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.
This place truly saved my sister’s life. The house was spotless, the staff was incredibly supportive, and the care provided exceeded our expectations. My family and I are beyond grateful for everything they did. I would wholeheartedly recommend this place to anyone in need of help.
Kristina Kaphan
1 month ago
My friend was here. I could tell that the staff was very kind and the facilities were very well taken care of, everything was great and I highly recommend this location.
Excellent Place, Excellent Staff, Very good hearted people who work there. Profound saved my life ❤️ LOVE EVERYONE AT PROFOUND ❤️
Neva Littlegeorge
3 weeks ago
Profound has made me believe there is more to life than my addiction. The staff is amazing & all care beyond belief. I couldn’t be more grateful for this experience. They aren’t here for a paycheck, they genuinely care. This is not just a rehab but a very honest program.
Doug, Jessie, Justin, Brian, Elizabeth, Mele, Rachel, Anthony, Jennifer, Alexis, Mickey, the entire staff I love you, thank you for making me believe in myself again and look forward to a sober life.
I am blessed to be a part of this family. ♥️🙏🏻
From the bottom of my heart, Thank you!
Jennine Garcia
4 weeks ago
Grate staff, carring, professional
Got me ready with excellent tools for success on my new lease of life and a new beginning.
Making the decision to go to Beachway was, by far, the most positive and impactful experience of my life. The entire staff was incredible, as was the community as a whole. I felt safe, seen, and supported throughout my stay, and even now, as I continue my healing journey at home. I was completely set up for success in my healing journey thanks to Beachway, and I will forever be grateful.
Beth Hagan
3 weeks ago
My experience at Beachway was a 100/10. The life skills I learned are priceless and that’s putting it lightly. Beachway was the third treatment center I had been to, following the sudden loss of a loved one. I had prior sobriety before beachway and was convinced that I was only there because of a death, and that that was why I was spiraling. The staff at Beachway saw I needed much more help than that. They all knew before I did that if that death didn’t happen, I probably wouldn’t have stayed sober anyway. There was still much more therapy to be done, and more to learn.
The staff took a genuine care in doing so, and looking back at their clinical process they are nothing short of a power house of a team. I never felt so cared for as a human being by people that just met me. The staff quickly became my family, cheering me on while also taking it extremely serious. They are unapologetically honest, which in my experience is the #1 thing needed in recovery. Many of the things they said to me during my time there still stick with me (a year later) and help me navigate life!
I tell anyone that has a loved one with Substance abuse or mental health issues about beachway.
There is no other place like it🤍
Patrick Kelly
3 weeks ago
I owe Beachway my life for sure. I won’t lie and say that I loved every minute of it because I didn’t. A lot of it was very painful, because confronting inner demons is painful. It was a lot of group therapy (especially given how afraid of people I was going in), but they truly helped me gain sobriety and face down my trauma. And they put up with a lot of my crazy behavior while I was going through withdrawals in detox. Like any rehab, you’ll get out of it what you put into it. Surrender to the process for best results. Rehab isn’t a magic wand that makes problems vanish. Rehab gave me the opportunity to accept the ways in which I cause my own suffering instead of blaming everyone around me, while surrounded by professionals who prevented me from hurting myself while my dried out, and helped me identify the underlying causes of my addiction. It will be tough. It will be scary. It will be worth it. I wish I’d gone sooner. The staff there are wonderful and don’t get enough credit. Thank you Beachway.
This program was the best experience of my life. It brought me out of a very dark time. I learned how to love myself and be disciplined. I had a slip up in the program but they didn’t turn there back on me. The treehouse community is like home to me. When I left I went home for awhile and messed up. But I called Matt Sawires and he got me set up to come back to CA to detox the next day. And I was accepted back into the community immediately
Garrett Geib
2 weeks ago
If you’re looking for a quick fix, this isn’t the place for you. But if you’re ready to truly heal and have a second chance at life, Treehouse Recovery in Costa Mesa, California is it.
It’s the best addiction treatment I’ve ever experienced. Their program demands more time, energy, and sweat than typical centers — but the results are real. I left stronger, with more energy for my friends, family, and myself, and in the best mental and physical shape of my life.
The addiction counselors here don’t just hand you another pill; they guide you through real work that leads to lasting recovery. This is the only place I’ve seen people truly get better and stay better.
luke
2 weeks ago
I want to thank Matt and everyone at Treehouse Recovery. Matt was instrumental in getting my nephew into the program. Matt walked him through the whole process of taking the leap of faith and going 3000 miles away to join this unique program. Matt is an amazing asset to Treehouse. The program is unbelievable for the men that are brave enough to join this program. If you have a love one battling addiction, Treehouse Recovery, in my opinion, is the best program in the country!!!!
I am truly grateful for Springhill Recovery. Immediately I was made to feel at ease, safe & secure. I quickly realized that I was in competent, caring hands with all of the staff that I met.
I learned so much about myself here! I can see where I need to work on a few things and I now have to tools to do it thanks to the amazing groups here.
