Does Highmark Cover Rehab Treatment?

Highmark is a health insurance company that offers a variety of plans to individuals, families, and businesses. The coverage offered by Highmark can vary depending on the plan you have and the state you live in.

Published On

October 1, 2023

If you or a loved one is struggling with addiction, seeking help is the first step towards recovery. However, the cost of rehab treatment can be a significant barrier for many people. If you have Highmark insurance, you may be wondering whether your policy covers rehab treatment. In this article, we will explore the coverage options for Highmark members seeking addiction treatment.

Does Highmark Cover Rehab Treatment?

Highmark is a health insurance company that offers a variety of plans to individuals, families, and businesses. The coverage offered by Highmark can vary depending on the plan you have and the state you live in. However, all Highmark plans are required to provide coverage for addiction treatment under the Affordable Care Act (ACA).

Highmark insurance covers a variety of addiction treatment options for its members. The coverage offered by Highmark can vary depending on the plan you have and the state you live in. However, all Highmark plans are required to provide coverage for addiction treatment under the Affordable Care Act (ACA). Inpatient rehab treatment, outpatient rehab treatment, medication-assisted treatment, behavioral health services, and detoxification are all covered by Highmark.

Coverage for Inpatient Rehab Treatment

If you require inpatient rehab treatment for addiction, Highmark will cover the cost of your treatment. Inpatient treatment involves staying at a rehab facility for a period of time, typically 30-90 days, to receive intensive treatment and support. Highmark will cover the cost of inpatient treatment as long as it is medically necessary and provided by a licensed healthcare provider.

Coverage for Outpatient Rehab Treatment

If you require outpatient rehab treatment for addiction, Highmark will also cover the cost of your treatment. Outpatient treatment involves attending therapy and support groups on a regular basis while living at home. Highmark will cover the cost of outpatient treatment as long as it is medically necessary and provided by a licensed healthcare provider.

Coverage for Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a form of addiction treatment that uses medications, such as methadone or buprenorphine, to help manage withdrawal symptoms and cravings. Highmark covers the cost of MAT for members who require it as part of their addiction treatment.

Coverage for Behavioral Health Services

Highmark provides coverage for a range of behavioral health services, including therapy and counseling. These services can be beneficial to those struggling with addiction, as they can help address underlying mental health issues or emotional trauma that may contribute to addiction.

In addition to addiction treatment, Highmark recognizes the importance of addressing the root causes of addiction and offers support for a holistic approach to healing.

Whether you are seeking treatment for addiction or looking to improve your overall mental well-being, Highmark's behavioral health services can provide valuable resources and support.

Coverage for Detoxification

Detoxification, commonly known as detox, is a crucial first step in addiction treatment. It involves removing drugs or alcohol from the body and managing the symptoms of withdrawal. Highmark recognizes the importance of safe and effective detoxification and covers the cost of medically necessary detox services for members who require it as part of their addiction treatment.

With Highmark's support, individuals can undergo detoxification in a controlled environment under the supervision of medical professionals to ensure their safety and comfort. This coverage ensures that members have access to high-quality care when they need it most and can begin their journey to recovery with peace of mind.

Types of Addiction Treatment Programs

Highmark insurance covers various types of addiction treatment programs that cater to the different needs and preferences of individuals seeking recovery. Some of the most common programs include:

Inpatient Rehab Programs

Inpatient rehab programs are intensive treatment programs that require participants to live in a rehab facility for a set period, typically ranging from 30-90 days. These programs provide round-the-clock care, therapy, and support to help individuals overcome addiction.

Outpatient Rehab Programs

Outpatient rehab programs allow participants to receive treatment while continuing with their daily lives. They involve regular visits to a rehab center for therapy sessions and support groups.

Partial Hospitalization Programs (PHP)

Partial hospitalization programs offer structured treatment during the day, allowing individuals to return home at night. These programs provide intensive therapy and support while giving participants more flexibility than inpatient or residential rehab.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs provide more hours of therapy and support compared to standard outpatient programs. Participants attend therapy sessions several times a week for several hours each day but can continue living at home.

Medication-Assisted Treatment (MAT) Programs

Medication-assisted treatment involves using medication, such as methadone or buprenorphine, alongside counseling and behavioral therapies to treat substance use disorders. Highmark covers the cost of MAT as part of its addiction treatment coverage.

By offering coverage for various types of addiction treatment programs, Highmark ensures that its members have access to the care they need to overcome addiction and achieve lasting recovery.

Filing a Claim for Rehab Treatment with Highmark

If you have received addiction treatment and are looking to file a claim with Highmark, the process is simple. You will need to provide your insurance information to the rehab facility where you received treatment. The facility will then submit a claim directly to Highmark on your behalf.

It is important to note that not all rehab facilities may be in-network with Highmark. If you receive treatment at an out-of-network facility, you may be responsible for paying some or all of the cost of your treatment.

To find out if a rehab facility is in-network with Highmark, you can check your plan's provider directory or contact Highmark directly. If you have any questions about filing a claim for addiction treatment or need assistance navigating the claims process, Highmark's customer service team is available to help.

