU WORK IT! Thank you all from the bottom of my heart for saving my life.
Vaughn Tucci
2 weeks ago
Spring Hill is a special place to me. It’s peaceful, beautiful, and comfortable. While I was there everyone was so kind and helpful to me. All staff, from recovery specialist, nurses, caseworkers, clinicians and chefs to housekeeping. I learned so much about myself and my addiction. It is truly a place of healing. I’ve been in treatment before and I would recommend this place over any other place I have been to. I bet it’s the best in the country. Spring Hill will always hold a special place in my heart. Thank you.
Iraida Cabana
3 weeks ago
Springhill Recovery Center is a great spot for a loved one to received treatment for drugs, alcohol and mental health! Safe, clean and welcoming!
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse
Adult ProgramYoung Adult Program
MonthlySelf-Pay OptionsPrivate insuranceFinancial Aid
When I first came to Peaks, I was broken, depressed, hopeless, and completely lost. I truly didn’t believe things could get better. But my experience at Peaks changed my life in ways I never could’ve imagined.
From the moment I arrived, I was surrounded by a community of supportive, caring people who genuinely wanted to see me grow. I built friendships and connections that will last a lifetime, with people who stood by me through every high and low of my recovery journey.
The groups and therapists were absolutely incredible, I learned more here than I ever have in any other program. The structure at Peaks helped me build consistency, confidence, and real progress. The staff went above and beyond every single day, they truly cared about us as people, not just clients.
Even the food was amazing (shoutout to the chefs, you made every meal feel special!). The activities were another huge part of my healing, basketball, pickleball, volleyball courts right on property, yoga, art supplies, gym equipment, hikes twice a week, church, Recovery Dharma, and so much more. There was always something positive and grounding to be a part of.
I am endlessly grateful for my time at Peaks Recovery. This program gave me my life back and gave me the tools, support, and hope I needed to keep moving forward. Thank you to everyone who made my experience so meaningful and life-changing. ❤️
Amelie de Leeuw
1 month ago
Peaks Recovery is family! My story didn’t start or end here just part of my wonderful journey. An amazing recovery center based on community. Proud to be alumni!
Tyler holloway
4 months ago
What a great experience. People come here from all over the US because of how great Peaks is. Everyone was wonderful and I'd recommend to anyone in need
Casco Bay Recovery is an incredible place that truly cares about each person who walks through the door. The staff are compassionate, professional, and deeply dedicated to helping clients heal and rebuild their lives. The environment is supportive, warm, magical and focused on long-term recovery and personal growth. I can’t say enough good things about this team — they genuinely make a difference every single day! I am happy to be a part of such an amazing team and effort to change lives!
Colleen Garrick
1 month ago
If you're looking for a place to learn how to get sober and stay sober check out Casco Bay Recovery!
I had the opportunity to take advantage of their PHP(partial hospitalized patient) program and their IOP(intensive out patient) program.
The PHP program runs 6 days a week 6 hours a day including a long lunch. You get to spend the day with BHTs and clinical group facilitators who educate you on the disease model, model of addiction and the 12 steps of AA. Along with fun activitys, meditation and ice breakers.
The IOP program is great when you have some sobriety time under belt and enables you to focus on your recovery while also tending to family life and work.
It runs 4 days a week, two and half hours a day with an option of morning or night depending on your schedule.
The structure of the program includes meeting with a councler and psychiatric nurse practicioner.
Leslie Briggs will bring you through the admissions process which is simple and convienent.
I had a positive experience with clinical including Matt, Amanda, Bella and Kevin.
The Psychiatric Nurse Practitioner, Julie was very helpful and caring.
BHT Noah doesn't disappoint when it comes to exciting activitys, being a good listener and making you laugh.
You'll get a chance to meet Program Coordinator Mike. B who is very recovery smart and is the man to talk to when you need realistic, direct and positively impactful input.
In addition to all the things they can and will do for you, they will direct you toward sober living for men and women, meetings, sponsorship, Family Restored Meetings for your non-alcoholic friends and family and more.
Create friendships and connections that will strenthen your recovery community and foundation at Casco Bay Recovery!
