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.
As you search for reputable rehab centers or verify insurance participation, you can learn more about rehab options to discover programs that meet your clinical and financial needs.
By Michelle Tavares
Michelle Tavares is a registered nurse with over 15 years of experience in mental health nursing. She has worked in inpatient and outpatient settings as well as in bedside and administrative roles. She is a fighter of stigma and an advocate for getting people the mental health services they need.
Medically Reviewed by Anna Spooner
Anna has 10 years of experience in insurance and has been a content and copywriter since 2011. She strives to make all of her writing approachable and easy to understand while drinking copious amounts of tea. Anna writes about accessing addiction treatment, insurance, and finance.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionDual DiagnosisOpioid AddictionSubstance AbuseMental Health And Substance Abuse
Adult ProgramYoung Adult ProgramProgram For MenProgram For Women
Private insuranceSelf-Pay Options
My experience with All In Solutions has been a transforming experience from the moment they picked me up from detox. I walked in the door of their facility, broken, physically, mentally and spiritually. I was met at the front door by the intake coordinator. This lady completed my intake in a very welcoming, calming relatable and professional way.
Throughout the intake, she kept checking on me by offering me something to drink, eat and reassured me that I was safe and that there was Hope. I was immediately met with the medications, director, nurse, practitioner, nurse practitioner assistant and my amazing case manager. The housing director explained to me what my housing was going to look like. I was always given guidance and explained what was going on at all times.All of these people have been their for me every step of the way! I love the whole program at All In Solutions. The groups were facilitated by very professional, innovated, creative individuals that were not only relatable. Every employee at All In Solutions have been very kind, professional caring, giving people. Most of the employees are in recovery themselves, and even if they were not in recovery, they were still relatable, caring, giving people. I was only gonna stay for two weeks. Then extended to four weeks.Then I extended for six weeks at All In Solutions. I went from no Hope to seeing my life in a whole new perspective. All In Solutions gave me purpose hope perspective! They all gave me my life back in a whole new energized way! I can see clearly now that the rain is gone! I would definitely recommend All In Solutions to anyone! This is the best treatment facility I have ever seen in this country. Thank you so very much, All In Solutions!! You all saved my life!!
Cheryl Valdivia
5 days ago
What a great experience! The staff was incredibly friendly and professional, and the facilities were outstanding. The treatment education was enlightening and gave me a much better understanding of the process. I truly appreciated the care and attention I received and would highly recommend them.
Joel Buchholz
5 days ago
I love what this place has offered to me…I highly recommend this facility to the sick and suffering addicts, I promise your life will never be the same like they say “it work if you work it”…. Very clean, staff is nice and kind….what ever you need to succeed they got you. It’s like living at home….they need to have these facilities all over the world. I don’t regret coming here at all in fact I wish I could have stayed longer…..I love this place
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Spring Hill has been a life changing experience for me. The staff were kind, caring and professional. Groups were rich in educational information on addiction along with self awareness, and relationship therapy. The open campus allows for individuals to enjoy the fresh air and views. Highly recommended!
Beth hebb
1 month ago
The staff was amazing, very helpful in recovery, and, and supportive of my personal needs. Vert confidential of my well being, and the mesical staff / nursing,was outstanding the food, incredible, great variety. I would recommend spring hill to anyone neesing tratment.
Derek Moretti
2 months ago
Spring Hill was one of the nicest css programs I have been to. You are treated like a real human, not locked behind doors all day. Being able to be outside made all the difference in the world for me. I finally feel like I made good progress on my recovery.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
This place and the staff here are amazing, when I was at my lowest casco bay took me in. I followed their program and the steps and am now going on 4 months sober. And many many more to go.
I quickly grew attached to the staff which is wild. Because hated myself at that time. But I found help and happiness and companionship while my time in the program. And then found myself. You may walk in like a lamb. “I did” but I promise you, you will walk out like a lion if you want too. It’s up to you. And it starts with you. And casco bay is there for you. Day and night. I seriously have love for each of the staff members. And will absolutely be visiting and popping in to say hi from time to time. Thank you casco bay for all that you do!
