Millions of people in the United States suffer from some type of drug or alcohol addiction, and the numbers keep growing.
No matter what the cause, those who are affected by an addiction need medical help to recover from this type of brain disorder. While one would think that treatment would be easy to obtain, this isn’t always the case.
Less than 10 percent of those who have an addiction ever get treatment for it because they don’t think that they can afford it. Recent medical research that proves that addictions are part of a brain disorder is helping to change this, however.
Does Highmark Cover Addiction Treatment?
Highmark is a sister company of Blue Cross Blue Shield. It is sometimes called Highmark Blue Cross Blue Shield. This can be confusing because there are several different subsidiaries of this insurance company.
Highmark is different than some of the others because it is a non-profit organization even though its annual revenue is several billion dollars.
Highmark policyholders are fortunate in that the insurance company classifies alcohol and drug addiction as a health condition that requires medical treatment and offers coverage for the cost of addiction treatment.
Any type of experimental treatments that haven’t been approved by a doctor will not be covered when paying for addiction treatment with Highmark, though.
Since Highmark is affiliated with Blue Cross Blue Shield, the plans that they offer are usually similar to those offered by the main company. Highmark insurance company recently made changes to its tiers to ensure that even more people would be able to afford to purchase their health insurance plans.
Now, their policyholders in Western Pennsylvania will be able to choose from a low-cost plan that has three tiers instead of just selecting from the bronze, silver, gold, and platinum plans.
Before this new system was created, the company had two levels that they called their standard-value plan and the enhanced plan.
The new third tier that they are offering is the preferred-value plan. It is the least expensive option of all. The only downside to these new tiers is that policyholders are only able to choose doctors from the insurance company’s list of preferred physicians.
Does Highmark Cover The Cost Of Inpatient Drug And Alcohol Treatment?
Highmark insurance plans may cover the cost of inpatient rehab programs, depending on individual plan benefits. When inpatient treatment is covered, you may still be responsible for a copay or covering your deductible.
Find a treatment program that accepts Highmark Insurance today.
Call to be connected with a treatment specialist. 100% Free and Confidential.(844) 616-3400
Higher coverage tiers may incur lower copayments, while lower-tier levels may result in higher copayments for residential treatment. Your total out-of-pocket cost for inpatient treatment for addiction will largely depend on your individual Highmark insurance plan.
Does Highmark Cover The Cost Of Outpatient Addiction Treatment?
Outpatient rehab programs are generally covered by Highmark insurance plans, but your level of coverage can be affected by which Highmark plan you have.
Because each outpatient program differs greatly from the next, Highmark coverage for outpatient treatment for substance abuse may depend on a few factors. These factors can include whether the rehab program you choose is in-network with Highmark and whether you need prior authorization for the outpatient rehab program.
Does Highmark Cover The Cost Of Partial Hospitalization Programs?
Partial hospitalization programs (PHP) are a form of outpatient treatment that may be covered by your Highmark health plan. Commercial health insurance plans like Highmark may have strict eligibility requirements for covering PHPs.
These could require that partial hospitalization takes place for four to five days per week for a minimum of 20 hours and that the recovering individual is not in need of medical supervision.
Does Highmark Cover The Cost Of Intensive Outpatient Programs?
Highmark insurance may cover the cost of intensive outpatient programs (IOP) at the same rate of partial hospitalization. IOPs are similar in format to these rehab programs, but require less days and hours per week of therapy and counseling.
As with other rehab programs, your copay amount for intensive outpatient programs covered by Highmark may vary according to your individual insurance policy.
Does Highmark Cover The Cost Of Suboxone?
Medication-assisted treatment (MAT) with Suboxone helps individuals who are addicted to opioids and is often covered by Highmark health insurance. However, Suboxone is often part of a long-term recovery plan. Continued coverage for Suboxone therapy through Highmark may require that patients submit regular clinical assessments.
Does Highmark Cover The Cost Of Methadone?
Methadone maintenance therapy is usually covered by Highmark insurance plans. Often used as part of an opioid treatment program, methadone helps recovering individuals find relief from opioid withdrawal symptoms. Copayments for methadone through Highmark health plans will depend on your plan’s pharmacy benefits.
Does Highmark Cover The Cost Of Sober Living?
Sober living costs can be covered by Highmark insurance plans if they are part of an outpatient rehab or inpatient rehab program. Most sober living homes partner with rehab centers to offer a transitional living solution for newly recovering individuals and connect residents with outpatient treatment options.
Whether your sober living home costs will be covered by your Highmark plan may depend on the sober living facility you choose and where you live.
How To Use Your Highmark Plan For Addiction Treatment
Using your Highmark plan to pay for the cost of drug rehabilitation is a fairly simple process because the insurance carrier considers drug and alcohol addiction to be a medical condition. They usually go by a doctor’s recommendation for what is the best treatment.
For example, a person who is addicted to both drugs and alcohol may need to have a longer stay in a rehab program than someone who is addicted to only one substance. For these individuals, their doctor might recommend that they are admitted for at least 90 days to a long-term residential treatment program.
If a longer amount of time is needed than this, policyholders just have to get approval from their doctor to make sure that their Highmark plan will cover it.
It is important to mention that using your Highmark plan to pay for rehab still requires that the deductible is covered first. Those who have a plan with a high deductible will have to pay a higher portion of all of their treatment bills.
List Of Highmark Insurance Plans By State
Highmark health insurance plans are not available in all states, but the majority of plans are available in the states that offer Highmark.
The three states offer Highmark Blue Cross Blue Shield insurance:
Finding A Rehab Center That Accepts Highmark
Since Highmark insurance is only offered in three states, finding rehab centers that accept Highmark insurance can be difficult for anyone who needs to get addiction treatment quickly.
The insurance carrier may be willing to help with the process, but they mostly put the burden on the doctors and family members of the addicted person.
What also complicates finding rehab centers that accept Highmark insurance is the fact that some rehab centers frequently change the type of insurance that they will accept.
One way to speed up the process is by giving us a call to get a list of rehab centers in your area that take Highmark insurance.
Highmark insurance can be an excellent company to go through when you need to get treatment at a rehab center, as they readily acknowledge the medical necessity of getting treatment for addiction.
On top of this, they are willing to cover longer stays at a rehab center when a doctor deems a longer stay necessary. Those who need help finding an alcohol or drug rehab center that accepts Highmark insurance should give us a call to expedite the process.
Updated on July 27, 2020
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- Highmark Direct — Insurance Plans