Guide to Harvard Pilgrim Health Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author
Patricia Howard, LMFT, CADC
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Clinically Reviewed
Mark Frey, LPCC, LICDC, NCC
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All of the information on this page has been reviewed and certified by an addiction professional.

You Are Not Alone, Harvard Pilgrim Health Insurance Coverage for Addiction Treatment

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

Being in the grips of a drug or alcohol addiction is incredibly difficult. Even harder is coming to the decision that you need treatment in order to beat your addiction. You are faced with yet another problem, which is how you will be able to pay for the treatment. You need to go to rehab in order to get clean and the fact that this will cost money can cause a considerable amount of stress. If you have Harvard Pilgrim health insurance, then there are some provisions in place to help you cover some, or maybe even all, of the associated costs. Finding out exactly what your policy will and will not cover can take quite some time. Insurance providers use the standard Levels of Care used by rehab facilities to structure their policies. This means that the first thing you have to do is understand the various LoC’s that exist.

How Do You Find Out If Harvard Pilgrim Will Cover Your Treatment?

Under the 2010 Affordable Care Act, health insurance companies have to include coverage for substance abuse treatment. Thanks to this, thousands of people will be able to receive the treatment they need to actually save their lives by overcoming their addiction. However, every insurance company has different coverage getting to decide what is classed as a necessary LoC and what is not, and they use their own assessments to determine this.

So how do you know whether or not your Harvard Pilgrim policy will cover you for treatment? One way is to check the paperwork that came with your policy. You can also telephone the insurance company and explain your situation, confidentially, to an agent so they can determine what will and will not be covered.

By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.

An extremely positive development is that drug addiction and alcoholism are now finally seen for what they are: a disease rather than a lifestyle choice. The general public has changed its views on substance abuse, the payment options offered by insurance companies have changed as well. While it is socially acceptable for people to have to pay for alternative treatments like equine therapy or art therapy themselves, it is not for insurance companies to refuse to pay for necessary medical treatment.

Numerous other developments have been taking place in the legislative field, including the Mental Health Parity and Addiction Equity Act. Under this, insurance plans that are employer based have to cover addiction therapy in the same way as they would cover any other essential health benefits. These have been incredibly positive, life-saving decisions, ensuring that having addiction treatment is more affordable than it has ever been. While it is normal that you feel stressed, worried, and anxious about how you will pay for addiction treatment, there are many options out there for you.

Levels of Care in Rehab and Addiction Treatment Facilities

Three broad LoC’s exist:

  1. Inpatient detox: This is the start of your journey towards recovery, as your body rids itself of the toxins and chemicals of your drug of choice. This is a difficult period as you will experience significant withdrawal symptoms. This is something that can be almost impossible, as well as dangerous, to manage without medical supervision. During inpatient detox, your symptoms will be managed by medical staff, which means you are safe at all times. You may also be prescribed certain medications to make you more comfortable. Most importantly, the support will make it less likely that you will give in to temptation and relapse.
  2. Residential or inpatient rehabilitation: Once you have detoxed from your substance, you will have beaten the physical dependency and addiction. However, you will still be psychologically and socially addicted and these aspects have to be addressed. In an inpatient rehab facility, this is achieved by taking you out of the toxic environment in which your addiction was enabled and facilitated. You will be housed in a comfortable environment together with other patients and peers, learning to build habits that will hopefully keep you away from a relapse when you return home.
  3. Intensive outpatient rehabilitation: This is suitable for patients who are stable after their period of detox. In outpatient rehab, you can receive various forms of addiction treatment and therapy, but your home life will remain intact. This means that you can continue to meet your personal responsibilities and some educational and/or professional responsibilities. You do have to attend the rehab center regularly, sometimes every day, in order to receive the treatment and therapy you need to get clean.

Getting the Necessary Coverage with Harvard Pilgrim

Harvard Pilgrim Health Care offers fantastic levels of treatment for people who suffer from addiction. They have both employer-based plans and individual plans, but only for those who live in Connecticut, New Hampshire, Maine, and Massachusetts. Through the insurance company, you can be covered for a range of different behavioral health issues, which include substance abuse.

Harvard Pilgrim tends to want people to pay a higher copayment if they require residential rehab, and a lower one for outpatient rehab, as is common with most other insurance companies. For example, under the Tiered Copayment HMO in Massachusetts, a $10 copayment is required for group therapy on an outpatient basis, and $20 for individual therapy. For every admission into inpatient rehab, however, a $250 copayment is required. Cover is only available for in-network providers. The Tiered Copayment HMO is just one example, and Harvard Pilgrim has many other plans, each with their own payment arrangements. By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.

Insurance Worries Should Not Stop You from Getting Treatment

If you have Harvard Pilgrim Health Care Insurance, it is likely that you will be able to have at least a degree of cover. A rehab center should also be happy to do an insurance check for you. If you don’t have cover, or won’t get full cover, other arrangements can also be made so do not let that be the end of your journey to recovery.