Highmark Insurance is a BlueCross BlueShield Association licensee that serves 6 million residents of West Virginia, Delaware, Pennsylvania, and parts of New York. [1] The insurer offers coverage for substance abuse and mental health services through an extensive network of Highmark rehab centers.

If you have health insurance with Highmark and you need help addressing mental health or substance abuse issues, your plan will cover at least part of the costs of care, from detox and outpatient programs to residential rehab and ongoing care.

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Does Highmark Insurance Cover Drug Rehab?

Highmark health insurance plans cover at least a portion of the costs of drug rehab as mandated by the ACA (Affordable Care Act). Highmark acknowledges that addiction is a chronic and relapsing medical condition that warrants professional intervention [2].

Coverage for drug addiction treatment hinges on the plan type, the deductible amount of the plan, and the network status of providers. In-network Highmark rehab centers offer the most affordable options for treatment with the lowest out-of-pocket costs.

Verify benefits by calling the customer service number on your insurance card or logging into the member portal online. Highmark representatives will explain the limits of coverage and requirements for co-payments or co-insurance. They can also help you find Highmark drug rehab near you.

What Types of Addiction Treatment Does Highmark Cover?

Highmark health insurance plans offer coverage for the full continuum of addiction treatment [3]. Depending on medical necessity, this may include detoxification, inpatient treatment, or outpatient treatment at varying levels of intensity, from standard outpatient therapy to IOPs (intensive outpatient programs) or PHPs (partial hospitalization programs). The scope of coverage varies based on the plan tier.

Medical Detox

For most people, recovery begins with detoxification [4]. Highmark rehab centers offer medical detox in either inpatient or outpatient settings, depending on the severity of withdrawal symptoms and personal factors.

Healthcare professionals manage symptoms and provide medical monitoring to make the detox process as safe and comfortable as possible. The treatment center will assess the duration of substance use, the type of substance used, your overall health status, and any co-occurring conditions to evaluate the most effective level of care required during detox.

Medication-Assisted Treatment

Medication-assisted treatment combines FDA-approved drugs with talk therapies and counseling [5]. MAT for alcohol and opioid addictions is covered by Highmark Health insurance when it’s considered medically necessary and administered by qualified rehabs covered by Highmark. Medications can mitigate the intensity of cravings and withdrawal symptoms, reduce the likelihood of relapse, and promote ongoing recovery. Highmark plans typically cover the costs of drugs and medical monitoring.

Medications used for alcohol addiction include:

• Disulfiram.
• Naltrexone.
• Acamprosate.

Medications used for opioid addiction include:

• Buprenorphine.
• Naltrexone.
• Methadone.

Inpatient Rehab

Inpatient rehab is the most intensive form of treatment. Individuals receive 24-hour care in a residential setting. Programs last 30, 60, or 90 days, depending on the severity of the addiction and treatment progress. This level of care is covered by Highmark Health plans when healthcare providers deem it medically necessary.

Dual Diagnosis Treatment

Dual diagnosis occurs when someone has an addiction and a mental health condition, like anxiety or depression, at the same time. Research shows that integrated and coordinated dual diagnosis treatment delivers superior outcomes to treating each condition separately [6].

Highmark mental health coverage extends to dual diagnosis treatment programs in which psychologists, psychiatrists, and addiction specialists work together to tackle both disorders simultaneously through therapy, medications, and extended care.

Outpatient Treatment Programs

Outpatient treatment programs at Highmark rehab centers enable members to continue at home, work, or school while getting effective treatment for addiction or mental health issues at varying levels of intensity.

An IOP (intensive outpatient program) involves up to 15 hours of weekly treatment sessions. A PHP (partial hospitalization program) is more intensive, with 30 hours or more of weekly therapy sessions. Ongoing outpatient treatment helps people stay sober with 1 or 2 therapy sessions each week.  

Outpatient treatment programs are usually indicated for those with stable housing, strong support systems, and milder addictions. This is the most affordable and flexible form of treatment, and it’s almost always covered by Highmark Health insurance.

Counseling & Behavioral Therapy

Counseling sessions are central to effective addiction treatment. Highmark offers coverage for individual, group, and family sessions. Coverage also extends to talk therapies like CBT (cognitive behavioral therapy) or DBT (dialectical behavioral therapy), motivational therapies, and trauma-informed care.

