Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Its predecessor organizations, Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield, prioritized care for at-risk populations and ran local programs that were forerunners for national programs like the Children’s Health Insurance Program (CHIP) and Medicare. Highmark, which is based in Pittsburgh, now covers over 6 million Americans. Click here to see a directory of rehabs covered by Highmark, and read on to find a brief description of the care offered by the insurance provider and some avenues to get more information about the specifics of any particular plan.
What Kind Of Care Does Highmark Offer?
- Preferred Provider Organizations (PPOs)
- Exclusive Provider Organizations (EPOs)
- Point Of Service (POS) And Open Access Programs
- Health Maintenance Organizations (HMOs)
- Independent Practice Associations (IPAs)
What Plans Does Highmark Offer Under The ACA?
By law, health care plans offered on the Affordable Care Act’s (ACA) Health Insurance Marketplace are mandated to provide coverage for mental and behavioral health treatment, including inpatient services, along with substance abuse treatment. To check your coverage options in relation to substance abuse treatment, click here to contact a treatment provider. Within the requirements of the ACA, Highmark insurance plans are broken down into the 4 categories listed below.
- Gold. Gold plans are for those who would rather pay more money in premiums month-to-month but save money when it comes to out-of-pocket expenses.
- Silver. This is a “middle of the road” option, for those looking for a medium level of both monthly premiums and out-of-pocket expenses. Silver is also the only plan eligible for cost-sharing reduction, which could help lessen how much the insured spends in deductibles and copays.
- Bronze. This plan is the opposite of gold and is for those who would rather pay less in monthly premiums but also pay correspondingly more in out-of-pocket expenses.
- Catastrophic. This plan is only for Americans in their 20s and younger, or those who meet specific situational criteria. It’s meant to ease the impact of gargantuan health bills and is normally distinguished by low monthly premiums and very high deductibles.
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Does Highmark Insurance Cover Inpatient Treatment?
Inpatient treatment may include individual and group therapy, medically assisted detoxification, and associated services. Some Highmark insurance plans may very well cover the costs of inpatient treatment. However, it is incumbent on the individual to refer to the specifics of one’s own plan (available on Highmark’s website) to best get a sense of which rehabilitation centers may or may not be covered and what one’s out-of-pocket expenses, if any, may be.
Common Questions About Rehab
Does Highmark Insurance Cover Outpatient Treatment?
Outpatient treatment, which may involve spending time in a treatment center several times or a week or could be done entirely from home, may also be covered under a Highmark insurance plan. It’s impossible to say how much one could be expected to pay for outpatient treatment, however, without knowing the specifics of one’s situation. That’s why a trip to the Highmark website or a phone call to their toll-free number could be the best way to get information on what to expect.
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There are many variables that will determine how much of rehab is covered by insurance. But price should never be an obstacle to recovery. If you’re interested in learning more about treatment options and centers, contact a treatment provider right away.
Will Henken earned a B.A. in Advertising and Public Relations from the University of Central Florida. He has had his work published in the Orlando Sentinel, and has previous experience crafting copy for political action committees and advocacy groups dedicated to social justice. Addiction and mental health are personal subjects for him, and his greatest hope is that he can give a helping hand to those seeking healthy and lasting recovery.
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Reviewed by Certified Addiction Professional:
David embarked on his journey into sobriety in June of 2005, which led him to his current career path as a Certified Professional Addiction Recovery Coach in private practice in Greater Nashville. David is also a public speaker and the author of two books. David is cohost of the weekly Positive Sobriety Podcast, as well as being a frequent contributor to various articles and recovery based materials. As a member of the National Association of Alcohol and Drug Abuse Counselors (NAADAC), David works closely with area treatment centers, recovery orientated nonprofit organizations, as well as being a keynote speaker for various recovery-focused events.
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- Highmark Inc. Our Story. Retrieved August 3, 2021 at https://www.highmark.com/about/our-story.html
- HealthCare.gov. Mental Health & Substance Abuse Coverage. Retrieved August 3, 2021 at https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- Highmark Inc. ACA Health Insurance Basics. Retrieved August 3, 2021 at https://www.discoverhighmark.com/west-virginia/plans/aca-basics.html
- HealthCare.gov. Catastrophic Health Plans. Retrieved August 3, 2021 at https://www.healthcare.gov/choose-a-plan/catastrophic-health-plans/
- Highmark Inc. Highmark Provider Manual. (2018). Retrieved August 3, 2021 at https://content.highmarkprc.com/Files/EducationManuals/ProviderManual/hpm-chapter2-unit1.pdf