I leave here confident in my sobriety & recovery! I will seek connections with others in recovery because I’ve learned that absolutely nobody can do this alone.
Thank you Springhill Recovery for giving me a chance at life again!
Jackie Loewen
2 weeks ago
Amazing! Take everything they give you! Make connections with your peers! Day by day! Spring Hill is where recovery begins and you will leave with serenity, courage, and so much more.
Coming to The Center was one of the best decisions I’ve ever made. They give you the tools you need to build your own toolbox to go through life. It truly is A Place of Hope
Bekka lleH
2 weeks ago
Shoutout to the center 👰🏼♀️🤵🏼🐈⬛💍
Brandon Connely
2 weeks ago
I highly recommend this place!!! I came in not knowing who I was anymore and not knowing if I would ever be happy, but after a couple weeks at the program I’m happy to say that I am truly happy with myself! The team here is amazing and really cares for the clients and wanting to see them succeed. If you are considering this place please reach out they will help you like they helped me:)
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Simply an awesome caring facility. The staff gives 100 percent and then some! They display a true genuine concern for those in their care. Communication is exceptional! My son has been in many facilities over the years and Provive Welles is the best place that he has been in and made the most progress. Everyone that I’ve communicated with was phenomenal.
However, the majority of my communications were with Megan, Emily and David. I must give them special recognition for my sincerest appreciation.
Thank you Provive Wellness for caring for my son above and beyond my expectations.
Tina & Thomas
Tina and Tom Roberts
4 weeks ago
I’ve been with Provive for about a month or so now. I was having urges to drink myself into a blackout state. Been this way for about a week….I mentioned it in front of the house manager and nothing happened. Today was the worst of my urges. Megan had reached out to check on me and she was able to help me through without relapsing…. Thank you, Megan for all your help!!
MarySue
1 month ago
Brittnay was so helpful with placing my son in a perfect environment for him to heal!
These are all Angel's walking among us!!
Love the whole team, thanks for showing me a better life!!!!
Freddie Moor
2 weeks ago
Lantana Recovery is an outstanding facility with caring clinicians and supportive leadership. They truly put patients first and are dedicated to helping them succeed in their recovery.
Katie Zeigler
2 weeks ago
Where to begin? My life was not worth living. I was depressed, and broken up inside. Lantana Recovery Rehab made it possible for me to get to know myself in a way that, most importantly, was spiritually and physically sound. Something I could not say before, and was looking to change. You get out of the program what you put into it. I got my life back, which was more than I deserved. If you’re looking to be truly honest with yourself, get your life together, and get sober too, this is the place to do it. Shout out to Scott, Ashley, Josh, Jeff, Jen, and Eleanor. Without whom, I most likely wouldn’t be here today. There are many others I have left out, but they are all equally special, when it comes to sobriety and recovery. Thank you all, from the bottom of my heart. My family thanks you, my wife thanks you, and most importantly, I thank you for changing my life!!! Love you guys.
Great place! Thanks to all the staff for all the help and support !
Ryan Segura
2 months ago
The moment I walked in I felt welcome and never neglected. From the Program director, to the nurses and techs. Every person in this program will treat you like family. I also got everything I ever needed when I needed. I couldn’t have gone to a better place. I got all the support I needed and more everyday. I recommend this place to everyone looking for a place to change their life and future for the best. Thank you Laguna view detox and everyone apart of this wonderful organization.
Danny Magana
2 months ago
Awesome place with awesome people! I truly felt like every staff member cared about me and my recovery journey every day. Justin the case manager always had an open door to talk when I needed. Karen the program director and David the operations director helping me get paperwork filled out as painlessly as possible. Jeramiah, Lisa, Winnie, Jessie, and Tony on the nursing staff always ready with a smile and positive attitude. JJ, Lane, and Isabel, the techs that put up with me daily with a smile on their face no matter what I did. I can't recommend Laguna View Detox enough. If you're ready to start your recovery journey I can't think of anywhere else better!
Clean facility knowledgeable staff overall you learn a lot about yourself and you end up taking away with you a lifetime of fun positive memories
James LoPresti
3 weeks ago
They really helped me find the reasons for my alcoholism, and more importantly what to do with this knowledge. I came in hopeless, anxiety ridden, and lacking in any self confidence. Today, I'm happy with my life, accept myself for who I am, and see a bright future. I can't express my gratitude enough to the staff at Paramount who are passionate about what they do, truly care, and have authentic joy in seeing people like myself thrive in sobriety.
marc oliveira
1 month ago
Being a client at Paramount Recovery Centers, makes me feel dignified and like I have hope. The staff here are absolutely amazing and are willing to go to any length to help in any way they can. From the BHT's to the therapist even going all the way to the top. Everyone who works here has everyone's best interest at heart and it shows with every interaction you'll have. All in all I'd highly recommend PRC to anyone who struggles with substance abuse or mental health.
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Frequently Asked Questions
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.
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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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