Highmark Insurance Coverage for Rehab

Highmark Insurance health plans offer a range of health benefits for their policyholders, including substance abuse treatment, also known as drug rehab or alcohol rehab.

Highmark is part of Highmark Health, independently licensed through the Blue Cross Blue Shield Association to provide insurance benefits to members in some U.S. states.

This article will guide you through:

• What Highmark covers for alcohol and drug abuse treatment
• Where you can find information on coverage
• Where you can receive treatment if you have Highmark

Answer: Most plans through Highmark Insurance offer coverage for substance abuse treatment and mental health care.

What type of treatment your plan covers will depend on which plan you have. You can check your member account or use the number on the back of your insurance card to call Highmark.

Either option should help you determine what your plan covers and what your copay, deductible, and coinsurance costs might be.

Highmark also provides case managers for members with chronic conditions and an integrated care management team of nurses and social workers who help when you’re in the hospital. Log in or call Highmark to determine if your plan includes these benefits.

Answer: Addiction treatment coverage depends on your location and your insurance plan, but plans through Highmark are compliant with the guidelines of the Affordable Care Act (ACA).

This means they offer coverage for substance use disorder treatment and behavioral health services.

Inpatient treatment is usually more expensive than outpatient rehab, and any components of inpatient rehab may be more costly than their outpatient counterparts because of that.

Find out what level of care you will need, then go over your Highmark insurance plan to determine what your out-of-pocket costs might be for a specific treatment provider.

Medical Detox

Highmark insurance policies provide partial to full coverage for medical detox programs.

Discuss with your healthcare provider whether you need medical detox and if it should be done as an inpatient or intensive outpatient (IOP) approach. With that information, you can talk to Highmark or research your member site to find out how your rehab coverage applies.

Medication-Assisted Treatment

If you need medication as part of detoxification to cope with withdrawal symptoms, that’s part of medication-assisted treatment (MAT), which is covered by Highmark. You may also require extended prescribed medication throughout recovery, which is also MAT.

If either of these apply to you, you may be eligible to have your prescriptions delivered with your health plan.

Highmark has copay assistance available for some members, and members in its coverage area (except some in West Virginia and Delaware) can get discounts on some prescriptions when they sign up for delivery.

Inpatient Rehab

Highmark insurance plans offer coverage for inpatient rehab programs, though coverage depends on your specific health care plan and your treatment needs.

Hospitalization or partial hospitalization may be necessary to begin your addiction recovery. You may also need inpatient rehab for a lot longer than you initially planned.

Be sure to verify that your Highmark insurance provider covers the treatment facility and any treatment options recommended for your substance abuse treatment plan.

Dual Diagnosis Treatment

Dual diagnosis rehab is a common treatment program for people facing substance abuse. Because these programs are usually inpatient, they are also covered by HighMark

SUDs and mental health challenges are frequently diagnosed as co-occurring disorders. Navigating the treatment for both can be tricky, and you want to make sure that you’re getting the most out of your health benefits and reducing your out-of-pocket expenses.

If you’re getting lost trying to figure it out, you can call the number on the back of your insurance card. With Highmark insurance companies, each card has a phone number specific to the plan type and coverage, hopefully saving you a few steps.

Outpatient Treatment Programs

Outpatient rehab programs offer a less-intensive treatment option for Highmark policyholders who are seeking recovery but can’t commit to or don’t need an inpatient program.

Outpatient treatment can be fully outpatient or partial hospitalization, a combination of outpatient rehab and inpatient. Outpatient care tends to be less expensive.

If the cost of care for you or your loved one plays a heavy role in whether staying at a rehab facility is feasible, ask your primary care provider (PCP) if you can try outpatient.

Know that you may need to go through an intensive outpatient program, which usually requires very long hours at the hospital and only returning home to sleep.

Counseling & Behavioral Therapy

Highmark insurance plans cover mental health treatment, which includes counseling and a number of behavioral therapies.

These therapies are usually included as part of outpatient or inpatient rehab. Examples of behavioral therapy, also known as talk therapy, are cognitive behavioral therapy, dialectical behavioral therapy, and motivational interviewing, among others.

Continuing Care

To discover what continuing care options are covered under your Highmark plan, log onto the Member Portal or call your insurance provider.

Though alcohol and drug addiction treatment is covered, it doesn’t mean that the aftercare options like a sober living community or residential treatment program you’re considering will be.

Continuing care can include sober housing, outpatient services, group therapy, individual therapy, and other treatments.

Where you live is a significant factor for coverage through Highmark.

Highmark plans are available in the following areas:

• Pennsylvania
• Delaware
• West Virginia
• New York

Other factors that may affect your coverage include your individual policy and the level of care you need.

Answer: The cost should be covered for urgent or emergency care visits even if the provider is out of network for Highmark. The same goes for any out-of-network provider who treats you at an in-network facility unless you sign away your rights.

This is tricky, because you may need treatment in a different state from where you enrolled in coverage. Some Highmark plans will cover out-of-state providers or facilities, but they still may be in-network.

For residents of select states, Highmark insurance plans are available during open enrollment through the Healthcare Insurance Marketplace. The insurance company has small, medium/large, and national health plans for employers.

Highmark coverage is available under the following companies:

• Highmark Blue Cross
• Blue Shield: Covers 42 counties in Pennsylvania
• Highmark Blue Shield: Covers 21 counties in Pennsylvania and the Lehigh Valley
• Highmark Blue Cross Blue Shield West Virginia: Covers all of West Virginia
• Highmark Blue Cross Blue Shield Delaware: Covers all of Delaware
• Highmark Blue Cross Blue Shield of Western New York: Covers eight counties in western New York
• Highmark Blue Shield of Northeastern New York: Covers 13 counties in northeastern New York

Highmark offers the following Medicare options:

• Medicare Advantage
• Medicare Advantage Plans for Veterans
• Medigap Plans

Whatever drug or alcohol addiction you have, treatment for it may be covered by your Highmark plan. The type of addiction usually doesn’t rule out treatment.

However, the plan that you have can restrict things like:

• Providers
• Treatment centers
• Prescription medications
• Prescription length and amount
• Rehab stays
• Outpatient rehab length
• Continuing care options
• Mental health sessions

Most Highmark plans allow you to have a choice in your treatment provider, including specialists without a referral. However, you’ll have to verify that it’s true for your plan.

If you live in a Highmark coverage area, chances are there’s a rehab center close to your home that accepts your plan.

Here are the best ways to find out which rehab centers are covered by Highmark:

1. Call the number on your insurance card. With your Highmark plan, that number is specific to your plan type, which saves you some time in navigating their phone system.
2. Log into your member site and search for providers in your coverage area.
3. Take advantage of our easy-to-use rehab center directory. We list highly rated, certified, and licensed rehab centers in all 50 states.

Even with the resources provided by Highmark, finding in-network providers for drug and alcohol rehab can be challenging.

RehabNet.com is available 24 hours a day to help through our website or helpline. Call us today to learn more about rehab insurance coverage and for help finding the right treatment facility.