Continuing Care

Recovery is a lifelong process that extends beyond the completion of treatment at Highmark rehab centers. Ongoing care might include outpatient counseling, participation in support groups, or sober living communities when deemed medically necessary and delivered by licensed healthcare professionals. Aftercare plans are personalized and created before the completion of treatment to ensure a seamless transition.

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Factors That Affect Highmark Coverage for Drug Rehab

Your Highmark insurance plan influences coverage levels for drug rehab. Bronze tier plans are associated with lower monthly premiums and higher deductibles and co-payments, while gold tier plans offer broader coverage at the expense of higher monthly premiums.

Coverage decisions are also impacted by the level of care you need. Emergency detoxification generally benefits from instant approval, while inpatient rehab normally requires authorization and documentation to prove medical necessity.

The location of Highmark rehab centers may also affect coverage. The insurer operates in West Virginia, Pennsylvania, Delaware, and part of New York.

Does Highmark Cover Out-of-Network Rehab Programs?

Out-of-network rehab programs may receive coverage under Highmark health plans if you need emergency or specialized addiction treatment. Seeking out-of-network care leads to increased out-of-pocket costs, though.

Types of Highmark Healthcare Plans

Highmark delivers healthcare through individual marketplace plans, employer groups, and Medicare. All plans have different levels of coverage, provider networks, and arrangements for cost-sharing.

Marketplace plans operate in line with ACA requirements, offering the same level of coverage for addiction and mental health treatment as for other medical conditions.

Employer plans may have different network arrangements and benefits, depending on the contract negotiated by the organization.

Highmark-administered Medicare Advantage plans cover the costs of prescription medications and sometimes include transportation and care coordination.

Types of Addiction Covered by Highmark Insurance

Highmark rehab centers offer treatment for all addictions covered by insurance. This includes alcohol, marijuana, opioid, stimulant, and prescription drug addictions. Treatment providers will assess the medical necessity of treatment and create a tailored treatment plan.

FAQs

Does Highmark cover rehab?

Highmark health insurance plans meet at least part of the costs of rehab services like detoxification, outpatient programs, inpatient treatment, and aftercare when deemed medically necessary for recovery.

Does insurance pay for rehab facilities?

Health insurance helps cover some of the costs incurred by rehab facilities. Members must meet deductibles, co-insurance, and co-payments in line with the provider’s network status and the specifics of their health insurance plan.

How much does inpatient rehab cost a day?

The daily cost of inpatient rehab ranges from $500 to $1,500 or more, although these costs can be significantly reduced through health insurance coverage. The location of the rehab and the level of care provided impact overall costs.

How do you get into a rehab facility?

First, contact your health insurer to verify your benefits. Next, work with your healthcare provider and chosen treatment provider to complete evaluations and assessments, obtain prior authorizations, and arrange admission.

Does Highmark cover therapy?

Therapy coverage is provided at the same level as medical benefits through Highmark insurance, thanks to mental health parity laws. Therapy sessions typically incur the same co-payment as other specialist sessions.

Get Addiction Treatment Covered by Health Insurance at Gratitude Lodge in California

If you have been misusing drugs, alcohol, or prescription medications, reach out to Gratitude Lodge in Southern California for help kickstarting your recovery.

We offer a range of immersive inpatient programs at our luxury rehabs in Long Beach and Newport Beach, CA. You can also access detoxification services and dual diagnosis treatment for co-occurring mental health disorders. We work with many health insurance companies to broaden access to treatment and reduce your out-of-pocket costs.

All Gratitude Lodge treatment plans are tailored to individual needs. Therapies include:

• Medication-assisted treatment.
• Counseling.
• Family therapy.
• Group therapy.
• Motivational therapies.
• Behavioral therapies.
• Holistic treatments.
• Aftercare planning.

Access effective, evidence-based addiction treatment today by calling admissions at 844-576-0144. 

Sources

[1] https://highmark.com/

[2] https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction

[3] https://www.asam.org/asam-criteria/about-the-asam-criteria

[4] https://www.ncbi.nlm.nih.gov/books/NBK64119

[5] https://www.samhsa.gov/substance-use/treatment/options

[6]https://pubmed.ncbi.nlm.nih.gov/30352668/