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Highmark BCBS Insurance Coverage for Opioid Abuse and Opioid Addiction

On this page, you will learn about BCBS of Pennsylvania (Highmark) insurance coverage for Opioid abuse treatment and how to confirm what benefits are available under your specific plan.
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BCBS of Pennsylvania (Highmark) INSURANCE FOR Opioid Abuse and ADDICTION TREATMENT

Provider Overview

Does BCBS of Pennsylvania (Highmark) Cover Opioid Rehab?

BlueCross BlueShield of Pennsylvania is a  leader in providing quality health care coverage to residents of the state, with a wide range of health insurance plans, including individual and family plans, as well as group plans for businesses and organizations. But does BCBS of Pennsylvania (Highmark) cover drug rehab as well?1

Opioid addiction is a major health crisis across the US, and Pennsylvania is no exception. With close to 3,000 deaths annually attributed to opioid overdose, Pennsylvania sits among the states most affected by the opioid epidemic.2

Fortunately, there are numerous treatment options for those looking to help themselves or their loved ones. In addition to private payments, state-funded programs such as Medicare or Medicaid, and sliding scale fees, most private insurance companies such as BCBS of Pennsylvania (Highmark) healthcare plans cover opioid treatment, fully or to some extent, according to the affordable care act. Read on to learn more about what that coverage entails and how you can use it for opioid treatment.3

What is Highmark BCBS?

Highmark BCBS of Pennsylvania is a not-for-profit insurance coverage company headquartered in Pittsburgh, Pennsylvania. The company was founded in 1994 and provides health insurance products to over 6 million members in Pennsylvania, Delaware, and West Virginia.1

Highmark BCBS of Pennsylvania offers a variety of health insurance products, including individual and family plans, small business plans, and Medicare and Medicaid plans. The company also offers a variety of other insurance products, including dental, vision, and life insurance.1

What Services Are Included in BCBS of Pennsylvania (Highmark) Addiction Treatment Plans?

Treatment for opioid addiction can be expensive, and many people are not aware of what services are covered by their insurance. Highmark is one of the largest providers of health insurance in Pennsylvania, and they cover all levels of care from detox to outpatient services. They also cover behavioral therapies and treatment for co-occurring disorders. This means that if you are struggling with opioid addiction, you will likely be able to find a treatment program that is covered by your insurance.4

Screening and interventions are important tools for preventing and managing opioid addiction. There are a number of screening tools available to help identify people who may be at risk for opioid addiction. Brief interventions for opioid addiction can be conducted in a variety of settings, but usually at a substance abuse treatment facility in the presence of a licensed interventionist.5

Detox is a critical step in overcoming opioid addiction. It is the process of removing all traces of the drug from your system. This can be difficult, especially if someone is addicted to opioids. Detox can be dangerous and uncomfortable if it isn’t monitored by professionals, which is why it’s best conducted at a specialized facility.4

Inpatient and outpatient treatment for opioid addiction can vary in intensity and approach but typically centers around similar goals: to help the individual overcome their addiction and maintain sobriety. 4,5

Inpatient treatment generally involves living at a rehabilitation center for a period of time, typically ranging from several weeks to several months. This allows patients to focus exclusively on their recovery, and receive around-the-clock care and support from medical and mental health professionals.4,5

On the other hand, outpatient treatment allows patients to live at home while attending regular therapy sessions and Addiction Treatment classes. This can be a more flexible option for those with work or family obligations, but still requires a significant amount of dedication and commitment.4,5

Behavioral therapies are often used in opioid treatment to help people with addiction. Behavioral therapies can help people learn how to control their behavior, resist cravings, and stay away from drugs. There are many different types of behavioral therapies, and each one may be a little different. But most of them involve counseling or therapy sessions, where a person can learn new skills and strategies to manage their addiction.5

Co-occurring disorders are common for more than half of the people with a SUD. Following the initial assessment during the intake process, a medical professional will determine whether the patient has a dual diagnosis and will adjust the treatment plan accordingly. When it comes to treating co-occurring disorders, integrated care is key. This means that different areas of expertise are brought together to treat the whole person and ensure that treatment for one factor doesn’t interfere with the treatment of others.4,5

What Services Are not Included in the Coverage?

There are many non-medical and non-essential amenities and services that are available to those receiving opioid treatment that BCBS PA Opioid insurance does not cover. These can include holistic care services (acupuncture, yoga), recreation programs (art and music therapy), food delivery, private treatment services (expedited or same-day admission into treatment), and alternative therapies (reiki, holistic treatment). While these services may be beneficial for those in treatment, they are not typically covered by insurance plans.3

What Determines the Cost of Opioid Treatment?

The cost of opioid rehab can vary depending on the type and intensity of services offered and the duration of treatment. Amenities such as private rooms and luxury accommodations can also affect the overall cost.3

In general, outpatient programs tend to be less expensive than inpatient or residential programs. However, the costs can still range widely, from a few hundred dollars per month to several thousand.5

Some opioid rehab programs may be covered by insurance, but depending on the insurer and the specific program, this will vary. Many programs also offer financing options to help make treatment more affordable.3

What Are the Costs of Inpatient Opioid Rehab?

