Does Highmark BCBS of Pennsylvania Insurance Cover Inpatient Alcohol and Drug Rehab Centers?
Highmark Blue Cross Blue Shield of Pennsylvania (BCBS of PA) provides a variety of health insurance solutions and coverages to its covered members.1 If you’re struggling with addiction and have a Highmark BCBS of PA insurance plan, you may be wondering whether it covers the costs of addiction treatment. The short answer is yes, your Blue cross blue shield Pennsylvania mental health coverage provides some level of coverage for addiction treatment, such as treatment at inpatient alcohol and drug rehab centers in Pennsylvania.
However, how every specific Highmark BCBS of Pennsylvania plan covers such services will vary. Some plans may be subject to networks or cost-sharing requirements (e.g., deductibles and copays), and others may impose maximum coverage details. The best way to know what’s covered under your plan is to verify your benefits and coverage, and there are several ways that you can do this.
You can call the number on the back of your insurance card or log in to your online member portal to view your explanation of benefits (EOB) or summary of benefits and coverage (SBC). You could also call rehab centers directly to have them check your coverage. Finally, you can work with industry-leader American Addiction Centers (AAC), and their trained staff can help you verify your benefits via chat, helpline, or the verification form.
How to Find Highmark BCBS of Pennsylvania Covered Inpatient Drug Treatment Centers in PA?
Depending on your Highmark BCBS of Pennsylvania health plan, coverage for inpatient drug treatment may be limited to certain inpatient centers that are within the plan’s network. As such, you may be wondering how to find covered inpatient drug treatment centers in Pennsylvania. There are a variety of tools at your disposal to help you find a covered facility.
First, you can use the BCBS of Pennsylvania’s Find a Doctor tool on their website. By entering your plan details or logging in, you’ll be able to search for in-network providers. You can also call the number on the back of your insurance card and speak with a plan representative who can help you find facilities that are within a plan’s network.
Additionally, you can use American Addiction Centers to help you find covered facilities. By calling the confidential helpline, you can speak to a person who can check your benefits while you’re on the phone. They can also check whether your plan would cover treatment at the top-notch AAC facilities across the nation. If it does not, AAC will help you find a quality, covered facility near you in PA.
What Is Highmark BCBS of Pennsylvania?
Since the 1930s, Highmark BCBS has been helping Pennsylvania residents pay for the health care services they need.2 The genesis of the company that is known today as Highmark BCBS of Pennsylvania was first established by 2 organizations, Blue Cross of Western Pennsylvania (backed by a hospital association in Pittsburgh), and Pennsylvania Blue Shield (backed by Pennsylvania Medical Society).2 The 2 organizations merged in 1996, forming Highmark, Inc., which is now one of the U.S.’s largest health insurers.2
It is one of the largest health organizations and an independent licensee of the Blue Cross Blue Shield Association.2 Specifically, Highmark BCBS of PA, is the 4th-largest BCBS licensed plan in the country, providing insurance to 6 million members across Pennsylvania, Delaware, and West Virginia.2 There are multiple markets in which Highmark sells plans, including the individual and family Marketplace, Medicare market, employer-sponsored plans, and federal employee plans.3 “Helpful links” Call the number on the back of your card to find out what type of plan you have.
How Much Does BCBS of Pennsylvania Cover (Addiction Treatment)?
What your BCBS of PA covers and how much it covers regarding addiction treatment will depend upon the plan that you have, where you seek treatment, and the type of treatment you need. Depending on your plan, there may be copays, coinsurance, and deductibles that you may owe when you receive treatment. It’s best practice to call the number on the back of your insurance card to check your benefits and coverage to find out what is covered under your plan, and how extensive your coverage may be.
Aside from what is and is not covered under your plan, there may be common treatment methods that are suggested for your path to recovery. Your health care provider may suggest the following treatment methods for your addiction treatment:
- Inpatient or residential rehab. In inpatient or residential rehab programs, patients live and remain at the facility for the duration of their treatment. It generally involves medically supervised treatment in a structured setting, where medical professionals help patients manage withdrawal symptoms during detox or provide the structure they need to get on their path to recovery.4, Pg 8, “What types of treatment programs are available?” Para 2,
- Outpatient rehab or therapy. In outpatient rehab programs, patients attend sessions at a facility but go home after the session is done. Common outpatient rehab programs include therapy or counseling sessions.4, Pg 10, Para 2
- Intensive outpatient programs. In IOPs, there is more structure than in standard outpatient programs, as patients must attend a minimum number of hours of treatment per week (usually 9 hours/week), but no overnight stay is required.4, Pg 10, Para 3
- Partial hospitalization programs. In PHPs, patients attend 4-8 hours of treatment per day, multiple days a week, but do not stay overnight. These programs are commonly known as day programs given the structure of the program.4, Pg 10, Para 1
Although these are common methods for addiction treatment, it is not guaranteed that they will be suggested for your treatment plan. Nor is it guaranteed that they will be fully or partially covered under your Highmark insurance plan. Be sure to verify your benefits and coverage before seeking care whenever possible. Additionally, be sure to work closely with your health care provider to ensure that you’re on the most beneficial treatment path for you.
