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Using Highmark for Drug Rehab: How Will It Work?

Highmark insurance offers coverage for drug rehab. Thanks to parity laws, substance abuse treatment must be covered at the same level as other medical services.

Highmark 

Highmark is an insurance provider. They usually provide bronze, silver, and gold plans, but catastrophic coverage is available in some areas.

Highmark offers a variety of plans available in the following states:

  • Delaware
  • Pennsylvania
  • West Virginia

They serve over 4.5 million customers in these states.

Highmark maintains an A+ rating from the Better Business Bureau, marking it trustworthy by their metrics, despite complaints from some policyholders. Such complaints are common in the insurance industry.

Will Substance Abuse Treatment Be Covered?

If you are being treated for addiction, your substance abuse treatment will generally be covered like any other medical procedure. Addiction is a medical disorder, and per the Affordable Care Act (ACA), substance abuse treatment must be included in a similar way as to how other medical conditions are covered. 

This means that your addiction treatment must be covered by your insurance plan to some degree. The extent of that coverage varies greatly between plans. Similarly, the extent of your coverage for other types of medical care varies greatly, depending on the specific plan you hold.

Levels of Coverage

Individual characteristics, such as age and location, impact the plans available to you and their costs. Depending on your plan, options like copays and the cost of regular doctors’ visits and deductibles can be radically different. 

This said the federal government has a categorization system for health insurance plans based on precious metals.

The following plans are available:

  • Bronze plans cover 60 percent of approved health care costs.
  • Silver plans cover 70 percent of approved health care costs.
  • Gold plans cover 80 percent of approved health care costs.
  • Platinum plans cover 90 percent of approved health care costs.
  • Catastrophic plans have the worst level of coverage, but they also tend to be the cheapest, assuming nothing goes wrong. While better than no plan, you should try to avoid catastrophic plans since they offer only bare-bones coverage.

Monthly Costs

The average cost of a Highmark health insurance plan will vary greatly, depending on the tier level of the plan. Bronze plans offer the lowest monthly premiums (other than catastrophic plans), and they require the highest out-of-pocket costs in terms of the co-insurance amount that must be paid until the deductible is met. Platinum plans feature the highest monthly premiums and the best level of coverage.

A comparison of Highmark’s Blue Cross Blue Shield plans paints a picture of plans about on par with those expected elsewhere. To determine the best plan for you, speak with a customer service representative from Highmark.

Covered Services

covered services

In terms of rehab, certain services will usually be covered. These services may need to be deemed “medically necessary” by a primary care provider (PCP) or other doctors before they will be covered by insurance.

Generally, medical detox services, behavioral therapy, and necessary prescription medications will be covered. Alternative therapies that do not have sufficient research support will not be included. Luxury amenities, such as massage therapy or spa services, are not covered.

Before enrolling in a particular drug rehab program, confirm that they accept Highmark insurance. Then, work with a representative from the program to determine your exact level of coverage. Outline all the specifics, so you are fully aware of the amount you may be required to pay out of pocket.

Paying for What Insurance Doesn’t Cover

Even with insurance, you may still end up with a hefty rehab bill, depending on the extent of your coverage. Many rehab facilities offer payment plans to help you manage the bill that isn’t covered by insurance.

Ready to get Help?

Talk to a treatment expert

Talk to prospective drug rehab representatives about their payment options and how they can make these bills manageable for you. Most often, they will be willing to work with you to make treatment possible. You may be able to finance the cost of your care and pay that bill off on a monthly basis once you have a firm footing in recovery.

Sources

(2017) Understanding Mental Health Parity: Aetna Behavioral Health. Aetna. Retrieved March 2019 from http://www.aetna.com/individuals-families-health-insurance/document-library/understanding-mental-health-parity.pdf

Glossary of Health Coverage and Medical Terms. Centers for Medicare and Medicaid Services (CMS). Retrieved March 2019 from https://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf

(May 2013) Aetna Becomes Third Insurer to Submit Rates for State Health Exchange. Hartford Courant. Retrieved March 2019 from https://www.courant.com/business/hc-xpm-2013-05-31-hc-aetna-rates-exchange-20130531-story.html

When Silver Costs More Than Gold: How Trump’s Actions Have Scrambled Insurance Prices. The New York Times. Retrieved March 2019 from https://www.nytimes.com/2017/10/27/upshot/when-silver-costs-more-than-gold-how-trumps-actions-have-scrambled-insurance-prices.html

Health Care 101. Highmark. Retrieved March 2019 from https://discoverhighmark.com/individuals-families/member-benefits/health-care-101

Coverage Details. Highmark. Retrieved March 2019 from https://www.highmarkbcbs.com/sbc/bcbs.html

Highmark Blue Cross Blue Shield. Better Business Bureau (BBB). Retrieved March 2019 from https://www.bbb.org/us/pa/pittsburgh/profile/health-insurance/highmark-blue-cross-blue-shield-0141-4880

Region Selector. Highmark. Retrieved March 2019 from https://www.highmarkbcbs.com/chmptl/chm/jsp/regionSelector.do

BCBS® Companies and Licensees. Blue Cross Blue Shield Association. Retrieved March 2019 from https://www.bcbs.com/bcbs-companies-and-licensees

Pennsylvania Highmark Blue Cross Blue Shield Plans – Compare Rates. Affordable Pennsylvania Individual Health Insurance. Retrieved March 2019 from https://www.pahealthinsurancecoverage.com/latest-news/pennsylvania-highmark-blue-cross-blue-shield-plans-compare-rates-a27.html

Delaware Health Insurance Marketplace: History and News of the State’s Exchange. healthinsurance.org. Retrieved March 2019 from https://www.healthinsurance.org/delaware-state-health-insurance-exchange/

Overview of Ratings. Better Business Bureau (BBB). Retrieved March 2019 from https://www.bbb.org/overview-of-bbb-ratings

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