A few factors can affect the cost of inpatient opioid rehab. The first is the location of the rehabilitation center. Facilities in major metropolitan areas often charge more than those in rural areas. The second factor is the type of program. A luxury rehab center with additional services such as a spa or gym access will be more expensive than a standard program. Finally, the length of stay in rehab can also affect the cost.5

Therefore, the average cost of inpatient opioid rehab can vary significantly depending on the factors mentioned above. Depending on their plan, members of BCBS PA Opioid insurance can expect part or all of their costs to be covered. Others may need to finance the entire amount themselves. There are also a number of state-funded programs available to help offset the costs of treatment.5

What Are the Costs of Inpatient Opioid Rehab?

There are many factors that determine the costs of outpatient opioid rehab, but prices generally vary from one treatment center to another. The frequency and intensity of treatment are the most important factors, followed by the duration of the outpatient rehab program.5

While patients don’t have to cover the costs of residing at the treatment facility if it’s in-network with BCBS of Pennsylvania, they are still expected to pay for transportation privately. However, since outpatient programs allow patients to continue working while receiving treatment, they may be able to offset some of those costs. In addition, most insurance companies cover the treatments offered during outpatient rehab.4,5

What Are the Costs of Opioid Partial Hospitalization Programs (PHP)?

The cost of an opioid partial hospitalization program (PHP) can vary depending on the type and location of the program, as well as if it is private pay or insurance. The structure of an opioid partial hospitalization program (PHP) can vary depending on the program, but most include group and individual therapy sessions, as well as medication management services if necessary. PHP programs typically last 4-6 hours per day, 3-5 days per week.6

The length of time someone spends in an opioid partial hospitalization program (PHP) can vary depending on the severity of their addiction, but most programs last 30-90 days. After completing a PHP program, patients may transition to an outpatient treatment program to continue their recovery.6

What Are the Costs of Medication-Assisted Treatment?

The costs of medication-assisted treatment (MAT) can vary depending on a number of factors. For example, methadone treatment costs an average of $126.00 per week or $6,552.00 annually. Buprenorphine treatment costs nearly $6,000 per year, while Naltrexone may cost close to $5,600, including medication and integrated psychosocial and medical support services. It is important to note that these costs may vary depending on the specific treatment program and individual circumstances.7

The Costs of Treatment Compared to Addiction Costs

The costs of treatment for opioid addiction can vary depending on the type of treatment you need. Inpatient treatment, for example, can be more expensive than outpatient treatment. However, when you compare the costs of treatment to the costs of opioid addiction, treatment is usually much less expensive.8

According to the National Institute on Drug Abuse (NIDA), the average annual cost of treatment for opioid addiction is $1,500.8

When you compare the costs of treatment to the costs of opioid addiction, it is clear that treatment is much less expensive. The cost of treatment is not the only factor to consider when deciding whether or not to seek treatment. The costs of not seeking treatment can be even higher. Opioid addiction can lead to job loss, financial problems, legal problems, and health problems. In addition, by choosing a BCBS of Pennsylvania (Highmark) substance abuse treatment facility as a member, your expenses will be covered at least partially.8

According to NIDA, the cost of opioid addiction is $11,000 per year. This includes the cost of medical care, lost productivity, prosecution, and criminal activity related to opioid addiction. To put this into perspective, opioid addiction cost the US close to $78 billion in 2013, and only $2.8 was allocated for treatment.9

How Long Does Insurance-Funded Opioid Treatment Last?

Most insurance-funded opioid treatment programs will last between 30 and 90 days. However, some programs may be shorter or longer, depending on the individual patient’s needs. It is important to work closely with your treatment team to ensure that you are getting the care you need for as long as you need it.5

Your insurance company will have information about your specific plan and how long your opioid treatment program will last. Be sure to talk to the BCBS of Pennsylvania (Highmark) helpline if you have any questions about your rehab coverage or benefits by calling the number on the back of your insurance card. It is important to understand your insurance coverage so that you can make the most of your treatment program.5

Choosing Between Inpatient and Outpatient Treatment for Opioid Abuse

Inpatient rehab for opioid abuse involves a stay at a rehabilitation center, usually for a period of at least 30 and up to 90 days. This type of rehab offers around-the-clock care and support from medical professionals and addiction counselors.5

Outpatient rehab for opioid abuse does not require a stay at a rehabilitation center. Rather, patients attend treatment sessions at an outpatient facility while continuing to live at home. This type of rehab is typically less intensive than inpatient rehab, but can be effective for some people.5

Both inpatient and outpatient BCBS of PA-covered opioid rehab can include a variety of treatment methods, such as behavioral therapy, medication-assisted treatment, and peer support groups. Treatment is typically tailored to each individual, based on factors such as the severity of their addiction and any underlying mental health disorders.5

Inpatient rehab for opioid abuse is often seen as more intensive and thus more effective than outpatient rehab. Patients in inpatient rehab receive around-the-clock care and support, while those in outpatient rehab typically only attend treatment sessions. This difference can be crucial for people with a severe addiction or any underlying mental health disorders. While it is typically more expensive, BCBS of Pennsylvania (Highmark) rehab coverage can cover a part of your cost.5

Where and How Can I Find BCBS of Pennsylvania (Highmark) Addiction Treatment Centers?