-Casco Bay Graduate Desmond. A (6 months sober)
Desmond Aldrich
1 month ago
An amazing place to be a part of. I am proud when I hear the name Casco Bay Recovery
Green Mountain Treatment Center saved my life. I was sick and scared when I arrived, but the transformation that occurred for me during the 80 days I spent on the mountain was nothing short of a miracle.
I quickly recognized that hard work on my part needed to be done, or I'd be miserable and missing out on the gifts of the program. Thankfully, there is an incredible staff in place who walked with me through the introspection I had to do and showed me that recovery was possible. I marked 5 months sober yesterday and I truly believe that God removed my alcoholic obsession while I was on the mountain.
Everyone's experience is different and I can only speak of my own, but I personally could not see myself succeeding as I did in any other facility. I'll be thankful to Green Mountain for the rest of my life.
Courtney
10 months ago
GRC changed my life for the greater good!
Justin Haskins
10 months ago
The most caring recovery team that works there. Awesome accomodations. All around though really good program. First time to rehabilitation center and was my favorite stop on my recovery road. Glad I choose to go there. Hands down best place to go for real recovery survivors 100%
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult Program
Private InsuranceSelf-Pay OptionsFinancial Aid
Thank you Andrew for your help with great communication and speed with getting us the help we needed today! Keep up the great work! 🙌💛
Dane Michael
1 week ago
Residential was ok PHP was great. Kelly and LeRae are both AMAZING.
Chad White
1 month ago
I just want to say a big thank you to all the staff nurses,doctors,etc I was there last year going through a very rough time in my life everyone was extremely compassionate and sensitive to my care no one made me feel out of place everyone helps you get adjusted and gets you the proper care you need I highly recommend checking into immersion it absolutely saved my life! 🤙💪😁🥳🥳 **To the staff please feel free to contact me I would love to hear from yall updates went forward out of there and never went back to that lifestyle I 100% could not have done it without you thank you all so so so much 🤩😍👍👍👋👋 the programs that truly designed for success you just have to accept and surrender get outside your comfort zone and get better and the staff here will 100% make that possible above and beyond! THANK YOU 🤝 -Josh D.
I had a great experience with All In Solutions The staff is nice, knowledgeable and helpful, I would like to give a special shout out to my Therapist KAREN CASTON she is a awesome therapist and an amazing caring, loving women. She really went above and beyond to get me through my obstacles
Tanya Brooks
5 days ago
All In Solutions (AIS) in Cherry Hill, NJ is an exceptional facility, and we give complete credit for our son’s sobriety and vastly improved mental and physical health to the excellent staff and therapists at AIS. They were truly the best!
All in Solutions provided our son with the best support and right tools he needed to guide him in the right direction in his recovery. The care provided by the staff is exceptional, they are kind, knowledgeable, authentic, and can relate to their patients’ addictions and recovery process. Every staff member that we dealt with was professional, compassionate, and genuine.
Services and support provided by AIS were numerous and very effective. We so appreciated the weekly calls from his therapist on his progress, being able to always reach someone at the AIS facility where he was located, and the weekly zoom family support sessions. The support groups, AA meetings and his AA sponsor has all been invaluable to our son then and now as he is transitioning back into life outside of AIS.
We are forever grateful for the support our son received at All In Solutions and we highly recommend All In Solutions in Cherry Hill, NJ to anyone with drug and alcohol addiction.
Chris Cantwell
1 week ago
This place was wonderful! I love the staff and the groups! They have helped me so much on my thru this process of understanding addiction! Thank you All In Solutions!
There’s something special about Green Mountain. The energy is pure and uplifting, and you can tell the staff are there from the heart and that makes all the difference!
Julia Lopez
1 week ago
The mountain is absolutely incredible!!! I have never been apart of something so beautiful. What a great place to get well
Mack Runyan
1 week ago
Green mountain treatment center i cant say enough about! My son went there and he's thriving today, the foundation he achieved from there i have no words for as his mom, I got my son back!! The councilors are wonderful and always was there for him and me!