Does Blue Cross Blue Shield of Pennsylvania Provide Coverage for Mental Health Facilities?
The Affordable Care Act (ACA), a federal health care reform law, mandates that all U.S. health plans, including BCBS of PA plans, provide some level of coverage for mental health and substance abuse treatment.5 The ACA mandate enables many Americans who need treatment for mental illness, behavioral health, and co-occurring disorders, to use their insurance coverage to cover some or all of the costs for such services.5
Specifically, inpatient mental and behavioral health services, behavioral health services, and substance use disorder treatment (e.g., rehab) must be covered in some fashion by your plan.5
So, whether you’re seeking treatment for a stand-alone heroin rehab or co-occurring disorder treatment, which is the treatment for someone who has both a mental illness and substance use disorder, you can likely use your insurance to cover the costs.6
In 2020, 17 million Americans had co-occurring disorder, which illustrates that it’s a common occurrence.7 Because the 2 conditions are interconnected, as it’s believed that those with a mental illness are twice as likely to develop a substance use disorder and vice versa, tandem treatment is often recommended.6 “What should I do?” Tandem treatment refers to when each condition is treated separately at the same time.6 “What should I do?” To find out what exactly is covered by your plan, call the number on the back of your card today.
How Long Does Highmark BCBS of Pennsylvania Insurance Cover Alcohol and Drug Rehab Programs?
The extent of your Highmark BCBS of PA coverage regarding the length of coverage for alcohol and drug rehab programs depends upon your specific health insurance policy. Highmark BCBS of Pennsylvania mental health coverage will be influenced by your plan, where you seek care, the type of care you seek, and how long you need to be in treatment.
It is important to note that how long your plan will cover treatment may be different than how long you’re recommended to be in treatment. Look up your plan’s details on your insurance card or call the number on the back of your card to speak with a plan representative, who can walk you through your plan’s specific details.
When it comes down to it, you should prioritize staying in treatment for the length of time suggested by your provider. While every person’s situation and recovery needs differ, experts recommend the average treatment program last for at least 90 days to improve overall outcomes.8, bullet 5 Please note that treatment lengths could be shorter or longer depending on your needs. Work with your doctor to come up with a treatment that’s the best fit for you.
What if My BCBS of Pennsylvania Policy Does Not Cover an Inpatient Drug Rehab Program?
It is possible that your BCBS of Pennsylvania policy may not cover all or some of the costs associated with inpatient drug rehab programs. If this happens to you, you may be wondering how to pay for rehab. While you may have to pay for the costs fully out-of-pocket, there may be payment options available to you. Ask the rehab facility directly whether there are financing opportunities or scholarships available to you, which can help offset the costs of treatment. Don’t hesitate to ask for assistance in paying for rehab, as it’s critical to get the treatment you need now; do not push it down the road.
BCBS of Pennsylvania In-Network vs. Out-of-Network Inpatient Drug Rehab Centers
Highmark works with healthcare providers and facilities to provide lower-cost healthcare services to its covered health insurance members.9 “In-network Provider/Network Provider” This is what is known as a network provider.9 “In-network Provider/Network Provider” For covered members, using in-network providers typically results in lower health care costs than using out-of-network providers.9 “In-network Provider/Network Provider”
Depending on your plan, you may not have coverage for out-of-network providers or services. Call the number on the back of your card to find out more about your network coverage details. You can also ask the representative to help you find an in-network treatment facility. Alternatively, you can call the AAC helpline today for assistance in finding an in-network inpatient drug rehab center near you.
Which Rehab Centers Take Blue Cross Blue Shield of Pennsylvania?
BCBS of Pennsylvania members have access to a large network of healthcare providers in Pennsylvania and beyond, including those who offer treatment for substance use disorder. American Addiction Centers has several rehab facilities in the United States that accept BCBS insurance, including:
- AdCare Rhode Island: Located in Rhode Island, AdCare provides high-quality, evidence-based addiction treatment in a supportive environment.
- Desert Hope Treatment Center: Located in sunny Las Vegas, Desert Hope Treatment Center provides a high level of care and individualized treatment plans to help address addiction and co-occurring mental health disorders.
- Greenhouse Treatment Center: This Dallas, Texas, rehab facility provides a wide variety of addiction treatment services and individualized treatment plans for people with addiction and co-occurring mental health disorders.
- Laguna Treatment Hospital: Located in Orange County, California, Laguna Treatment Hospital provides high-quality addiction treatment and care in a supportive environment with staff available around the clock.
- Oxford Treatment Center: Located in Etta, Mississippi, Oxford Treatment Center provides high-quality drug and alcohol addiction treatment in a serene environment.
- River Oaks Treatment Center: This Riverview, Florida, treatment center has advanced accreditations and professional staff who provide the highest level of care.
- Sunrise House Treatment Center: Located in Lafayette, New Jersey, Sunrise House Treatment Center is a premier addiction center that provides a comprehensive continuum of care and individualized treatment plans.
American Addiction Centers is committed to helping individuals struggling with drug or alcohol use break the cycle of addiction. If you have questions about addiction treatment or want to know what your BCBS insurance covers, you can contact us at .
Our admissions navigators are available around the clock to provide resources, offer support, and assist you with the admissions process when you’re ready.