Highmark Detox & Rehab Benefits Guide

Highmark Detox & Rehab Benefits Guide

It’s particularly critical to understand your insurance options if you are need detox and rehab for an alcohol and/or drug addiction. Some people who struggle with addiction fail to seek treatment because they are unsure of their insurance options. If you are experiencing addiction, you may have wondered: does health insurance cover detox? With Highmark insurance, you can be assured of having access to substance abuse and detox services.

Highmark Inc. partners with healthcare affiliates and provider networks across the nation to offer insurance services and plans to its members. Its plans cover approximately 5.6 million people in Pennsylvania, Delaware, and West Virginia. (1, 1st paragraph) Highmark Insurance is also a Blue Cross Blue Shield-affiliated organization. Individuals and families are eligible for a variety of Highmark insurance options through the Affordable Care Act.

This Highmark insurance guide will help you understand and access your insurance plan for drug and alcohol addiction programs.

Does Highmark Cover Detox?

When dealing with substance addiction, you may wonder, will detox be covered by insurance? You may also be worried about whether Highmark has drug rehab insurance coverage. Don’t let these concerns keep you from seeking the drug detox treatment you need. Federal law prevents insurance providers from denying coverage for addiction needs. All Marketplace insurance plans cover mental health and substance abuse services. (6, pg 1) So, if you have Highmark, you’re covered for detox and rehab.

You can select from qualified mental health and substance abuse professional providers, which ensures that you get the level and type of care appropriate to your situation. If you’re seeking inpatient mental health and/or substance abuse care, be sure to find out if your plan requires a physician’s referral, prior authorization, or other necessary precertification. (7, you get a range of covered services, last para) Highmark drug rehab coverage treatment will include inpatient mental health services, substance abuse admissions, and outpatient treatment sessions. (8, 8-1)

Dependents under 26 years of age are also eligible for treatment through the Highmark plan. (9, pg. 11) This is particularly reassuring for parents of family members who need substance abuse care. There is no reason to worry about you or a loved one going without addiction services.

How to Check Your Highmark Insurance Benefits

Before you get started with treatment, it’s a good idea to verify your insurance benefits with your provider. Call the number on the back of your card to speak with a Highmark representative who can help you understand the specifics of your coverage.

It’s also important to make sure that the treatment facility will accept your insurance. At American Addiction Centers (AAC), we are available 24/7 to verify your insurance and get you started with the admission process. Your information is safe and secure and you can have an answer quickly. If you’d prefer to speak to someone directly, you can contact AAC’s 24/7 hotline at 1-888-935-1318 toll-free.

 

Types of Highmark Insurance Plans

Highmark provides the following types of managed care insurance programs for their clients: (3, pg6)

Preferred Provider Organizations (PPOs)

A PPO plan usually gives members the ability to obtain care from a network without having to choose a primary care physician (PCP). Members may also receive care from providers who are not in the network. Members will be responsible to pay the difference between the provider’s charges and the payment provided by Highmark. (3,  pg7)

Exclusive Provider Organizations (EPOs)

EPOs function like PPOs but you can’t go out of the network (except for emergency services). Members are not required to select a PCP to coordinate covered care, but it is recommended.(3,  pg. 11)

In Pennsylvania, the EPO insurance plans are Community Blue plans: Community Blue EPO, Community Blue Flex, Connect Blue, and Community Blue HMO.(3,  pg. 12)

Point-of-Service (POS) and Open Access Programs

If you have the POS managed care benefit plan, you will select a PCP who will assist you in securing care and services. The PCP will ensure your services are within the network. If you do, however, use a non-network provider, you may have to pay out-of-pocket costs. This Highmark plan is offered in Delaware and West Virginia. (3,  pg. 14)

Health Maintenance Organizations (HMOs)

The Highmark HMO plan is for Pennsylvania and Delaware members. This type of health care plan provides comprehensive services that members must use within the network of participating providers (except for emergency care and urgent care). (3, pg. 20)

If you’re in any of Pennsylvania’s 29-county Western Region, then you are eligible for the Highmark Choice Company, which utilizes the Keystone Health Plan West managed care provider network. Residents in the Northeastern region of PA receive HMO products through the First Priority Health managed care network. (3, pg. 21)

Highmark and the Affordable Care Act (ACA)

Highmark insurance is also available through the Affordable Care Act (ACA), which provides comprehensive health coverage for those who don’t have insurance offered to them through an employer. (ACA, 1st para) If you meet the financial eligibility requirements, you can purchase Highmark ACA through the Marketplace, also known as the Exchange, and you’ll have a lower monthly payment. (4, Where to buy your plan) APA plans vary based on your location and other factors, so it’s best to consult your plan for specific information.

If you’re seeking help for addiction, Highmark plans will include the following: (4, What is ACA)

  • Outpatient services
  • Preventive care and chronic disease management
  • Emergency care
  • Prescription drugs
  • Rehabilitation services and devices
  • Hospitalization
  • Mental health and substance use disorder services
  • Behavioral health
  • Laboratory services

Highmark’s Metal Levels

All medical insurance plans are categorized by metal levels. These levels have nothing to do with the quality of service you’ll receive; they simply reflect how much you’ll pay monthly and at the time of service. The metallic levels include: (4, Choose your metal)

  • Gold—You pay a higher monthly premium and have lower out-of-pocket fees.
  • Silver—Your monthly payment is balanced with the out-of-pocket costs, so your costs are moderate for both.
  • Bronze—You pay lower monthly premiums and higher costs at the time of service.

Catastrophic insurance is also available. People under 30 years old or those who are dealing with catastrophic health issues are eligible.

Finally, if you are a Medicare recipient, you can choose a Highmark plan if you are enrolled in Part A and Part B. To find out more about how Highmark coordinates with Medicare, you can call 1-888-935-1318. (5, contact us)

Using Highmark Insurance at American Addiction Centers

You can find hope for substance addiction by seeking help at a reputable, qualified treatment center. American Addiction Centers provides top-quality service with a high staff-to-patient ratio using research-based methods. You’ll receive care from experienced physicians, psychiatrists, licensed social workers, registered nurses, psychologists, and other professionals. With conveniently located facilities throughout the United States, we work with many insurance providers, including Highmark, to ensure you can access the treatment you need.

Our compassionate staff is standing by to help you take the first step toward a substance-free life. Contact us today at 1-888-935-1318 for personalized, confidential help without judgment. We are here 24/7 to guide you through verifying your insurance, scheduling an evaluation, finding the right facility, and setting up a treatment plan. Your new future is just a phone call away.

  1. (2020). Our story.
  2. Highmark Health. (2020). Highmark Health Plans.
  3. Highmark Provider Manual. (April 2018). Page product information: Product overview.
  4. (n.d.). ACA health insurance basics.
  5. Highmark West Virginia. (2020). Contact us.
  6. gov. (2020). Mental health & substance abuse coverage.
  7. Highmark BCBS. (n.d.). More than just coverage.
  8. Highmark Blue Shield Facility Manual for Care Management and Quality Improvement. (2008). Unit 8 Behavioral Health Care Management
  9. Highmark Provider Manual. (2020). Page general information: Highmark member information
  10. (2020). Post enrollment.