Drug And Alcohol Rehabs That Accept Highmark Insurance
What Is Highmark?
Highmark is based in Pittsburgh, Pennsylvania. Along with their affiliates, Highmark offers services to 5.2 million members within Delaware, Pennsylvania, and West Virginia. According to their website, Highmark is “among the largest health insurers in the United States and are the fourth largest Blue Cross and Blue Shield-affiliated company.” They continue, explaining that they are “an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.”
Understanding Highmark’s Plans And Coverage
As explained on their website, Highmark offers the following types of plans:
- Preferred provider organization (PPO) plans
- Exclusive provider organization (EPO) plans
- Health maintenance organization (HMO) plans
- Medicare plans
When seeking rehab, treatment facilities will be considered in or out-of-network. The type of plan dictates if and how you’re able to access care from these providers. The good news is that Highmark offers you extensive options since they’re part of the Blue Cross and Blue Shield network. This allows them to offer members “access to more than 93% of all U.S. physicians and more than 96% of all hospitals.” Your insurance representative can explain further and tell you if a certain facility is considered in or out-of-network.
For in-network cost-sharing, Highmark explains that if offers two to three levels of benefits, depending on your plan. These include:
- Preferred Level of Benefits: You may pay the least in out-of-pocket costs.
- Enhanced Level of Benefits: You may pay somewhat less in out-of-pocket costs.
- Standard Level of Benefits: You may pay the most in out-of-pocket costs.
Your addiction treatment coverage will vary depending on your plan and what level of benefits it falls within.
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Does Highmark Cover Inpatient Addiction Treatment?
If you have insurance through Highmark or one of their affiliates, your plan might be able to help you pay for treatment. Highmark plans outline coverage for outpatient substance abuse care, inpatient substance abuse detox, and inpatient substance abuse rehab. Your exact copay and any restrictions or limit on care will depend on the specific plan and level of benefits. Examples of copays range from $300 each per day for inpatient detox and rehab at the Gold level to a $1,500 copay each per admission under the Bronze level.
Are Medications Covered?
Various types of drug addiction require the use of certain medications during detox and throughout treatment. These may be used to treat symptoms of withdrawal, cravings, and/or any co-occurring disorders. Highmark Blue Cross Blue Shield plans for the most part rely on the four-tiered Essential Formulary. This is a closed formulary, which means that only certain generic, brand, and specialty drugs are covered. Your treatment facility can work with Highmark to determine if your medications are covered.
What Is A Precertification?
Certain services, such as inpatient treatment, may require precertification. Precertification or prior authorization is a decision made by your insurance company regarding medical services you are seeking, in this case addiction treatment. This process determines if the treatment you desire is “medically necessary.”
Precertification must be approved before services can be rendered. Once it goes through, you can continue taking steps to obtain treatment. Just because it’s approved does not mean the entire treatment will be covered. You still need to be aware of your plan details and benefits to determine what the insurance covers and what portion and/or copay you might be responsible for.
What Type Of Treatment Should I Seek?
Before you choose a rehab, we encourage you to take time to explore your options. Your treatment plan won’t necessarily be the same as someone else’s. In fact, the best type of addiction treatment is individualized care created just for you. How is this determined? To start this process, we’ll want to consider:
- What drug(s) are you addicted to?
- How long have you abused this drug for?
- How intense is the addiction?
- Will you need to undergo a medically supervised detox?
- Do you have any health conditions which require special care during treatment?
- Do you have a co-occurring mental health disorder like anxiety, depression, or any other?
- What are your family obligations?
- Excluding the actual cost of treatment, how long can you afford to miss work for?
If you have a more mild substance use disorder (SUD), outpatient treatment may meet your needs. But if you’re suffering from a moderate to severe SUD, a co-occurring disorder, or polydrug addiction, inpatient treatment is likely the best choice. RehabCenter.net can help you go over your options to figure out what form and length of care is best for your needs. Once we figure this out, we can help you find a treatment program.
How Can You Supplement Your Insurance Coverage To Pay For Treatment?
While any treatment is better than none, you may have options beyond what your insurance covers. If you need care that is more extensive than what your insurance offers, don’t give up yet. Fortunately, there are still a variety of options which may supplement your benefits.
Have you spoke to your loved ones? Sometimes close friends and family members see financial assistance as an investment in your future. They may be willing to help you pay for treatment. If this isn’t an option, perhaps you can take out a personal loan.
Beyond this, you may also consider looking into scholarships and grants. While not everyone may meet the criteria for these, you may be surprised. Remember, every little bit helps. There may even be financing options and sliding fee scales offered from the rehab itself. Lastly, medical credit cards may help. But keep in mind, with their high interest rates you may want to consider them as a last resort.
We Can Help You To Invest In A Drug-Free Life
Please, don’t your treatment needs slide out from under you because of the cost. We want you or your loved one to have the opportunity for a sober and meaningful life. Our staff at RehabCenter.net understands how to connect the dots between insurance, other financing options, and your end goal of comprehensive care. Contact us today.