Drug and alcohol addiction is a serious, debilitating and life-threatening illness that can hinder all aspects of a person’s life. Highmark recognizes the importance of detox and rehabilitation programs and provides coverage options to help patients cover the costs they incur during treatment.1 Below are some frequent topics of interest that may help you better understand your Highmark insurance coverage.
Does Highmark Cover Detox Services?
Medically-assisted detox under the care of a physician can provide patients with medication to help keep them safe, ease withdrawal symptoms and prevent relapse.Detoxification is the first phase of the treatment process. People typically exhibit many painful or uncomfortable withdrawal symptoms as the drug leaves the body. This withdrawal period can last days and even weeks, depending on the drug. Medically-assisted detox under the care of a physician can provide patients with medication to help keep them safe, ease withdrawal symptoms and prevent relapse.2,3
Detox services are covered under most Highmark insurance plans. Individual coverage can vary greatly depending on your individual plan, however. Some plans may provide full coverage while others provide for co-insurance. This means that Highmark pays a certain percentage, and the patient is responsible for paying the remaining costs.
For example, if your co-insurance was 30%, Highmark would cover 70% of the costs and you would be responsible for 30%. Many plans also require a copay, which is a specific dollar amount paid up front at the time of service – otherwise known as a deductible, which is a specified amount the patient must pay out of pocket before coverage kicks in.
Does Highmark Cover Rehab?
Highmark typically provides some level of coverage for substance abuse rehabilitation programs since substance abuse is considered an illness. As with detox, the amount of coverage depends on your plan, so the amounts and types of coverage vary. There may also be coverage available if you have been diagnosed with a co-occurring mental illness that contributed to your drug or alcohol addiction.
Highmark covers a variety of rehabilitation programs, including both inpatient and outpatient treatment facilities. Be sure to carefully review your Summary of Benefits or speak with a Highmark representative to accurately determine your coverage prior to undergoing treatment. Alternatively, you may also speak with one of our recovery advisors at 1-888-341-7785 to better determine what your health insurance will cover.
Addiction Treatment Length Highmark Will Cover
The duration of substance abuse treatment can vary. The most common residential programs last from 28 to 30 days, but there are 60 days and 90-day programs, and some programs that last a year or longer.2,3 Highmark insurance plans will typically let you choose the length of your treatment, depending on your individual needs and your physician's documented recommendations.
Both inpatient programs and outpatient treatment are covered under the Substance Abuse and Mental Health portion of coverage. Specific coverage may differ according to your individual plan and whether you have already met your deductible and your out-of-pocket spending limit for the calendar year. Coverage may be limited for stays that last more than 30 days. It’s best to speak with a Highmark representative to better understand your coverage.
Specialty Alcohol and Drug Treatment Through Highmark
In addition to standard treatment, luxury and executive rehab facilities offer specialized treatment and amenities that may include:
- Gourmet meals.
- Private rooms.
- Spa treatments.
Highmark does not usually provide additional coverage for these amenities, as they are not considered essential to medical treatment. If you do not have coverage for an amenity or the specialized treatment you desire, consider talking with the treatment facility about other payment arrangements. In some cases, some individuals may decide to make out-of-pocket payments for the added amenities that insurance may not cover.
Insurance for Inpatient Addiction Treatment vs. Outpatient
Substance abuse treatment is available on both an inpatient and an outpatient basis. Inpatient treatment is provided 24 hours a day, seven days a week in a residential care facility in which treatment rules and schedules are strict, and patients are typically given little access to or contact with the outside world. This full-time care can help patients focus on recovering from their addiction and reduce their odds of succumbing to a relapse.
Many patients prefer outpatient treatment because it allows them to remain close to friends and family, to continue working or going to school, and to otherwise maintain their personal and professional lives outside of treatment. Both inpatient and outpatient treatment programs generally offer some combination of counseling and therapy, support groups and physician visits.
Outpatient treatment is often much cheaper than residential treatment, making it a more affordable option for some. Inpatient treatment provides many benefits that a person should take into consideration when choosing a rehabilitation program, however. For example, inpatient treatment facilities offer addicts more advanced and specialized treatment programs as well as the opportunity to be surrounded by other people who have a similar recovery goal.3
Many of the insurance plans that Highmark provides cover 80% co-insurance for inpatient rehabilitation, making it a more affordable treatment option for those seeking help for a substance abuse problem.
Highmark provides a wide variety of coverage options for inpatient and outpatient recovery programs. Insurance coverage for both inpatient and outpatient treatment services ranges from 100% coverage to partial assistance, depending on a person's plan. Highmark typically covers both local and out-of-state treatment programs, but the amount of coverage may vary.
Although out-of-network benefits are typically less than coverage for in-network providers, Highmark often pays up to 50% co-insurance for out-of-network providers. Some providers do not accept Highmark insurance. Confirm coverage with your Highmark representative as well as your admission counselor or recovery advisor before you begin treatment.
How to Cover What Insurance Won’t
It can be challenging to pay out-of-pocket costs for treatment that isn't covered by insurance, but it is important not to let finances stand in the way of getting help for an addiction that is chronic and debilitating.It can be challenging to pay out-of-pocket costs for treatment that isn't covered by insurance, but it is important not to let finances stand in the way of getting help for an addiction that is chronic and debilitating. Consider speaking with your provider or a treatment facility about payment options if you are struggling to pay your co-insurance or other necessary aspects of your treatment. Many rehab programs offer specialized installment options, payment plans and sliding-scale rates.
Verifying Coverage and Finding the Best Treatment
Calculate your budget and verify your insurance coverage before starting substance abuse treatment. If you do not fully understand your coverage after reading your Summary of Benefits, consider speaking with a Highmark representative or contact one of our recovery advisors by calling 1-888-341-7785. This helpline is available 24 hours a day, seven days a week. Recovery advisors can help you better understand your treatment needs, determine your coverage with Highmark and help you set up payment arrangements if necessary.
- Individual Families.
- The Science of Drug Abuse and Addiction: The Basics. (September 2014). NIH: National Institute on Drug Abuse.
- Drug Facts: Treatment Approaches for Drug Addiction. (January 2016). NIH: National Institute on Drug Abuse.