Duane
1 month ago
Haven’t been a model patient, despite that they’ve been there time and time again
They truly do care
Shoutout Colleen, Mike B, Noah,, Leslie
Aidan K
3 months ago
This place saved me and I will gladly say if you need help this is the place to be. Shoutout to Colleen for being the best counselor I ever had and thank you to everyone at casco for saving my life
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Very good appointment. Came up with a plan for my knee.
keith beaulieu
2 months ago
Dr Kovalenko is an extremely skilled orthopedic surgeon and has a great, friendly manner with patients. I recommend him and all the St. Mary’s staff very highly.
robin crawley
2 months ago
I have been so impressed with the whole St. Mary's health system. I met with Dr. Kovalenko and his team yesterday for a knee replacement. Both Dr. Kovalenko and his nurse were amazing. They allowed me to take as much time as I needed to get all my questions, concerns, and options answered so I was completely comfortable with my up coming surgery. Highly recommend to anyone looking at orthopedic help.
Very plesant group, quick to get you scheduled for appointments, and I have never waited more than 5 minutes in the waiting room.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
The staff from Chefs, TAs, Nurses, Case workers, Clinicians, Couselors, Drivers basically everyone that works at adcare made me feel supported and loved in my pursuit to sobriety. If it wasn't for them I dont think I couldn't of kept trying and kept my head up to stay strong to be happy and enjoy life. I love the adcare team and am indebted for all the love and support they showed me every time I walked through those doors. Thank you all and you will see me again this time I will be coming in for a commitment not as a patient.
Love always,
Val
Valery Lopez
1 month ago
My experience at ACARE RI has been incredible. The staff are very polite and understanding around my addiction to alcohol. In particular my case manager Scott quickly identified my direction for treatment in conjunction with his team. He has been an incredible support and doesn't make u feel less than you truly are. IMPORTANT! I would also like to give a shout out to Jen from the kitchen staff. She is incredible and knowledgeable in this recovery field. Great person!
So too ADCARE from the bottom of my ❤️.
So, the to
Kevin Turner
1 month ago
What can I say about a place that gave me a second chance at life . First the staff . I have never met more compassionate, caring, knowledgeable professionals. The therapy, group and individual really got to the bottom of what made me abuse substances. I learned so much about myself. I was given tools that will help me navigate in the real world. Not just platitudes but real strategies. The facility is fabulous. I’ve taken yoga classes. I’ve had acupuncture. I returned to working out in the great gym they have. There’s every kind of art supplies you could ask for. Together with healthy meals and unlimited snacks it’s the total package. I haven’t mentioned the community. You meet people who are going through the same things you are . I made friends. If life isn’t what you want it to be because of substance abuse and you want to do a restart please walk in their door. You won’t regret it. I’m Steve and I’m a alcoholic.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Very supportive ! You get what you put in. Very satisfied with there support! Nate was big support! Proud to have graduated! They saved my life!
Norman White
4 months ago
Granite Recovery Center (specifically Green Mountain Treatment Center) gave me the tools to live a successfully sober life. All the 12 Step Coordinators were fantastic and greatly helped me in my journey!
IZZYRAY08 Raymo
5 months ago
GRC saved my life, they taught me how to manage my emotions in a healthy way without the need for substances. I am forever grateful
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse
Adult ProgramYoung Adult ProgramLGBTQ Program
Private InsuranceSelf-Pay Options
My previous assumption of inpatient rehabilitation was completely wrong after coming through Northpointe's program! The facility is beautiful and very clean. Meals are excellent and I can't say enough how welcoming and loving the staff is! I consider them part of my family now! Super RAD experience and I gained alot of knowledge going through Northpointe Recovery's program. Thank you and onelove NP!
aarik valvas
1 month ago
Northpoint was a life saver for me. Highly recommend it. Great staff. They go above and beyond. Million Thanks to Northpoint!!
Destiny Reiter
1 month ago
I found northpoint when I was in need of a real change in life & honestly it was the best decision I ever made.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse
Adult ProgramYoung Adult Program
MonthlySelf-Pay OptionsPrivate insuranceFinancial Aid
Izzy is the best staff member there along with Clint Linley and Kyle where beyond helpful and I can’t thank them enough <4
Ashley Rae
3 months ago
Peaks will forever hold a place in my heart.
