Does Highmark BCBS of Pennsylvania Insurance Cover Inpatient Alcohol and Drug Rehab Centers?

Substance use disorder is a debilitating illness that can cripple many parts of your life. You may not know where to start when deciding to seek help for addiction. The good news is you’re already in the right place. A huge factor for many is figuring out how to afford treatment. Don’t let the burden of financing addiction treatment hold you back from seeking the help you need. Many insurance providers cover some or all of the costs for alcohol and drug addiction treatment programs.

Highmark Blue Cross Blue Shield of Pennsylvania understands the importance of providing appropriate drug and alcohol treatment. Substance use disorder is very common in the U.S., with about 20 million Americans reporting addiction to drugs and alcohol.^{1 Intro} In 2020, over 5,000 Pennsylvania residents died from drug overdoses.^{2 Data table} Highmark BCBS of Pennsylvania works to help those struggling with addiction by offering coverage for various types of substance abuse treatment programs.

If you’re wondering whether your insurance covers the treatment you desire, reach out to the rehab center you’re interested in, and they can check your coverage based on the information you provide.

You can also call the number on the back of your insurance card for more information about your specific plan or reach out to American Addiction Centers (AAC). By filling out the SSVOB form on the AAC website or reaching out through chat or by phone, you can get the information you need about your insurance coverage.

How to find Highmark BCBS Of Pennsylvania covered Inpatient drug treatment centers in PA?

AAC can verify your  insurance coverage for you. You can call our helpline and speak directly with a representative who will check your benefits right when you’re on the phone. Every year, hundreds of people go into rehab financed through Highmark BCBS of Pennsylvania.

AAC offers access to some of the best rehab facilities in the nation. You can create an individualized treatment experience to focus all your energy on getting better without distractions. Many of our facilities offer top-notch amenities and specialized alternative treatments.

Whether you want a more spa-like experience, prefer alternative therapies, or want to be surrounded by nature during your recovery, AAC has an option for you. Our leading facilities include:

• Sunrise House Treatment Center: This New Jersey treatment center offers a comprehensive continuum of care through medical detox, cognitive-behavioral therapy, and intensive outpatient treatment programs.
• AdCare Hospital: Massachusetts & Rhode Island: AdCare Hospital provides evidence-based treatment with 2 inpatient addiction treatment facilities and 7 outpatient facilities throughout Massachusetts and Rhode Island. They offer high-quality addiction treatment and care in a secure and supportive environment.
• Desert Hope Treatment Center: This premier treatment center provides high-quality, individualized treatment plans to address addiction, co-occurring mental disorders, and medical conditions.
• Greenhouse Treatment Center: Located in Dallas, Texas, Greenhouse Treatment Center offers individualized addiction treatment services to best fit your needs. They understand that everyone is unique and provide different treatment options, such as family programs, medical detox, and co-occurring disorder treatment.
• Laguna Treatment Hospital: Laguna Treatment Hospital, located in Laguna Beach, California, offers a supportive environment and high-quality substance abuse treatment plans with personalized treatment and addiction aftercare.
• Oxford Treatment Center: The Oxford Treatment Center, located in Etta, Mississippi, is a comfortable, secure place for recovery. They offer exceptional alternative therapies like yoga, art therapy, and equine therapy in a natural, serene environment.
• River Oaks Treatment Center: Located in Riverview, Florida, River Oaks Treatment Center is highly accredited with a well-regarded staff, offering outstanding addiction treatment options and aftercare.

What is Highmark BCBS Of Pennsylvania?

Highmark Blue Cross Blue Shield of Pennsylvania is an independent licensee of the Blue Cross Blue Shield Association and one of America’s leading health insurance organizations. Established during the Great Depression in the 1930s, Highmark BCBS has assisted Pennsylvania residents with paying for healthcare for decades.^{3 about/our story}

Before merging in the mid-1990s, Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania independently created several innovations, such as a dedicated program for children’s health insurance, along with a health program for seniors. These 2 nonprofit organizations merged to create Highmark Inc.^{3 about/our story}

Today, Highmark Inc. operates as Highmark Blue Cross Blue Shield and serves over 500,000 individuals in 13 different counties in Pennsylvania. There are hundreds of drug rehab centers available in the Highmark BCBS network.

How Much Does BCBS Of Pennsylvania Cover (Addiction Treatment)?

Highmark BCBS of Pennsylvania will likely cover some, if not all, of the cost of several substance abuse treatment options. Common treatment options include:^{4 What types of treatments are available?}

• Inpatient or residential rehab programs: Inpatient programs are helpful, safe spaces where you live while in treatment. Programs vary in length, with most lasting between 30 to 90 days. Longer programs are also available and can last anywhere from 6 months to 1 year. Inpatient programs allow you to take time for recovery without having to deal with other stressful daily obligations. You’ll be able to learn and apply new coping skills to help support your long-term recovery.
• Outpatient rehab or therapy: Most outpatient programs include therapy in individual and group settings, peer support groups, and counseling focused on building skills to prevent relapse. Outpatient programs are a great choice if you would rather continue living at home and tending to commitments like work or family while seeking treatment.
• Intensive outpatient programs (IOP): These programs are more rigid and require you to attend a certain number of times per week. Similar to outpatient programs, you can still live at home and take care of your responsibilities.
• Partial hospitalization programs (PHP): Sometimes referred to as day treatment programs, PHPs are facilities that require you to attend treatment for about 20 hours a week, at least 5 to 7 days a week, while living at home.

