Harvard Pilgrim Insurance Coverage for Drug and Alcohol Rehab Treatment
If you’re struggling with addiction, know that you’re not alone. Often, the path to recovery is not a linear one, and it’s a process that takes time. In many cases, the cost of rehab deters people from getting the care that they need. However, if you have health insurance, your plan should help offset some of the costs associated with treatment.
Harvard Pilgrim plans provide coverage in some capacity for members’ mental and behavioral health treatment, including treatment for substance use disorders. Coverage will vary depending on your plan and where you seek treatment. Fortunately, many American Addiction Centers (AAC) facilities are in-network providers with Harvard Pilgrim. To check whether an AAC facility is in-network with your plan, call the number on the back of your insurance card.
What is Harvard Pilgrim Health Care?
Harvard Pilgrim Insurance is a Massachusetts-based healthcare company that has provided medical coverage for about 50 years.1 Offering a variety of health maintenance organization, preferred provider organization, and point-of-service plans for its 3 million members, Harvard Pilgrim provides its members with a network of quality care providers.
What Does Harvard Pilgrim Health Care Insurance Cover in Addiction Treatment in New England?
The services covered by your Harvard Pilgrim Health Care plan depend on your plan type, location, and facility selected. Your provider will determine what type of treatment you need and how long you should be in treatment to make a full recovery.
Common treatment types include:2
- Harvard Pilgrim For Inpatient/residential treatment, which involves a patient staying at the facility for a few days or weeks (known as inpatient care) or a few months (known as residential care) to receive treatment for their substance use disorder. While in treatment, the patient receives intensive medical care for detox and withdrawal support, as well as medication, other medical care, and therapy.
- Harvard Pilgrim For Outpatient treatment, which typically involves a patient going to a facility once or twice a week to receive care, which is usually a therapy session.
- Harvard Pilgrim For Intensive outpatient programs (IOPs), which are typically for people who need a more structured program than a typical outpatient program. With an IOP, a patient would receive therapy or other outpatient services more than twice a week, but they would return home after those sessions.
- Harvard Pilgrim For Partial hospitalization programs (PHPs), which offer more structure than IOPs but are not as involved as inpatient or residential care. With PHPs, you go to a facility to receive treatment for a few hours a day, a few days a week.
This list is not inclusive of the different types of treatment available for addiction treatment. Your provider will determine what the best course of treatment may be for you, and it may include one of the above types of treatment.
Does Harvard Pilgrim Health Care Cover Mental Health & Co-Occurring Disorder Treatment?
Under the Affordable Care Act (ACA), which is the federal healthcare reform act, all health plans must provide coverage for 10 essential health benefits. One of these 10 benefits that must be covered by your Harvard Pilgrim Health Care plan is mental and behavioral health services.3 Specifically, your plan must provide some level of coverage for substance use disorder treatment, inpatient mental and behavioral healthcare, and behavioral health treatment.3 This mandate enables millions of Americans to get the care they need for their mental health or substance use disorders, which frequently overlap (i.e., co-occurring disorder).
The National Institute of Drug Abuse reports that approximately 7.7 million Americans have co-occurring disorders.4 If you have co-occurring disorders and only address one of the conditions, the other is still likely to affect you, which could cause you to relapse or may inhibit your recovery. Thanks to the ACA mandate, treatment is available for both conditions, setting you up for success in recovery.
How Long Does Harvard Pilgrim Health Care Cover Inpatient Alcohol and Drug Rehab programs?
Different healthcare plans cover different levels of care. Your plan will likely provide different depths of coverage than someone else’s plan. There is no standard length of coverage for inpatient alcohol and drug rehab programs with Harvard Pilgrim Health Care plans. Research suggests that treatment for substance use disorders should last at least 3 months to avoid negative outcomes and increase the chances of success.5
Your plan determines the length of time that your inpatient drug and alcohol rehab will be covered. The only way to verify this is to check your summary of benefits and coverage, which you can do by logging on to your Harvard Pilgrim Health Care portal. You can also call the number on the back of your insurance card to speak to an insurance representative. Alternatively, you can work with a member of the staff at an AAC facility, call the AAC helpline, or use the chat function on the website to verify your benefits and coverage before seeking care.
What if my Harvard Pilgrim Health Care Policy Does Not Cover an Inpatient Drug Rehab Program?
Your health plan may not fully cover the cost of your inpatient drug rehab program. In this case, you will likely be responsible for outstanding costs. But don’t panic. Many credible rehab programs offer payment options to offset the cost of getting treatment.
Some treatment facilities offer payment plans or special financing that you may be eligible for, while others may offer scholarship opportunities. You won’t know what may be available to you unless you ask about payment options.
Remember, getting the care that you need to overcome your addiction is of the utmost importance, and it’s not something that you should put off. Delaying treatment can result in your condition worsening, and potentially could result in lengthier treatment times to overcome your addiction.
Harvard Pilgrim Health Care In-Network vs. Out-of-Network Inpatient Drug Rehab Centers
Determining whether a provider is within your insurer’s network can save you a headache—and a fortune—down the road. In-network providers’ costs are typically covered at a higher rate than out-of-network providers, which can translate to lower costs for you. In-network providers have contractual agreements with your insurance company and often have lower rates. In some cases, your claims may be processed faster because they have a working relationship in place.
While your plan may provide some level of coverage for out-of-network providers, this coverage tends to be at a lower percentage—if it’s covered at all. Many times, seeking care out-of-network results in higher out-of-pocket costs for you.
How to Find Harvard Pilgrim Health Care Coverage for Inpatient Drug Rehab Centers in New England?
Your plan likely provides coverage for inpatient drug treatment centers and other types of treatment facilities in New England. Harvard Pilgrim Health Care representatives can help you find out whether your facility of choice is a covered provider within your plan’s network. You may also be able to log on to your plan’s portal and search for in-network providers.
AAC has a variety of facilities across the country and works with major insurers.
You can call the AAC helpline, your nearest facility, or verify your benefits on a treatment center’s page to find out coverage details.
AAC has 4 locations in the northeastern United States. Learn more about each facility: