Highmark Rehab Insurance Coverage

What Is Highmark Insurance?

Highmark insurance is a popular insurance company. It is a nonprofit healthcare company that works with subsidiaries to provide various health insurance coverage options. One of the largest health insurers in the United States, it provides users with not-for-profit health insurance options as well as for-profit, private plans.

The most used and well-known insurance coverage under Highmark is Blue Cross, Blue Shield. Another subsidiary is United Concordia. Having such insurance coverage can provide the help necessary to pay for substance abuse treatment.

Providing Treatment Coverage for Adults

Increasing numbers of professionals and health authorities are stating that substance abuse is a brain disease. This type of coverage is viewed as a priority by many insurance companies. It is important for the health insurance coverage to cover some, if not all, of the treatment necessary to help individuals overcome their addictions.

Addiction is recognized as a chronic medical disease but it is a disease that is treatable. The addiction can cause complex interaction between brain circuits. There are various reasons why addiction occurs, such as genetics and individual life experiences. Those with addictions may make choices and face other factors that produce harmful consequences.

What Substance Abuse Treatments Does Highmark Cover?

Highmark insurance plans cover a number of substance abuse treatment options, including detox, inpatient and outpatient treatment, rehab centers, and medications.

Detox Services

Detoxing can become dangerous and be uncomfortable. Highmark offers coverage for medically supervised detox services in approved detox facilities.

Professionals affiliated with Highmark insurance rehab centers will monitor clients, provide medication to make the detox process easier, and help them get through the process. The medications covered under Highmark depend on individuals’ insurance plans. People may have to choose specific medications due to the conditions of their coverage, and some plans may cover a portion of the costs of the medications instead of the entire cost.

Inpatient Services

Inpatient services are usually recommended for people who are undergoing alcohol or drug addiction treatment. Such services help people who once used substances to avoid them for longer periods of time. Stays for inpatient treatment programs usually last from thirty to ninety days, though some programs may require people to stay longer.

Outpatient Services

Outpatient services enable clients to follow rehab plans, but do not require them to stay in facilities if they are unable to do so. The facilities develop care plans that clients can follow during the day, allow clients to go home at night, and provide therapy and other treatment protocols.

Relapse Prevention Programs

Following up with treatment centers and services is important. Relapse prevention programs help clients who are leaving facilities stay away from addictive substances.

Therapy Options

A number of therapy options are available and covered by Highmark insurance, including group, individual, and family therapy. Clients can participate in therapy in inpatient settings or through an outpatient basis, allowing them to participate in therapy sessions as needed.

Does Highmark Cover Rehab for Different Amounts of Time?

The length of time that Highmark covers for treatment can vary, based on a number of factors. The type of plan, the medical necessity of the program, the length of the program, where the program is located, and other variables are considered to determine what your Highmark insurance policy will cover.

Many Highmark insurance plans provide 80 to 100 percent coverage of the cost of inpatient rehab. Some alcohol rehab Highmark insurance plans will even consider paying for out-of-state residential rehabs for their policyholders. Usually, if the services are out-of-network, Highmark will cover up to 50 percent of the treatment costs, leaving the other half the responsibility of the clients.

It is important to note that if a treatment is considered experimental, it will not be covered by Highmark and will be the responsibility of the client.

Does Highmark Insurance Cover Drug Rehab Services for Children?

Though we may not like to think about it, sometimes people under the age of 21 may require addiction treatment. If this is the case, Highmark provides the same types of coverage for children as they do for adult members under their plans.

Highmark insurance drug rehab coverage will often cover the following services for clients under the age of 21:

  • Detox services under medical supervision
  • Inpatient and outpatient rehab services
  • Day treatment services for children and young people still in school
  • Relapse prevention programs specific to children and young people
  • Therapy for individuals, in group settings, and for the whole family

Will I Need Prior Authorization from Highmark for Treatment?

Many insurance companies request prior authorization for various treatments, such as CT or MRI scans. Obtaining authorization is intended to save money. To find out if your treatment will be covered, prior authorization may be required.

Certain treatments do require prior authorization with Highmark Insurance rehab coverage. You may want to talk to Highmark or the rehab center you choose to help determine if you will need prior authorization before obtaining treatment for your addiction.

Will Highmark Insurance Drug Rehab Coverage Charge Out of Pocket Expenses for My Treatment?

Out of pocket expenses may arise when paying for rehab or treatment for substance addiction.

The costs can include, but are not limited to:

  • Out of pocket deductibles
  • Co-payments
  • Alternative treatment fees
  • Travel expenses and fees

Usually, with Highmark plans, clients are responsible for paying about 15% of the entire cost of treatment. It is important to examine the summary of benefits from Highmark or speak with a representative to learn more about the substance abuse treatment coverage that your policy carries.

What Makes Highmark a Great Choice for Insurance Coverage?

Highmark insurance alcohol rehab coverage is different from other insurance plan coverage options because Highmark has some notable features.

The provider classifies people with alcohol addiction as people with a medical condition that requires treatment. This changes the way Highmark insurance alcohol treatment is covered under a particular insurance plan.

Coverage amounts depend on the specific plans that clients have. However, many Highmark Insurance rehab plans provide total cost coverage for treatment. As long as people meet their deductible expenses for the plan period, they can obtain coverage from Highmark for their substance abuse treatment.

The amount Highmark insurance addiction treatment will cover for the cost of treatment varies from plan to plan, so it is especially important to learn how the coverage works and what it covers exactly. People who have plans that do not cover the full amount of addiction treatment and rehab may want to consider attending rehab facilities that offer sliding scale payment plans to help pay for the remaining cost of treatment.

Further insurance coverage information and substance abuse treatment specifics through Highmark can be found by studying your insurance materials or by calling Highmark. Since times are changing, assistance is available for those who have addiction issues that need to be addressed.


Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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