This is the best place to be ! They saved my life and helped me find myself. If you or anyone you know needs help, this is the best place to be!!! The staff is great! I love y’all Starbridge !
Caution 2Solidd
2 months ago
I was worried about my loved one going out of state for treatment. But it was the best thing that he could have done. I am grateful for all of the staff and the great team that helped get him in the door. I know this is just the beginning and everything is a lot better than it was.
PHM INC
3 months ago
Amazing facility, staff, and resources. Not my first treatment center but definitely the most beneficial one. Would highly recommend to anyone struggling with substance abuse and/or mental health.
The team at Tranquil Shores is amazing. My clients get great treatment, and their families get consistent communication. The facility is beautiful, clinical staff and programming are legit. As an industry pro for 15 years, I'm happy to share that Tranquil is great.
Darren Hobbs
2 weeks ago
Excellent program, clinicians and staff are top notch!
Clover
2 months ago
Wonderful therapists, nursing, support staff, and fantastic location! Truly I cannot over-hype this team of professionals. If you value your time, and are looking for help with your troubles, Tranquil Shores provides a holistic approach that just cannot be matched. 5/5 stars, thank you again!
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Frequently Asked Questions
What Are Harvard Pilgrim Health Care Plans?
Harvard Pilgrim Health Care offers individual and family plans on the state insurance Marketplace in Maine and Massachusetts along with New Hampshire. These plans are generally either health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
An HMO allows you to coordinate your care through a primary care physician (PCP) who gives you referrals for specialists like addiction or mental health professionals. Your doctor will also help you get preauthorization if necessary. You will need to seek care within the provider network.
For a PPO you can see in network specialists without a referral. A PPO also gives you the opportunity to see out of network providers but you will pay significantly more out of pocket. You may still need preauthorization for certain types of care.
If you have Original Medicare and need help with your out of pocket expenses you can get a Medicare supplement plan from Harvard Pilgrim Health. Another option is replacing Original Medicare with a Medicare Advantage plan. Advantage plans cover everything Original Medicare does and often offer additional benefits such as vision or dental coverage. However you generally need to use providers in the plan’s network and you may need preauthorization for certain services.
What Perks Come With Harvard Pilgrim Health Care Plans?
Harvard Pilgrim plans come with some helpful perks. For example you may have access to wellness programs and discounts and the Harvard Pilgrim mindfulness program. They also have telehealth options and experts such as nurses and social workers who can help answer your questions.
Another helpful perk is the discount they offer on complementary and alternative therapies. Certain plans allow you to get up to a 30% discount on alternative medicine services if you select a provider from the network they have partnered with.
What Inpatient Addiction Treatment Does Harvard Pilgrim Health Care Cover?
The first step to getting addiction care is for a provider or clinician to assess what level of care you need. If inpatient addiction treatment is the right level of care, they will recommend it to you. The assessing clinician will likely be the one who asks your insurance company for prior approval, but sometimes it’s your primary care provider who does that part. Either way, inpatient addiction treatment is very resource intensive, so most insurance companies want to make sure it’s the right place for you, thus the requirement for prior approval.
There are a couple of different types of inpatient addiction treatment that Harvard Pilgrim may cover for you. One inpatient treatment type is medical detox. The goal of detox is to get you safely through opioid or alcohol withdrawal. Treatment center staff medically monitor your progress and manage your symptoms. The length of time you’re there depends on how quickly you are able to detox, usually somewhere between three and ten days.
Once you’ve completed detox, you can start to focus on changing your behaviors to keep from relapsing. You may be referred to residential rehab to work on developing these skills. The structured environment of residential rehab is designed to help break behavioral patterns that lead to using or drinking. The groups teach you about addiction and how to prevent relapse. A stay most commonly lasts for three to four weeks but can go longer.
What Outpatient Rehab Does Harvard Pilgrim Health Care Cover?
You can find a number of outpatient addiction treatment centers with Harvard Pilgrim’s network. Below are some of the treatment types you might be able to find.
