Does Highmark Cover Drug and Alcohol Rehab?
Highmark, an organization affiliated with Blue Cross Blue Shield, offers coverage for addiction and mental health treatments, giving members access to a variety of rehabilitation options to combat substance abuse. Rehabs covered by Highmark provide comprehensive, quality treatment for individuals who are ready to take the first step toward recovery. However, coverage and the cost of drug rehab can vary depending on your specific Highmark plan, the type of treatment you need, and the rehab facility you choose.
Table of contents
» What Types of Addiction Treatment Does Highmark Cover?
» Are There In-Network Facilities Through Highmark?
» Does Highmark Cover Dual Diagnosis Treatment?
» What If Highmark Denies My Rehab Coverage?
» Key Takeaways on Rehabs Covered by Highmark
» Resources
What Types of Addiction Treatment Does Highmark Cover?
Highmark, like other health insurance providers, is required by the Affordable Care Act (ACA) to cover essential health benefits, which include mental health and substance use disorders (SUD). As stated by Mental Health America, substance use disorders are classified as primary, progressive, chronic, relapsing, and treatable diseases.
This perspective highlights the necessity for ongoing, comprehensive treatment for SUD, which is why the ACA requires these services to be included in insurance coverage, just like any other medical condition. Highmark offers a wide array of addiction treatment services to ensure that individuals with SUD receive appropriate care tailored to their specific needs.
Highmark’s coverage generally includes, but is not limited to, the following levels of care and therapeutic approaches:
- Medical Detoxification (Detox): This is typically the initial phase of treatment, where individuals undergo medically supervised withdrawal from substances to safely manage acute symptoms. Patients receive continuous care, medications to alleviate withdrawal symptoms, and support for nutrition and hydration.
- Inpatient/Residential Treatment: This entails individuals residing at the rehabilitation facility throughout their program, providing a focused and structured environment dedicated to their recovery. Highmark plans frequently cover inpatient rehab, although the length and details may differ by plan and often necessitate pre-authorization.
- Outpatient Treatment Programs: These programs enable individuals to stay at home while participating in treatment sessions at a facility. They provide greater flexibility for work and family obligations while maintaining a structured approach with diverse therapy options. Various levels of care are available within outpatient treatment, such as partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs), which may be included in your Highmark insurance policy.
- Medication-Assisted Treatment (MAT): Highmark rehab coverage frequently encompasses MAT for opioid and alcohol use disorders, integrating FDA-approved medications such as methadone and naltrexone with counseling and behavioral therapies.
- Aftercare Planning and Support: As a crucial element of managing any chronic disorder, private insurance for long-term addiction treatment often covers aftercare components to promote ongoing success and minimize the risk of relapse. Aftercare can include ongoing therapy, support groups, and sometimes sober living arrangements.
Are There In-Network Facilities Through Highmark?
Insurance providers that offer addiction treatment coverage, like Highmark, often have pre-negotiated fees with healthcare providers and facilities, creating a network of providers. Highmark has an extensive network of in-network facilities and providers for drug and alcohol rehab.
According to Highmark, choosing in-network providers results in lower out-of-pocket costs for members through copayments and deductibles. The extent of coverage and the specific services offered, including detoxification, inpatient rehabilitation, and outpatient programs, can differ based on your individual insurance plan.
Selecting Highmark in-network rehabilitation centers may simplify the pre-authorization and billing processes. These facilities are generally more acquainted with Highmark’s protocols and often manage pre-authorization, claims, and paperwork with greater efficiency. Furthermore, you are likely to have a clearer understanding of which services are covered, minimizing the chances of unexpected charges.
On the downside, relying solely on in-network providers can restrict your options and might not provide the most appropriate care tailored to your needs. Well-known in-network facilities may also experience longer wait times due to increased demand from insured patients. If your Highmark plan includes out-of-network benefits, you could still receive partial coverage, which might justify the additional expenses.
The most direct way to find in-network rehab facilities is to visit the Highmark website and use their “Find a Provider” or “Find a Doctor” tool. Alternatively, you can contact the member services number listed on your insurance card to speak with a representative who can assist you in finding providers in your vicinity.