If you are seeking addiction treatment and have BCBS of Pennsylvania (Highmark) rehab coverage, American Addiction Centers can help verify your insurance. Making the decision to seek treatment for addiction is difficult, and their admissions navigators will do everything they can to make the process as easy as possible for you. Their team of experts will work with your insurance company on your behalf to help verify and understand your coverage, all during a single phone call.

There are a number of ways to find BCBS of Pennsylvania (Highmark) addiction treatment centers. One way is to search the internet for “BCBS of Pennsylvania (Highmark) inpatient drug rehab nationwide.” This will provide you with a list of facilities that accept this type of insurance. Another way to find a facility is to contact a local treatment center such as the prestigious Sunrise House Treatment Center in New Jersey and directly check with them whether they accept BCBS of Pennsylvania (Highmark) healthcare plans.

How to Read Your Insurance Provider Card
  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
Local BCBS Rehab Coverage Guide
  1. Highmark. Our Business.
  2. National Center for Drug Abuse Statistics. Opioid Epidemic: Addiction Statistics.
  3. (2019) Paying for Treatment
  4. (2019) Treatment Options.
  5. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition.
  6. National Association of Addiction Treatment Providers. Levels of Care.
  7. National Institute on Drug Abuse (2021) How Much Does Opioid Treatment Cost?
  8. Office of National Drug Control Policy. (2012). Cost Benefits of Investing Early in Substance Abuse Treatment.
  9. National Institute on Drug Abuse (2021) Medications to Treat Opioid Use Disorder Research Report.

Check Your Policy Coverage

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Frequently asked questions

What to Expect at a BCBS of Pennsylvania (Highmark) Substance Abuse Treatment Facility?
When you arrive at the treatment facility, you will likely be greeted by a staff member who will ask you to complete some paperwork. Once you are finished with the intake process, you will meet with your assigned counselor. During this meeting, your counselor will discuss your history and addiction and develop a treatment plan specifically for you.5 Your treatment plan may include individual therapy, group therapy, and/or FDA-approved medication for opioid use treatment. You will likely meet with your counselor several times a week at first, and then less often as you progress in treatment.5 Treatment usually lasts between 30 and 90 days, but some people may stay in treatment for longer periods of time. After you have completed treatment, you will likely be encouraged to participate in aftercare programs such as 12-step meetings, sober living houses or continue with outpatient or MAT. These programs can help you stay on track with your recovery.5
How Long Does Treatment Last Under BCBS of Pennsylvania (Highmark) Rehab Coverage?
Unfortunately, insurance coverage for addiction treatment varies greatly from policy to policy. Typically, insurance will cover a certain length of treatment, such as 30 or 60 days, but may not cover additional days if needed. It is important to speak with an insurance representative to better understand what is covered under your specific policy.3 In order to ensure that your addiction treatment is covered by insurance, it is important to choose an in-network treatment facility. An in-network facility will have a contract with your insurance company, which means that most if not all of the treatment costs will be covered. In contrast, using BCBS of Pennsylvania (Highmark) out of network coverage could result in you having to pay a higher sum upfront.3 It is also important to check with your chosen treatment facility to see if they accept your insurance. While most in-network facilities will accept a variety of insurance plans, some may only accept certain types of insurance, such as Medicare or Medicaid.3
Does BCBS of Pennsylvania (Highmark) Addiction Treatment Cover Executive Rehab Centers?
Under the Affordable Care Act, insurance companies are required to cover the costs of treatments that are evidence-based and medically necessary. Therefore, additional services and amenities offered at an executive treatment facility may not be covered by your BCBS of PA (Highmark) insurance. However, it is important to check with your insurance company about what your coverage entails.3 Executive addiction treatment centers provide programming and services specifically designed for executives, business owners, and high-functioning individuals with addiction issues with complete confidentiality. These centers understand the unique challenges that executives face and offer a tailored approach to treatment. Executive addiction treatment centers offer a range of services, including individual and group therapy, 12-step meetings, psychiatric care, and medication management.5
Are Luxury Rehab Centers Included in the BCBS of Pennsylvania (Highmark) Substance Abuse Coverage?
The services and amenities offered at luxury treatment centers such as private rooms, fine dining, exclusive couples rehab programs, access to a gym, spa, or other premium amenities are likely not covered by BCBS of Pennsylvania (Highmark) insurance coverage. However, insurance may help cover the medical portion of the substance abuse treatment. You should check with your insurance company or the treatment center whether your insurance will cover your stay and what aspect of treatment is covered.2 Luxury addiction treatment centers are those that offer the highest level of care and treatment. This can make a huge difference in the lives of those who receive it. These centers provide a premium service at exclusive locations, with amenities that set them apart from other treatment centers. They offer a unique and individualized approach to addiction treatment, which can be very beneficial for those who are struggling with addiction.5

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