Highmark Insurance Coverage for Drug & Alcohol Rehab

Drug and alcohol addiction can be a debilitating, life-threatening condition that can hinder all aspects of a person’s life. Highmark insurance may be able to help members cover some or all of the cost of addiction treatment services.¹ Understanding what Highmark insurance is and how it can be used to help cover the costs of addiction treatment is an important step in achieving recovery.

Does Highmark Cover Addiction Treatment?

As part of the Affordable Care Act (ACA), Highmark provides marketplace insurance plans that cover some or all the costs of drug and alcohol rehab programs. Since the ACA mandates that plans provide some degree of coverage for the medically-necessary treatment of substance use disorders, you may be able to use your Highmark insurance plan to cover some or all of your rehab costs.

Highmark typically provides some level of coverage for addiction rehab programs since addiction is considered an illness. The amount of coverage depends on your plan, so 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 recovery 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.

This page is intended to be a general overview of how Highmark covers addiction and mental health services, not a comprehensive guide on the subject. For specific questions about your Highmark policy and coverage for addiction treatment at American Addiction Centers’ facilities, call a Highmark representative directly and learn more about paying for rehab.

What Types of Addiction Treatment Does Highmark Cover?

With most Highmark plans covering at least some of the costs of treatment for alcohol addiction or drug addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:^5,6

Medical detox: Under 24/7 medical supervision, staff will work closely with you while you clear substances from your system. They may prescribe medications to help ensure that you withdraw from substances safely and that your symptoms are addressed as needed.
Inpatient treatment: Inpatient treatment, where you reside at the facility, typically involves group and/or individual therapy along with other therapeutic options. You may remain in inpatient treatment for a few weeks to months at a time.
Partial hospitalization: These programs allow you to live at home throughout treatment and spend your days at the treatment facility. This is sometimes referred to as day treatment.
Intensive outpatient programs: These programs typically involve attending treatment programs approximately 3 evenings a week. People in these programs can live at home and go to work during the day.
Outpatient treatment: An outpatient facility allows you to receive therapy during the week, but for shorter periods of time that other outpatient options. This means that you can get treatment for your SUD while still maintaining your daily life.

Check Your Highmark Rehab Coverage

There is no set time limit for addiction treatment, and oftentimes the extent of treatment and the coverage for it will vary. Some residential programs last from 28 to 30 days, but there are 60-day and 90-day programs, and some programs that last a year or longer.^2,3

Before choosing the right rehab treatment center for you, check your Highmark policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your insurance card or log in to your account on Highmark’s website to learn more about what your specific policy plan covers.

Knowing exactly the type of coverage your Highmark plan 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 Highmark insurance plans and to learn more about yours, call , click here, or fill out the form below.

Do Rehab Centers Need to Be In-Network To Accept Highmark Insurance?

In most cases, you will need to seek drug and alcohol addiction treatment at a rehab facility that is in-network with Highmark to receive the full benefits of your coverage. However, based on your plan, even if you choose a treatment facility that is in-network, you may still be responsible for some of the treatment costs.

If you choose a facility that is out-of-network, you may be responsible for all the costs of your addiction treatment. Discussing financing options, such as a payment plan or scholarships offered by the facility, may help you plan for covering out-of-pocket costs.

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. However, some providers do not accept Highmark insurance. Confirm coverage with your Highmark representative as well as your admission counselor before you begin treatment.

What Are Highmark’s Coverage Levels and Plans?

Highmark provides the following types of managed care insurance programs for their clients:^2-3

Preferred Provider Organizations (PPOs)
Exclusive Provider Organizations (EPOs)
Point-of-Service (POS) and Open Access Programs
Health Maintenance Organizations (HMOs)
Highmark and the Affordable Care Act (ACA)

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

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.

Finally, if you are a Medicare recipient, you can choose a Highmark plan if you are enrolled in Part A and Part B.

How to Verify the Coverage of Your Highmark Plan

Before deciding on a rehab center, check your Highmark policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Highmark’s website to determine how much you may need to cover in terms of copays and any deductibles that must be reached before you can receive full coverage.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the center you are considering is in-network with Highmark. Or, call to connect to one of our admissions navigators and have them check your benefits.

What Should I Do if Highmark Won't Cover the Total Cost of Rehab?

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. There are many other ways to finance your treatment and get the help you need. Some ways to pay for rehab include:

Payment plans, where you pay off rehab in affordable installments.
Sliding scale fees, where the rehab decreases your cost to something you can reasonably afford based on your income level.
Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehabs, offer grants and scholarships to pay for people who can’t afford treatment.
Purchase affordable insurance on the Healthcare Marketplace.
Open a healthcare credit card or take out a specialized healthcare loan.
Use your savings or a credit card.

Here are additional resources that provide more information about other ways to pay for rehab with or beyond what Highmark covers:

We know that finding a rehab center is a confusing task, but we’re ready to help you navigate through the world of treatment centers. Call one of our rehab admissions navigators if you’re worried about a loved one or you’re ready to take action to begin the process toward recovery.

Insurance Providers and Rehab Treatment Coverage Levels

Sources

Highmark. (2020). Our story.
Highmark Health. (2020). Highmark Health Plans.
Highmark Provider Manual. (2018). Page product information: Product overview.
Highmark. (n.d.). ACA health insurance basics.
National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.