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.