Does Blue Cross Blue Shield of Pennsylvania Provide Coverage for Mental Health Facilities?

The Affordable Care Act mandates insurance providers offer coverage for mental health care and treatment.^{5 Essential health benefits} This includes mental health conditions such as co-occurring disorders, or “dual diagnosis”, which is when a person suffers from at least one mental health disorder along with a substance use disorder.^{1 Intro}

Co-occurring disorders are extremely common, with about half of those struggling with substance use disorder also suffering from a mental illness.^{1 Intro} The onset of dual diagnosis isn’t clear. Some develop a mental health illness from prolonged use of drugs and alcohol, while others might use substances to alleviate the symptoms of a mental health disorder, resulting in addiction.^{1 Does One Cause The Other?}

Seeking help in a mental health facility where both illnesses can be addressed simultaneously is the best option for efficient care. Addressing the issue as a whole greatly increases your chances of fully recovering and remaining sober after treatment.^{6 Points to Remember}

If you have Highmark Blue Cross Blue Shield of Pennsylvania insurance, some or all of your expenses for co-occurring disorder treatment and stand-alone heroin rehab will be covered.

Does Blue Cross Blue Shield of Pennsylvania cover addiction treatment therapies?

Addiction treatment therapies play an essential part in a successful recovery. Most inpatient and outpatient programs offer therapies as a part of treatment. Cognitive-behavioral therapy, along with other alternative therapies, is a common option.

After treatment, most professionals recommend remaining in therapy until you feel secure in your sobriety. Finding coverage for continuous addiction therapy will give you peace of mind as you continue your recovery journey.

Highmark Blue Cross Blue Shield of Pennsylvania offers coverage for at least some of the cost of addiction treatment therapies. Your level of coverage will depend on different factors like the provider you choose, your specific plan, and whether or not the treatment center is in your insurance network.

How Long Does Highmark BCBS Of Pennsylvania Insurance Cover Alcohol and Drug Rehab programs?

Spending enough time in treatment is crucial to how effective it will be. Everyone has unique needs, but mental health professionals agree that longer treatment times are generally considered the most effective.^{6 Points to remember} The more time you spend working on yourself and thoroughly addressing your addiction and underlying issues promotes full recovery and reduces your chances of relapse.

The amount of time you spend in treatment can affect how much of your treatment is covered under insurance. Because of the different types of policies and tiers of coverage, your length of time in treatment covered by Highmark Blue Cross Blue Shield of Pennsylvania will vary. If you’re wondering exactly what’s covered under your insurance plan, you can call the number on the back of your insurance card for more information.

What if my BCBS Of Pennsylvania policy does not cover an Inpatient drug rehab program?

Don’t be discouraged if the inpatient drug rehab program you’re interested in isn’t covered under your insurance. Depending on what program you choose, financing or scholarship options might be available that will cover some or all of the costs. Many federal, state, and local governments and organizations provide access to financing options. These include:

• The Affordable Care Act (ACA): People with low or no income who are seeking treatment can receive subsidies from the ACA, which cover different addiction treatment options.^{7 Affordable Care Act}
• State-funded rehabs and local assistance: Many state and local organizations fund medical detox and addiction treatment programs. Some local organizations offer full or partial scholarships where some or all of the costs for treatment will be covered.
• Government-funded programs: Block grants offered by the Substance Abuse and Mental Health Services Administration (SAMHSA) assist people with finding addiction treatment. These grants serve high-risk and at-risk populations, such as mothers or expecting mothers, IV drug users, and those struggling with addiction.^{8 What is a Block Grant?}
• S. Department of Veterans Affairs (VA): Veterans suffering from substance use disorder can receive financial aid from the VA.^{9 How do I access VA services for substance use problems?}
• Loans and financing: Banks can offer loans to assist you with financing your recovery journey.

Several options for treatment are available. Getting the appropriate treatment as soon as possible is most important and shouldn’t be pushed off for another day.

BCBS Of Pennsylvania In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

When deciding on a drug rehab program, be sure to check whether the provider is in your network. Choosing an in-network provider will ensure that at least some of your treatment will be covered. You may still have to pay some out-of-pocket costs like deductibles and co-pays. If you choose a program that is out of your network, you’ll likely have to pay all costs on your own.

Highmark BCBS currently offers the following managed care plans:

• Preferred Provider Organizations (PPOs): A PPO plan doesn’t require members to select a primary care physician (PCP) and allows them to receive care from providers who are out of network. They must cover any costs not covered by Highmark.
• Health Maintenance Organizations (HMOs): This plan requires that members use comprehensive services offered within the network of participating providers.
• Exclusive Provider Organizations (EPOs): Similar to PPOs, members aren’t required to select a PCP, but they must remain in-network.
• Point-of-Service (POS) and Open Access Programs: The POS benefit plan requires members to choose a PCP who will help them secure in-network care and services. Any out-of-pocket costs from out-of-network providers are covered by the member.
• Highmark and the Affordable Care Act (ACA): The ACA also offers Highmark BCBS insurance, providing comprehensive health coverage for those who don’t have insurance from their employer.

To find out whether a treatment provider is in your network, you can search online or contact your insurance provider for specific details on your plan. You can also get more information from AAC by contacting us online or speaking directly with a representative on the phone. If you’re ready to start your journey to recovery, we’re here to help.