Harvard Pilgrim Insurance Coverage for Rehab

Insuring more than 3 million Americans in the New England area, Harvard Pilgrim Health Care is a popular health insurance company. Many Harvard Pilgrim policyholders use their insurance plan to help cover the cost of addiction treatment.

Curious about drug and alcohol addiction treatment coverage through Harvard Pilgrim? Keep reading to learn about types of treatment, coverage levels, and different health insurance plans.

Answer: Yes, Harvard Pilgrim does cover alcohol and drug addiction rehab.

This is thanks to the Affordable Care Act (ACA), which requires all plans in the marketplace to cover addiction treatment at least partially. Substance use disorder (SUD) treatment is listed as an essential health benefit under the ACA.

Because the ACA only requires addiction rehab to be covered partially, there are limits to health insurance coverage under your Harvard Pilgrim plan. Coverage will vary between plans and be contingent on several factors.

Answer: Through your Harvard Pilgrim insurance plan, you may be able to receive coverage for a wide range of addiction treatment services, but coverage will vary between treatment options.

You may find that you need a specific type of treatment or a combination of treatment services based on individual needs.

Below you’ll find a list of common treatment services, what you can expect from them, and coverage estimates.

Medical Detox

Many Harvard Pilgrim insurance plans cover medical detoxification to some extent. You will likely be responsible for a copay for this service.

Medical detox is a rehab service that helps rid the body of addictive substances prior to a treatment program. Detoxification services are incredibly important as detoxing at home can be extremely dangerous.

With medical detox, your care team will help you safely detox from substances while managing withdrawal symptoms, monitoring your vitals, and administering medications or treatments as needed.

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is another service most Harvard Pilgrim insurance plans cover. You may be responsible for a copay or coinsurance for each MAT visit.

MAT is an evidence-based treatment method that treats addiction with the use of FDA-approved medications. These medications in combination with other treatment methods help to reduce cravings and withdrawal symptoms as well as reduce the risk of relapse over time.

Inpatient Rehab

A lot of Harvard Pilgrim plans also cover inpatient treatment partially. You’ll have to pay a copay or coinsurance depending on your plan, though copays are limited to one per quarter.

Considered to be the most intensive treatment options, inpatient rehab provides round-the-clock care in a designated facility. Individuals live in the rehab center through the duration of their treatment.

Inpatient care uses a combination of treatment methods to create a comprehensive care plan for each individual. Inpatient programs are heavily structured and rely on a schedule.

Dual Diagnosis Treatment

Much like inpatient treatment, dual diagnosis treatment is often partially covered by Harvard Pilgrim. Depending on your plan and the treatment setting, you may need to pay a copay or coinsurance.

Dual diagnosis treatment is a kind of addiction care that focuses on the mental health disorders often found in conjunction with addiction. These are referred to as co-occurring disorders and can even be the main cause of addiction.

Dual diagnosis treatment programs treat mental illnesses like anxiety, depression, post-traumatic stress disorder (PTSD), or bipolar disorder alongside the physical aspects of addiction. Therapy and counseling are often a big part of these programs.

Outpatient Treatment Programs

Outpatient rehab is typically covered under Harvard Pilgrim plans but you may need to pay a copay for each visit.

Outpatient treatment is often considered to be a step down from inpatient treatment as it is still effective and comprehensive, but requires individuals to travel to a treatment center. During an outpatient program you’ll likely have treatment for several hours on several days of the week.

There are variations of outpatient treatment like intensive outpatient programs (IOPs) and partial hospitalization programs (PHP) if you are not ready to fully step down to outpatient care.

Counseling & Behavioral Therapy

Many Harvard Pilgrim plans cover counseling and behavioral therapy, though you may need to pay a copay per visit or quarter depending on the treatment setting.

Counseling is a treatment service offered both in one-on-one and group settings. During a counseling session, you’ll share your thoughts and emotions surrounding your addiction and recovery as well as any goals or concerns.

On the other hand, behavioral therapy is a kind of psychotherapy that focuses on behavioral health. Often used for people with mental health disorders, behavioral therapy focuses on changing thought patterns and behavioral tendencies.

Some common kinds of behavioral therapy you may encounter include cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).

Continuing Care

Coverage through Harvard Pilgrim is a little bit different when it comes to continuing care or aftercare services. This is because this type of care differs vastly between individuals.

Aftercare services are treatment options that you continue to receive after completing a treatment program.

Some, like behavioral therapy, group therapy, or MAT, may be partially covered whereas others like sober living may not be. Be sure to check with Harvard Pilgrim for specifics.

While there are coverage levels for each addiction treatment service, there are several factors that affect the level of coverage you will receive.

Factors that can affect your treatment coverage include:

• Where you live: The state you live in can affect the amount of coverage you receive for a couple of reasons. First, there may be local laws and regulations that affect coverage. Additionally, different states have access to different insurance plans.
• Your plan: Coverage differs from plan to plan. Some plans may cover more of your treatment costs than others. Additionally, different plans have different copay, coinsurance, deductible, and premium expectations.
• Type of treatment: Different treatment services will often have different coverage levels.

Answer: Some Harvard Pilgrim health insurance plans will cover out-of-network rehab programs partially after you meet your deductible, but this will vary from plan to plan.

For example, after you meet your deductible, you may be responsible for a certain percentage of the treatment costs at an out-of-network provider. In other words, your out-of-pocket costs will likely be much higher.

That being said, you will always receive the highest level of coverage if you stick to an in-network provider. Harvard Pilgrim works closely with Spectrum Health Systems and Better Life Partners for substance abuse treatment.

Harvard Pilgrim offers a variety of individual and family plans as well as Medicare plans in Maine, Massachusetts, and New Hampshire.

Harvard Pilgrim insurance plans include:

• Health Maintenance Organization (HMO) plans (bronze, silver, gold)
• Standard plans (bronze, silver, gold)
• Standard ConnectorCare plans
• Preferred Provider Organization (PPO) plans
• Medicare Advantage Strive plans
• Medicare Supplemental plans

Harvard Pilgrim doesn’t provide coverage based on the type of addiction you have. In other words, you can expect treatment for almost any substance addiction to be covered in part.

Some common addictions you may receive coverage for include:

• Alcohol
• Cocaine
• Heroin
• Meth
• Prescription drugs
• Opioids
• Benzodiazepines

These are just some of the most common addictions people seek treatment for. If you’re unsure of whether your addiction will be covered, check with Harvard Pilgrim for more information.

Once you have a better understanding of your insurance plan and addiction treatment coverage, you’ll need to find a treatment center that accepts your insurance plan. This can feel overwhelming for some but there are many great resources, such as:

1. Ask your healthcare provider for a referral. If you’re seeing a medical provider for your addiction, they should be able to give you a list of rehab facilities that accept your insurance.
2. Use the “Find a provider” function on Harvard Pilgrim’s website. Here, you’ll be able to find addiction treatment centers close by that take your insurance.
3. Check out our list of addiction treatment facilities by state. Each list offers information about reputable rehab centers, many of which are accredited, including what insurance providers they are contracted with.

Harvard Pilgrim is a widely used insurance company in the U.S. Many people who are insured through the company use their coverage to receive addiction treatment. And Harvard Pilgrim plans offer coverage for a wide range of services.

If you or your loved one is ready to take the first step in your recovery journey, give our helpline a call today. We can connect you with top providers that accept your insurance coverage or help you find a suitable treatment alternative.