How to Determine if a Specific Rehab Facility is Covered by Highmark Insurance

If you are considering a specific rehab facility for addiction treatment, it is important to determine whether it is covered by your Highmark insurance plan. To do this, you can take the following steps:

  1. Check your plan's provider directory: Highmark provides a list of in-network healthcare providers on their website. You can search for the rehab facility in question to see if it is listed as an in-network provider.
  2. Contact Highmark directly: If you are unable to find the information you need on the provider directory, you can contact Highmark's customer service team directly. They can provide you with information about your coverage and help determine whether the rehab facility is covered by your plan.

It is important to note that even if a rehab facility is not listed as an in-network provider, you may still be able to receive some coverage for your treatment. Some Highmark plans offer out-of-network benefits, which means that they will cover a portion of the cost of treatment received at an out-of-network facility.

Before making any decisions about addiction treatment, it is always best to confirm your coverage with Highmark and understand any costs or limitations associated with your plan.

Cost-Sharing Requirements for Addiction Treatment Services under Highmark Insurance

While Highmark insurance covers addiction treatment services, it is important to understand the cost-sharing requirements associated with these services. Cost-sharing refers to the amount that you are responsible for paying out of pocket for your healthcare services.

Highmark plans typically have deductibles, copayments, and coinsurance that apply to addiction treatment services. Deductibles are the amount you must pay out of pocket before your insurance coverage kicks in. Copayments and coinsurance refer to the percentage of the cost of a service that you are responsible for paying.

The cost-sharing requirements for addiction treatment services can vary depending on your specific Highmark plan and the type of service you receive. In general, however, members can expect to pay some portion of the cost of their addiction treatment services.

It is important to note that under the Affordable Care Act (ACA), there are limits on how much members can be required to pay out of pocket each year for healthcare services. These limits apply to in-network services only and do not include premiums or out-of-network costs.

Before seeking addiction treatment services under your Highmark plan, it is recommended that you review your policy documents or contact Highmark's customer service team to understand your specific cost-sharing requirements. This will help you better prepare financially for your treatment and avoid any surprise bills down the line.

How to Navigate the Pre-Authorization Process for Rehab Treatment under Highmark Insurance

Before receiving addiction treatment services, it is important to understand that some Highmark insurance plans require pre-authorization for certain types of treatment. Pre-authorization is a process that involves getting approval from your insurance company before receiving treatment.

To navigate the pre-authorization process for rehab treatment under Highmark insurance, you can take the following steps:

  1. Check your plan's coverage: Before seeking addiction treatment services, review your policy documents or contact Highmark's customer service team to understand which types of services require pre-authorization.
  2. Get a referral: In some cases, you may need a referral from your primary care physician before receiving addiction treatment services. Check with your doctor to see if this is necessary.
  3. Submit a request for pre-authorization: Once you have determined that pre-authorization is required for your specific type of addiction treatment service, submit a request to Highmark's pre-authorization department. This can typically be done online or over the phone.
  4. Provide necessary information: When submitting your request for pre-authorization, be sure to provide all necessary information about your treatment plan and medical history. This will help ensure that your request is processed quickly and accurately.
  5. Wait for approval: After submitting your request, it may take several days or weeks for Highmark to review and approve it. Be patient and follow up with the pre-authorization department if you have not heard back within a reasonable amount of time.

By following these steps, you can navigate the pre-authorization process for rehab treatment under Highmark insurance with ease and ensure that you receive the coverage you need for successful recovery.

Telehealth Services for Addiction Treatment

Highmark recognizes the importance of accessibility and convenience when it comes to addiction treatment. That's why they offer telehealth services as part of their behavioral health coverage for members seeking addiction treatment.

Telehealth services allow members to receive addiction treatment from the comfort of their own homes, eliminating the need to travel to a healthcare facility. These services can be especially beneficial for individuals who live in rural areas or have mobility issues that make it difficult to attend in-person appointments.

Highmark's telehealth services for addiction treatment include virtual therapy sessions and support groups. These services are provided by licensed healthcare providers and can be accessed through Highmark's online platform.

To access telehealth services for addiction treatment under your Highmark plan, simply log in to your account on Highmark's website or contact their customer service team. They can provide you with information about available telehealth options and help you schedule an appointment with a licensed healthcare provider.

By offering telehealth services, Highmark ensures that its members have access to high-quality addiction treatment regardless of their location or physical abilities.

Finding a Treatment Provider

If you are seeking addiction treatment and are a Highmark member, it's important to find a treatment provider that accepts your insurance to minimize your out-of-pocket expenses. Highmark offers an extensive network of providers who specialize in addiction treatment and can provide the care you need.

You can easily search for providers on the Highmark website or contact their customer service team for assistance. They can help you find a provider that meets your needs and guide you through the process of accessing your benefits. By taking advantage of Highmark's resources, you can focus on your recovery without worrying about the financial burden of treatment.

Conclusion

If you have Highmark insurance and are seeking addiction treatment, you can rest assured that your policy will cover the cost of your treatment. Whether you require inpatient or outpatient treatment, medication-assisted treatment, behavioral health services, or detoxification, Highmark will provide coverage as long as it is medically necessary and provided by a licensed healthcare provider. If you or a loved one is struggling with addiction, don't let the cost of treatment hold you back from seeking help. Highmark is here to support you on your journey to recovery.

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