Guide to Highmark Insurance Coverage for Drug and Alcohol Treatment

Last Edited: December 29, 2023
Author
Bianka Fisk
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Clinically Reviewed
Andrew Lancaster, LPC, MAC
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All of the information on this page has been reviewed and certified by an addiction professional.

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It is very important to acknowledge the seriousness of drug and alcohol abuse and addiction. In fact, substance abuse disorders affect all aspects of society. Thankfully, this has been recognized by the government and by medical insurance companies, including Highmark. They have adapted their plans so that their members can get help towards the cost of both detox and rehabilitation and help get their life back on track when they have a substance addiction.

Highmark Insurance Coverage for Alcohol and Drug Detox

Getting clean from drugs and alcohol starts with a period of medically assisted detox, keeping you monitored and safe at all times. Physicians will help you to manage the symptoms, while also helping to prevent relapse. Withdrawal symptoms can be very hard to manage on your own, and this can last for days or weeks, depending on which substance you abuse. This is why it is now recognized that using medication is vital to helping people get through this period.

Most Highmark insurance plans cover detox services as a standard provision. Exactly what they will cover, however, will depend on your plan. Some, for instance, will cover 100 percent of the costs, while others only provide co-insurance, where you are responsible for the payment of a percentage of the cost. It is important, therefore, that you know what is your co-insurance percentage.

Furthermore, a copay is also often required on Highmark insurance plans. This means that there is a specific amount of money that you have to pay yourself, before the insurance policy will cover the rest. Knowing your deductible or copay, therefore, is equally important.

Highmark Insurance Coverage for Alcohol and Drug Rehab

Typically, you can expect at least some level of coverage for a rehab program if you have Highmark insurance. This is because addiction is now recognized as being an illness. However, just as with detox services, exactly what will be covered and how much will depend on your individual plan, as well as on your individual situation. For instance, you may have a co-occurring mental illness that contributed to your addiction, which will then have to be treated as well.

Highmark covers a good range of rehab programs, for both outpatient and inpatient facilities. It is very important that you look into your personal Summary of Benefits so that you know what your plan covers. Alternatively, you can speak directly to a Highmark representative and find out the coverage that you have in place.

Types of Highmark Insurance Plans

Powered by BCBS, Highmark Insurance can go by several other names;

  • Highmark Blue Cross Blue Shield Delaware
  • Highmark Blue Shield
  • Highmark Blue Cross Blue Shield
  • Highmark Blue Cross Blue Shield West Virginia

How Long Will Highmark Cover Your Alcohol and Drug Rehab Treatment?

The length of time that Highmark will cover you will also vary. Commonly, inpatient treatment programs last between 28 and 30 days, but they can be much longer as well. In fact, some last as long as a year. Typically, you can choose how long you want to be treated, but Highmark will require a demonstration of needs, preferably through documentation from your physician.

The Substance Abuse and Mental Health element of your policy covers both inpatient and outpatient rehab. Your specific coverage, however, will vary depending on your plan, on your out of pocket limit, and on your deductible, which is calculated yearly. If you want to stay in rehab for longer than 30 days, there may be some limitations on your coverage as well.

Highmark Insurance Coverage for Specialty Alcohol and Drug Rehab

Some people prefer to go to specialized treatment facilities, which have more luxurious amenities, such as spa treatments, massages, acupuncture, aromatherapy, private rooms, and gourmet meals. However, it would be rare for Highmark to cover you for those elements as they are not considered to be medically essential. Nevertheless, it may be possible that they will pay for the medically necessary elements of the treatment, and that you pay the rest out of your own pocket.

Highmark Insurance Coverage for Inpatient and Outpatient Treatment

As stated, Highmark will cover you for both inpatient and outpatient treatment. If you opt for inpatient treatment, you will live in a facility, cut off completely from the outside world, monitored 24/7 by medical staff. You will also have to abide by a very strict schedule. With outpatient treatment, you will visit the facility at regular times, but return to your own home at the end of the day. While this is much more convenient, as well as less expensive, there is a significantly higher chance of relapse and it is not recommended for people who have more than a mild addiction.

Choosing Between Inpatient and Outpatient Treatment

It is very important that you consider carefully which type of treatment is right for you. Many will grasp on to the convenience of outpatient treatment, believing themselves to be strong enough to suddenly resist the temptations of the environment, triggers, and enablers that they were exposed to before seeking treatment. It is easy to see, in other words, why most people relapse with outpatient treatment. Depending on your personal situation and addiction, it is far more likely that you require intensive professional monitoring until you truly are strong enough to return to the real world.

The vast majority of the Highmark insurance plans offer an 80% co-insurance for inpatient rehab. This means it is a reasonably affordable option. Additionally, they have other plans, some of which even cover up to 100% of your treatment. Not just that, they may even cover you for a stay in an out of state program, albeit not all of it. If the provider is out of network, it is typical for Highmark to still pay half of the co-insurance.

When You Have Out of Pocket Expenses

It is likely that you will have at least some out of pocket expenses if you want to go to rehab and have Highmark insurance. Luckily, there are always options out there for you. For instance, many banks and credit card companies now offer specific treatment loans. Rehab facilities, meanwhile, tend to offer payment plans on a sliding scale, based on your income. You could sell some of your belongings, or even ask your loved ones to borrow you money for your treatment. Either way, you must find a way to pay for treatment if you are to live a happy and healthy life.