If you are looking for help with depression, addiction, alcoholism, trauma, anxiety, body image issues… you name it. This is the place that will not only help you, they will LOVE you through it!
From the moment I called, I felt loved and cared for. Angela - You are an Angel! Angela kept in contact with me several times a day until I was on a plane to CO. As soon as I got there, Katie picked me up from the airport, she was a doll! She made me feel so comfortable going in. I met with a few staff members, and stayed in “detox” for 2 days.
When I first got to the Women’s house, I met Miss. Pat - She’s the most incredible woman I’ve ever met. I’ll never forget her. EVER.
I went in for Trauma and Depression. Within 7-10 days, I could tell my life was changing. I had never felt this good in my life.
Chris, Bobbie, and his team hired a staff that is like nothing I would have ever imagined. From the Director (Sara), Doctors, Therapists/Counselors (Kate, Madi, Shayna, Sam), PA’s (Alyson), Gym Instructors (Nicole and Dan), my caseworker, Tyler, the chef, Taylor, and the staff (Miss. Pat, Cassie, Leah, Kayla, Mariano, Julie, and Cheyanne), - They are all AMAZING! Everyone has a heart of gold!
Each week in group they discuss a topic. The topics discussed are LIFE CHANGING! There are things in life that you think you know, you don’t. I learned so much in group and I’ll hold onto that info for life.
I also met with my Therapist/Counselor Kate, 2-3x a week. Kate is part of the reason I am who I am today. ❤️
I can’t say enough good things about this place. If you are looking for a place that will truly save your life, Peaks is where you want to go. I promise you. ❤️
Love, hugs, & Prayers for anyone taking the time to read this.
I believe in you! Make the call! Much love!❤️
*****Edit - In the last 3 years I’ve had a few people reach out to me and ask questions. If you are struggling on making a decision and want to speak with someone, please don’t hesitate to reach out to me via facebook messenger. I would love to help you in your journey to getting better. ❤️*****
Angie Glass
4 months ago
Peaks was truly an amazing experience. From the staff, to the groups, to the food, I loved it there. Special shoutouts to Clint and Alyssa for being awesome.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
This place saved my life. The staff here is amazing. These are some of the most understanding, helpful, caring and intelligent people I have ever encountered. They really can change your life. This place has taught me that I am worth it. If you are lost in addiction and your sick and tired of being sick and tired. Please give them a call. I am so incredibly grateful to have had Gatehouse treatment, and their guidance in my recovery thus far this place is one of a kind top notch care. Thank you to everyone here.
Misty Hayes
3 months ago
Corinne is a caseworker at the Gatehouse Recovery center. She is great at what she does and can help you with whatever you need. She's helped me with alot of things and for that I'm grateful for.
Most importantly she takes her job serious and is very respectful. She's helped hundreds of clients and deserves appreciation. All around a great person. Good job corinne!
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Had a great time here meet so many good people! 7 months sober & feeling great!! Thank u so much to all!!!
__ashlee_ bee
5 months ago
My name is Ashley and I am from Tarboro NC and I also have been to the granite house was a great experience for me too but I had a old man that helped me get threw this experience 2 months after leaving New Hampshire he passed away so that was really hard for me as well really miss the staff there they were amazing too just want to say think you for help And Jimbo thinks u too I'm sure even tho he passed but over and I was a great place to get help
Maverick Outsider
5 months ago
I would like to say thank you to all at the granite house for helping me in my path to recovery. Today I celebrate 1 year of sobriety. Would like to say it was fun 😆, it was well worth the time and effort I spent there, thank you
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Frequently Asked Questions
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.
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.
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.
Calls to numbers on a specific treatment center listing will be routed to that treatment center. Calls to any general helpline could be forwarded to SAMHSA or a verified treatment provider.
If you wish to connect with non-sponsor centers, you can browse top-rated listings, visit our homepage and browse by state, or visit SAMHSA.
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