The most intensive type of outpatient treatment is partial hospitalization. This type of treatment looks very much like residential rehab. You’re usually there all morning and all afternoon. The one big difference is you go home in the evening and on weekends. Since you have large chunks of time when you’re not in a supervised setting, this is a good option for people who can go a few hours or days outside a structured program without relapsing.
The next level down is intensive outpatient. This level usually requires a two or three time a week commitment for a couple of hours each day. The programming usually consists of groups and individual sessions where you learn and practice relapse prevention strategies.
Standard outpatient treatment is the level of care that most people are familiar with. This usually involves enrolling in a program where you see a therapist and a psychiatric provider. They may offer some groups you can choose to attend. You and your providers will determine how frequently you’ll meet.
Does Harvard Pilgrim Health Care Cover Methadone & Suboxone (MAT)?
Methadone and Suboxone are two FDA approved medications that treat opioid addiction. They can be used to help you stop opioids or as a maintenance treatment to help prevent you from relapsing during treatment.
These medications and others are sometimes used within a detox program. When they’re used this way your insurance plan will have the same coverage as it has for detox.
Suboxone and methadone are also used for maintenance treatment. This is when you receive these medications to keep you from going into withdrawal. Suboxone can be prescribed by your primary care or psychiatric provider. If this treatment is appropriate for you, your insurance plan may cover it as an outpatient treatment.
Another way to get Suboxone and the only way to get methadone is to go to a specialized opioid treatment clinic. Harvard Pilgrim has several of these clinic types within their network, and may cover this service if you’re eligible. Be sure to check your insurance plan for details before starting treatment.
Does Harvard Pilgrim Health Care Cover Other Mental Healthcare?
Harvard Pilgrim may cover a variety of different mental health services. Some of the acute services you may find in their network include inpatient psychiatric hospitalization for people of all ages from children to older adults. Some emergency departments have specialized crisis services that Harvard Pilgrim may also cover.
Certain plans may cover in home behavioral interventions for children and adolescents where the service is available. They also have providers who work with people who have autism including providers who use applied behavioral analysis.
People who find it difficult to travel to appointments may appreciate Harvard Pilgrim’s telehealth services benefit. This benefit allows you to see a provider online instead of going in person. Harvard Pilgrim partners with a telehealth only service provider but many brick and mortar offices offer telehealth too.
If you’re having trouble finding a provider Harvard Pilgrim can help connect you to someone through their case management service. If you just want some reliable information about a health condition their website includes a library of information you can access.
How Long Will Harvard Pilgrim Health Cover Rehab?
The length of treatment in most levels of care can be very individual. There is often some level of reassessment happening every few days. It’s common for residential treatment to last for three to four weeks for most people but some may stay up to 90 days.
Other programs like partial hospitalization and intensive outpatient also have highly variable lengths of stay. These programs can continue from weeks to months. Together with your treatment team you’ll be involved in setting the treatment goals that will inform your length of stay. You’ll get the best results if you participate fully in the goal setting stage and the totality of your treatment.
Can I Travel Out of State For Treatment With Harvard Pilgrim Health?
Your individual plan will determine whether you can travel out of state for treatment. Harvard Pilgrim’s network tends to be more concentrated in the states they operate in which are Massachusetts and Maine and New Hampshire. They do have one plan that is specific for families with dependents living out of state such as those who have a child in college. That plan has out of state options.
Some of Harvard Pilgrim’s plans will not allow you to seek care out of network at all even within your state. Plans that do allow you to go out of network will usually have higher copays and deductibles if you go that route. Those fees are generally much more than what they would have been had you received care from inside their network. If you are able to stay within their network for care you will be able to avoid these additional fees. If you do decide to get care from out of network pay special attention to your plan details to avoid surprises.
How to Verify Coverage With Harvard Pilgrim Health
You have a few options to verify what services your Harvard Pilgrim plan covers. One option is to call their customer service line and ask about the service you’re interested in. You can also log in to your account online and check if a service provider is part of your plan network.
One more way you can check is to speak directly to the service provider you would like to see and ask them to verify that they’re covered under your plan. Whichever of these options you choose to use it’s important to check using the name of your specific plan since different plans within Harvard Pilgrim have different provider networks.
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By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
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