Highmark Insurance Coverage for Addiction Treatment
Discover how Highmark Insurance covers drug rehab and mental health treatment in the Northeast. Verify your plan for recovery options.
Highmark Insurance Coverage for Addiction Treatment
Discover how Highmark Insurance covers drug rehab and mental health treatment in the Northeast. Verify your plan for recovery options.
Highmark Insurance started in 1996 after two of the oldest health insurance companies in the U.S. merged. The two companies were Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield. Now known as Highmark, they offer plans in four northeastern states.
Where Does Highmark Insurance Operate?
The four states that Highmark Insurance works out of are Pennsylvania, New York, Virginia and Delaware. This means they cover people and companies based in these states, but it doesn’t mean that the services they cover are also limited to these states.
Does Highmark Insurance Cover Drug Rehab?
Most Highmark Insurance plans cover drug rehab and mental health because the 2010 Affordable Care Act (ACA) requires most plans to cover 10 essential health benefits. These benefits include both substance use treatment and mental healthcare.
However, there are exceptions to the law, so be sure to review your insurance coverage before you start treatment. You’ll also want to work with your doctor to create a treatment plan because that will be the guide your Highmark plan uses to determine medically necessary care.
What Are Highmark Plans?
If you have a chance to choose your plan, there’s a lot to consider. Certain types of plans give you more flexibility to get care outside the provider network. These plans also have more flexibility in how you access specialist care, such as a psychiatrist or addiction counselor. However, those plans tend to have higher monthly premiums.
Here are the types of individual and family plans available from either your employer or the Insurance Marketplace in your state.
Health Maintenance Organization plans (HMOs)usually have the cheapest monthly premiums but also the least flexibility. You’ll need to choose a doctor to be your primary care provider and you’ll need to stay in network with your care.
A Preferred Provider Organization (PPO) planusually has a higher premium than an HMO plan but you don’t need a primary care provider and you can go to any in network provider without a referral. A PPO generally offers some coverage out of network but you’ll pay more out of pocket for the care.
A Point of Service (POS) plan provides in network care without a deductible and will let you go out of network as long as you have a referral from your primary care provider.
Highmark also offers a variety of Medicare plans. You can get Medicare Part D to help with prescription drugs on Original Medicare, or you can get a Medicare Advantage plan to replace Original Medicare and give you additional benefits such as vision and dental care. However a Medicare Advantage plan will likely have a limited provider network.
How to Verify Coverage With Highmark Insurance
Before you get started with treatment, it’s important to know the details of your insurance. To verify your coverage, you can call the insurance company directly or login to your online Highmark account to see what coverage is available.
You can also use the Highmark Find-A-Doctor Website to find an addiction treatment provider that’s within your plan’s network. You can start by clicking on the “Medical” link. Set the network to your specific plan, and enter your zip code in the location field. From there, browse by category: Behavioral Health and then select Addictions Medicine. To find more providers, expand the search radius.
Does Highmark Insurance Cover Other Mental Healthcare?
In 2010, the Affordable Care Act went into law. As a part of this legislation, mental health care was considered essential health care and must be a part of most health insurance plans.
There are exceptions to the law and every plan is different so be sure to check with your insurance provider to determine what services are covered. Some treatment may need a referral or preauthorization. Also treatment will need to be within the Highmark network for the greatest coverage and lowest out of pocket expenses.
For many with addiction, there is a co occuring mental health condition such as depression, anxiety, PTSD, and bi-polar disorder. Highmark recognizes that successful recovery not only means sobriety but that underlying conditions are also addressed. Most Highmark plans will cover the integrated care you need to address your mental health and substance use at the same time.
Mental healthcare can include both inpatient and outpatient care and you will get therapy and medication management along with other evidence based care.
What Inpatient Addiction Treatment Does Highmark Insurance Cover?
Highmark offers inpatient addiction treatment. These services include inpatient detox and residential rehab services. You will need to work with your primary care provider to determine what care you need and create a treatment plan that will guide you in the recovery process.
Inpatient medical detox is often the first step in the recovery journey. During inpatient detox individuals receive close medical observation and care that may include the use of FDA approved medications to ease withdrawal symptoms and reduce cravings. Medication assisted treatment (MAT) also helps to normalize brain chemistry and body functions. For some MAT is needed only during the detox period and for others long term use of medications such as methadone, buprenorphine, and naltrexone is necessary for successful long term recovery.
Inpatient or residential rehab centers include individual and group therapy in a structured setting with 24/7 support. In some programs you can continue with longer term MAT depending on your unique needs. Many inpatient programs also use other therapy methods such as music and art therapy along with holistic treatment options such as massage and yoga.
What Outpatient Rehab Does Highmark Insurance Cover?
Outpatient alcohol and substance use disorder treatment is covered by most Highmark plans. Outpatient care allows you to live at home or in sober living while attending treatment during the day.
Some outpatient care is more intensive and other programs are less so. A Partial Hospitalization Program (PHP) is a full day program that’s similar to residential care except you don’t live at the facility.
An Intensive Outpatient Program (IOP) is often the next step in recovery once residential or PHP treatment is completed. Understanding that early recovery can be difficult IOP offers individuals intensive treatment including nine or more hours of treatment per week and a structured plan for recovery. You might also be able to receive MAT during treatment.
General outpatient care only meets once or twice a week and is focused on reinforcing your new mindsets and habits as you continue long term recovery. Aftercare can give you additional support and treatment options to help you establish your substance free lifestyle. You may get help with job training and housing along with other social services. Aftercare is unique to each person because it recognizes that individuals’ needs differ.
Does Highmark Cover Methadone & Suboxone (MAT)?
The use of Methadone and Suboxone as a part of medication assisted treatment (MAT) is covered by most Highmark plans if it’s an appropriate part of your care. You may need to get a referral or preauthorization. You’ll also want to look for a treatment center within your plan’s network.
Medication Assisted Treatment is used along with evidence based treatment to help you manage cravings and stay focused on your treatment program. This allows you to avoid relapse and the danger of overdose while you lay a solid foundation for your recovery. Over time you’ll taper off the medication support and live a truly substance free life.
Can I Travel Out of State For Treatment With Highmark Insurance?
Whether you can travel out of state for treatment depends on your plan. Many plans require you to stay within the defined provider network unless you need emergency help. That means you can’t travel out of state and still use your Highmark insurance to get addiction care.
Some Highmark plans do have coverage for out of network care but you’ll pay far more in terms of your deductible and copayments. So in that case you may be able to go out of state but it will cost you a lot more.
It is important for you to speak with care representatives or check your insurance benefits online before you start a program. That way you know whether you have out of network coverage and what costs you can expect. You also may need a referral or preauthorization even if you use a non network provider. Get the details in advance to avoid surprises during treatment.
Calls to any general helpline will be answered or returned by one of the treatment providers listed, each of which is a paid advertiser.
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.
Who Answers?
800-784-1361
Intensive Outpatient
Aftercare Support
Intervention Services
Partial Hospitalization Program
Outpatient
Private Insurance
Self-Pay Options
Sliding Scale Payment Assistance
Medicare
Adult Program
Young Adult Program
Inpatient
Sober Living Homes
12-Step
Military Insurance
Medically Assisted Detox
LGBTQ Program
24-Hour Clinical Care
Military Program
Medicaid
Telehealth
Financial Aid
