Does Harvard Pilgrim Health Care cover Alcohol and Drug rehab centers?

Are you struggling with substance use and looking to break free? If so, you already know that a treatment program is the best way to achieve long-term recovery. But how do you pay for rehab?

If you have Harvard Pilgrim insurance, you can use your health coverage to pay for some or all of the cost of treatment. The Affordable Care Act (ACA) is a law that, among other things, requires all long-term health insurance plans to cover 10 essential health benefits.^{1, bulleted list} These benefits include mental health and substance use treatment.^{1, fifth bullet}

Every Harvard Pilgrim health plan is different, and it’s important to understand the details before you commit to a treatment program. You can call Harvard Pilgrim directly, or you can contact American Addiction Centers (AAC) through online chat, by phone, or by filling out the form below. Our admissions navigators can review your insurance in just a few minutes while chatting with you and answer any questions you have about rehab.

What is Harvard Pilgrim Health Care?

Harvard Pilgrim is a family of companies that offers a range of health solutions, from employer plans to programs that help manage chronic diseases.^{2, Our family of…} The company is a non-profit.^{2, leadership}

You can get individual and family plans, along with Medicare Advantage plans, from Harvard Pilgrim Health Care.^{3, Individual; Medicare} The plans are available in Maine, Massachusetts, and New Hampshire.^{3, individual and family}

What does Harvard Pilgrim Health Care Insurance cover in addiction treatment?

No treatment program works well for every single person, so it’s important to work with your doctor to create a specific approach that meets your needs. Your doctor will ask about what substances you use and how often, your home environment, and more. It’s vital to be honest, so you get the care you need.

There are several types of substance use treatment, and the most common include:^{4, 5}

• Inpatient rehab. Inpatient rehab centers offer a safe, structured environment where patients can begin the process of recovery. Patients receive around-the-clock care and can focus on their treatment without any distractions. Treatment includes individual and group counseling, educational programs, and medication management (if required)
• Outpatient rehab. Outpatient sessions focus on drug abuse education, individual and group counseling, and teaching participants how to manage life’s stresses without substance use. Outpatient care is a few hours a week of therapy, counseling, or activities, which allows you to continue working or attending school during your treatment.
• Intensive outpatient programs (IOP). Intensive outpatient treatment, or IOP, is a type of care that is more focused than normal outpatient care. IOPs are structured programs that follow a schedule and routine, but you live at home outside of treatment. IOP programs offer courses to address the issues that cause addiction and might cover trauma, emotional regulation, self-discovery, and more.
• Partial hospitalization programs (PHP). PHPs bridge the gap between residential and outpatient treatment, offering patients a high level of care while they still live at home on evenings and weekends. PHPs offer a similar treatment intensity and daily structure to that of inpatient/residential programs but are less restrictive and may be more affordable.

No matter what treatment approaches your recovery process includes, what’s most important is that you follow through completely. It’s common to want to stop when you feel better but to achieve long-term recovery, you’ll need to practice your new habits in a safe environment for as long as possible.

Does Harvard Pilgrim Health Care Cover Mental Health Facility & Co-Occurring Disorder Treatment?

Do you struggle with your mental health as well as substance use? If so, you’re not alone. Research shows that around 50% of those who battle substance use also have a mental health diagnosis, which is known as a co-occurring condition.^{6, second paragraph} Some common mental health concerns that co-occur with substance use include attention-deficit hyperactivity disorder (ADHD), anxiety, depression, bipolar disorder, post-traumatic stress disorder (PTSD), and others.^{6, second paragraph}

What’s most important if you have a co-occurring disorder is to get treatment for both substance use and mental health at the same time. Studies show that this type of integrated treatment has far better outcomes than treating only one or the other.^{7, first paragraph}

Will your Harvard Pilgrim Health Care coverage cover your mental health treatment as well as rehab? It will, because the ACA includes mental health care in the list of 10 essential health benefits.^{1, fifth bullet} That means you can use your Harvard Pilgrim Health Care mental health coverage to get the care you need.

How Long Does Harvard Pilgrim Health Care Cover Inpatient Alcohol and Drug Rehab programs?

How long will treatment last? We hear this question often, but the answer is different for everyone. However, research shows that it takes most people at least 90 days to make a significant change in their substance use, including stopping.^{8, fifth point} That’s why many rehab programs are 3 months long. However, your specific treatment process may be longer and might include multiple treatment options in a row, such as an inpatient program followed by outpatient care. It’s important to follow your treatment process through to the end so you have the best chance of recovery.

Different Harvard Pilgrim plans may have different requirements and limits on how long they’ll pay for rehab, however, and it’s important to know the details. To find out, you can call the insurance company directly or connect with AAC anytime 24/7. Simply reach out by online chat, phone, or by filling out the form below. We’re here to help you understand how to use your insurance to get the care you need.

What if my Harvard Pilgrim Health Care policy does not cover an Inpatient drug rehab program?

As you look at your treatment options, you might find that your insurance covers only part of the cost of rehab, and you are responsible for the rest. Or, you might find a treatment center you’re interested in and then find out it’s not part of your Harvard Pilgrim Health Care rehab coverage, so you have to pay the full cost. Don’t let the financial arrangements stop you from breaking free from substance use. There are many ways to pay for rehab, and your insurance is only part of the answer.

For example, your treatment program might offer scholarships or payment plans for your portion of the cost. Or, you might be able to borrow money from friends and family to pay for treatment.

What’s most important is that you get the treatment you need right away. There’s no perfect time to attend rehab, and there are significant long-term legal and health consequences to substance use. It’s important to break free now, before it’s too late.

Harvard Pilgrim Health Care In Network vs. Out of Network Inpatient Rehab Centers

When you’re looking at different treatment programs, you’ll notice that some of them are “in-network” with Harvard behavioral health coverage, and others are “out-of-network.” What does that mean? Insurance plans all have a group of facilities, hospitals, and doctors that agree to treat plan members at a lower cost.^{9, p. 1 What’s a Provider Network} This group is known as the plan’s network.^{9, p. 1 What’s a Provider Network}

If you use a doctor or program that’s part of the network, you’ll pay less money yourself and get maximum benefits from your insurance plan.^{9, p. 2, Why do some plans…} However, most insurance plans don’t offer coverage outside the network, so you may have to pay the full cost yourself.^{9, p. 2, Why do some plans…} To maximize your insurance coverage, try to find a treatment program at one of the in-network Harvard Pilgrim Health Care rehab facilities. However, if that’s not possible, don’t panic—as we mentioned above, there are multiple ways to pay for rehab.

How to find Harvard Pilgrim Health Care Coverage for Inpatient Drug Rehab Centers in New England?

To find a treatment center that accepts your insurance, you’ll need details about your insurance plan. Fortunately, you can get that easily by contacting AAC anytime. Our admissions navigators can verify your insurance in just a few minutes while they chat with you. We’re also available to answer any questions you may have about treatment.

You deserve a life free of substance use so you can pursue your dreams and create a life you love. To take the first steps, contact us today!