If you have a specific addiction treatment center in mind, they often have an admissions team that can reach out to Highmark on your behalf to confirm your insurance coverage. They can then provide detailed information regarding your plan, including an estimate of out-of-pocket expenses.
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Does Highmark Cover Dual Diagnosis Treatment?
Addiction and mental health disorders often coexist and can significantly impact each other, which are referred to as co-occurring disorders. To effectively treat one, it is usually necessary to simultaneously address the other through dual diagnosis treatment, as noted by the Cleveland Clinic. Highmark understands that focusing solely on addiction while neglecting underlying mental health issues, or the other way around, often results in increased relapse rates, which is why they typically provide coverage for these services.
Highmark’s coverage for dual diagnosis treatment generally includes the same levels of care and therapies as those for addiction treatment, but with a particular emphasis on integrating mental health care. Your insurance policy may cover facilities and programs that provide integrated treatment, where therapists, psychiatrists, and addiction specialists collaborate to tackle both conditions simultaneously.
What If Highmark Denies My Rehab Coverage?
Experiencing a denial of rehab coverage by Highmark can be extremely disheartening, particularly when you are eager to take the steps toward recovery. Nevertheless, a denial does not signify the end of your options, as you are entitled to contest the decision.
Here are the steps you can take if Highmark refuses your coverage:
- Examine the Denial Letter Thoroughly: It’s crucial to comprehend the reasons behind the denial, which will be outlined in the letter. This could stem from a lack of medical necessity, an out-of-network facility, the absence of pre-authorization, or an administrative mistake.
- Gather All Relevant Documentation: Collect everything related to your treatment and the denial, such as medical records showing the history of SUD, a letter from your doctor or rehab facility explaining medical necessity, and any assessments or treatment recommendations.
- File an Internal Appeal: Submit a formal appeal directly to Highmark with a cover letter stating your request for reconsideration, all supporting documentation, and a clear argument why treatment is necessary and should be covered.
- Pursue an External Appeal (If Denied Again): Should your internal appeal be rejected, you have the right to seek an external review by an independent third party.
- Seek Assistance in Navigating the Process: It may be beneficial to obtain legal guidance from patient advocates or an attorney and collaborate closely with the treatment facility, which can assist you in filing your appeal and gathering all necessary documentation.
Key Takeaways on Rehabs Covered by Highmark
- Highmark Provides Comprehensive Coverage for Addiction Treatment: Depending on your policy plan, Highmark may cover part or all of your rehab costs through various levels of care.
- Using In-Network Facilities Reduces Costs: Choosing a facility within Highmark’s network may lower out-of-pocket costs related to copayments and coinsurance.
- Out-of-Network Coverage May Still Be Available: If your chosen rehab facility is not in-network, certain Highmark plans provide partial coverage for these locations, which can expand your treatment options.
- Dual Diagnosis Treatment is Frequently Covered: Highmark’s rehab coverage typically includes the treatment of co-occurring mental health issues, which can enhance the chances of successful recovery.
- You Can Appeal a Rehab Coverage Denial: If Highmark denies your treatment plan, it’s essential to examine the denial letter and take action to appeal the decision, as it could simply be due to insufficient documentation.
WhiteSands Treatment is a network of rehab facilities in Florida with extensive experience and knowledge working with various insurance providers, including Highmark. We offer comprehensive treatment programs encompassing medical detox, inpatient treatment, outpatient care options, and aftercare programs to meet you or your loved one wherever they are on their recovery journey. Our admissions and clinical team will work directly with Highmark to verify your insurance coverage, obtain pre-authorization, and submit all paperwork to ensure your treatment is covered so you can fully focus on healing.
If you wish to verify which rehabs covered by Highmark provide addiction treatment, please call WhiteSands Treatment in Florida today at 877-855-3470 to speak with one of our admissions specialists.
External Resources
- Mental Health America – Substance Use Disorders
- Highmark – Key Insurance Terms
- Cleveland Clinic – Dual Diagnosis
If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.
About the Author
Jackie has been involved in the substance abuse and addiction treatment sector for over five years and this is something that she is truly eager about. She has a passion for writing and continuously works to create informative pieces that not only educate and inform the public about the disease of addiction but also provide solutions for those who struggle with drug and alcohol abuse.
