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Harvard Pilgrim Health Care for Addiction Treatment

Choosing to get treatment for addiction and move forward with a new life takes a lot of courage. Along the way, you’ll find a variety of people, professionals, and programs ready to help you. The question you might have is, “Does Harvard Pilgrim cover drug rehab?”

The good news is that all long-term insurance plans are required to have some coverage for addiction and mental health services. The Affordable Care Act (ACA) defines these services as essential benefits and every plan must provide at least some behavioral health benefits.1

The specifics will depend on your plan. This page will help you understand Harvard Pilgrim plans for addiction treatment so that you can move forward with your recovery.

American Addiction Centers (AAC) strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.


Does Harvard Pilgrim Health Care Cover Addiction Treatment?

What kind of addiction treatment coverage can you expect from Harvard Pilgrim mental health coverage? Your healthcare coverage from Harvard Pilgrim includes a variety of behavioral health benefits. Behavioral health includes Harvard Pilgrim therapy coverage as well as Harvard Pilgrim Health Care plans for rehab. Harvard Pilgrim coordinates this type of care through Optum’s Live and Work Well program.2

Behavioral health treatment options through Harvard Pilgrim include outpatient therapy, such as talk therapy, medication, and group care; as well as coverage for inpatient or residential care if needed. To access higher levels of care, you’ll need to call the Behavioral Health Access Center. The care management program will support you through treatment and into follow-up care to help you stay on track.3


How to Check Your Insurance Benefits?

How do you know exactly what your health benefits cover? Fortunately, it’s easy to find out. You can check online by logging in to your Harvard Pilgrim member account. From your member dashboard, you can review your plan, make payments, and more.5 To talk to a representative directly about your plan and benefits, you can call Member Services.

Knowing exactly what Harvard Pilgrim plans cover can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Harvard Pilgrim plans and to check what your plan covers, call , click here, or fill out the form below.


What Are the Coverage Levels and Plans for Harvard Pilgrim?

Harvard Pilgrim Health Care health plans cover more than 3 million members across the New England area. You might receive your coverage through your employer or through the Health Insurance Marketplace in your state.6

The health care plans offered by Harvard Pilgrim are divided into three types. There are a variety of plans available within each type.7

A Health Maintenance Organization (HMO) plan will cost you less per month and may also have lower out-of-pocket costs than other options. These plans require you to set up a primary care physician (PCP) who can coordinate your care. An HMO plan generally does not extend coverage outside the provider network.

A Preferred Provider Organization (PPO) plan allows you more freedom to choose your providers, both inside and outside the network. You also don’t have to have a PCP to administer your care. However, you will pay a higher monthly premium, and care outside the network will have higher out-of-pocket costs.

A Point of Service (POS) plan combines features of an HMO and PPO. You’ll have a PCP, but you’ll be able to access out-of-network providers if you get a referral from the PCP. If you choose to get care outside of the network without a referral, you’ll have to pay most of the cost.

Harvard Pilgrim doesn’t administer Medicaid plans in any state, but they do offer Medicare Advantage plans. If you qualify for Medicare and are interested in an all-in-one replacement that can provide extra benefits, an Advantage plan may be a good option. However, you’ll need to make sure you get your care within the Advantage plan network.8


What Different Types of Addiction Treatment Does Harvard Pilgrim Cover?

Harvard Pilgrim covers a variety of inpatient and outpatient addiction treatment. How much is covered and exactly what services you can access will depend on your insurance plan, your personal situation, and your addiction history.9

  • Detox: Most treatment programs begin with a detoxification phase. This may be medication-assisted if necessary for your health and wellbeing. From there you may move to an inpatient or outpatient program.
  • Inpatient treatment: An inpatient program, also known as residential treatment, requires you to live at the facility. This has the benefit of getting you out of the environment where you use drugs and helps you to make new choices and form new habits. You’ll receive regular individual and group counseling to help you stay clean and sober when you graduate.
  • Outpatient treatment: Outpatient programs allow you to live at home and possibly continue to work or go to school during treatment. You’ll have several meetings each week to receive counseling, learn healthy habits, and develop coping skills so you can live substance-free.
  • Partial hospitalization program (PHP): A PHP combines inpatient and outpatient care. You’ll spend 4-6 hours a day, 5days a week, in treatment and counseling. At night you’ll return home. This can give you the intensive care you need at a lower cost.

Do Treatment Centers Need to Be In-Network?

When you have Harvard Pilgrim healthcare benefits you do not need a referral to see a behavioral health provider. However, it’s still a good idea to talk to your primary care physician (PCP) if you have one. They can provide you with assessments and help you understand your care options.4

Although you do not need a referral, you still need to check to ensure your insurance benefits apply to the treatment program you choose. Only certain insurance plans include out-of-network coverage, and even within the network, you need to be aware of your copayment and deductible.

Be sure to contact Harvard Pilgrim before you commit to a treatment program so there are no unwelcome surprises.


What Should I Do if Harvard Pilgrim Health Care Won’t Cover the Total Cost of Rehab?

While Harvard Pilgrim plans do cover at least some of the costs of rehab, it’s possible that they won’t cover 100% of it, especially if the treatment you’re considering is outside the network. Fortunately, there are alternative ways to pay for the care you need. You can talk to the treatment program and ask if you can set up a payment plan, or if they offer scholarships for clients in need. You might also consider getting a personal loan to pay for treatment.

Other options are also available. Take a look at these resources for more information:

Going into treatment is a courageous choice, and it’s important to know that your Harvard Pilgrim insurance plan is available to help you. Make sure to contact the insurer before committing to a specific treatment program so you fully understand what will be covered. Your new life awaits.


Sources

  1. Healthcare.gov. Mental health & substance abuse coverage.
  2. Harvard Pilgrim Health Care. (2021). Behavioral Health Care.
  3. Harvard Pilgrim Health Care. (2021). Behavioral Health Treatment Options.
  4. Harvard Pilgrim Health Care. (2021). Find a Behavioral Health Provider.
  5. Harvard Pilgrim Health Care. (2021). Login.
  6. Harvard Pilgrim Health Care. (2021). About Us.
  7. Harvard Pilgrim Health Care. (2021). Select a Plan.
  8. Harvard Pilgrim Health Care. (2021). About Our Stride Medicare Advantage Plans.
  9. National Rehabs Directory (2020). What are the Different Types of Addiction Treatment Programs?

More resources about Harvard Pilgrim Health Care for Addiction Treatment: