Highmark Behavioral Health Treatment Coverage
Highmark behavioral health coverage can help insured members access inpatient and outpatient care, often at more affordable rates. The cost of mental health and substance abuse treatment is one of the key barriers that Americans face when trying to get the support they need for an assortment of behavioral health concerns.
Highmark therapy coverage can be used for a range of behavioral health conditions, including mental health conditions, substance abuse concerns, and dual diagnosis conditions. Your Highmark mental health coverage can include a diverse range of therapies and treatment interventions. This includes cognitive-behavioral therapy, motivational interviewing, and holistic approaches. Continue reading to learn more about whether Highmark covers therapy services near you
What is Highmark Health Insurance?
Highmark Health Insurance is a regional insurer of the Blue Cross Blue Shield Association and operates as a non-profit health insurance provider. Highmark can trace its roots to 1996 through a merger with Pennsylvania Blue Cross plans. As a leading insurance provider, available plans typically include individual, family, and employer-sponsored plans.
Qualifying residents may be able to access publicly funded healthcare coverage such as Medicare and Medicaid. Highmark policies are often customizable, which allows insured members to choose plans based on their affordability and benefits. For example, individuals seeking low-cost options may opt for a Health Maintenance Organization (HMO) plan. Those who would like to have more flexibility when choosing healthcare providers may do so with a Preferred Provider Organization (PPO) plan, though they tend to have higher out-of-pocket costs, like deductibles and premiums.
Highmark Brands, Products, and Insurance Plans
Highmark has an assortment of product options under the Blue Cross Blue Shield brand. This can include HMO, PPO, EPO, and high-deductible plan options. Plan options are determined by an actuary who evaluates the risks and liability of behavioral health conditions and their appropriate treatment options. The underwriting process customizes these plans to your unique needs.
Highmark does cover mental health services under its behavioral health coverage options. This can include a range of rehabilitation programs, allowing members to access comprehensive care. Additional services commonly included in Highmark plans include telehealth services, chronic health management, dental, and vision benefits. Verifying your coverage is highly recommended so that you can make informed decisions about your healthcare providers.
Which States Does Highmark Operate In?
Highmark provides insurance coverage primarily in Pennsylvania, Delaware, New York, and West Virginia. Highmark serves Western and Northeastern areas of New York with BCBSWNY and BSNENY. Insured members can access treatment services nationwide with the use of the BlueCard program.
It is important to note that there may be variations in plan options in different regions. As an example, some areas offer publicly funded programs, like Medicaid, and others do not. If you would like to learn about the details of your Highmark insurance policy, we encourage you to verify your coverage with CheckMyInsurance.co today.
Statistics and Information on Behavioral Health Disorders
An estimated one in five adults experiences a mental illness each year in the United States. Serious mental health conditions affect about one in twenty adults. These serious mental illnesses can cause significant impairment and distress in daily life. Research shows that half of adults begin experiencing symptoms by age 14, and three-quarters show signs by age 24.
The lifetime prevalence of mental health conditions among adults in the United States is 46%, a high percentage of residents. Substance abuse conditions are an example of a behavioral health concern that affects millions of Americans annually. More specifically, over 28 million adults are living with an alcohol use disorder, and one quarter of those who use drugs struggle with drug dependency. While these statistics barely begin to scratch the surface regarding the prevalence of mental health concerns in the United States, it does show that these conditions affect more of us than we may initially realize.
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What Are Behavioral Health Insurance Needs?
Behavioral health insurance includes coverage for behavioral health conditions. This includes mental health illnesses, substance abuse concerns, and dual diagnosis conditions. These conditions are unique to each individual and typically require personalized treatment approaches. Highmark coverage can provide coverage for therapy, support groups, medications, and psychiatric services.
Behavioral health conditions can be the result of several factors, including life experiences, genetics, biological differences, trauma, abuse, and your living environment. Two individuals with the same condition may have different treatment needs due to variations in symptoms, their severity, and their effects. You may work with a range of mental health professionals within a mental health clinic, including therapists, counselors, social workers, psychiatrists, and psychologists. Some treatment facilities offer a range of support services and recovery coaches to promote long-term wellness.
Does Highmark Insurance Cover Behavioral Health Treatment?
Highmark insurance coverage can often apply to an assortment of behavioral health conditions. Approval is typically based on medical necessity, which can help you access the mental health services you need to improve your emotional well-being. Your Highmark coverage can include, but is not limited to:
Highmark Insurance Coverage for Mental Health Treatment
Highmark insurance coverage can include various mental health treatment options. This may include crisis services, inpatient care, and outpatient treatment. Psychiatric care is often available for those who require diagnostic services, testing, and prescription medications. Coverage does vary, and is heavily influenced by your current symptoms and level of functioning.
Highmark Health Insurance Coverage for Substance Use Disorder Treatment
Highmark coverage commonly includes comprehensive care for substance abuse, including polysubstance abuse and dual diagnosis concerns. Detoxification services, inpatient programs, and outpatient care are commonly used treatments in addition to medication-assisted treatment services. Intensive treatment programs may require prior authorization for maximum coverage.
Highmark Insurance Coverage for Detox Programs
Detoxification treatment is generally included in Highmark coverage options for those in active withdrawal. This is especially true for those who have dual diagnosis conditions and medical conditions that could be affected during this stage of recovery. Detox programs are short-term because they are focused on medical interventions and support. You may be responsible for various out-of-pocket expenses.
Highmark Health Insurance Coverage for Medication-Assisted Treatment
Yes, Medication-Assisted Treatment (MAT) is generally included in Highmark coverage options when it is medically necessary. Services are commonly used during detox, and may be continued on a long-term basis for some forms of addiction. MAT services can be used with inpatient and outpatient care for comprehensive treatment. Prescription drug coverage is often needed to fill prescriptions.
Highmark Insurance Coverage for Behavioral Addiction Treatment
Highmark does cover behavioral addictions like gambling and sex addictions. Treatment recommendations for behavioral addictions often differ from those for drug and alcohol addictions. Your coverage depends on your plan details, which are determined during the underwriting process. You may be responsible for premiums and deductibles.
Highmark Insurance Coverage for Eating Disorder Treatment
Highmark insurance coverage can include treatment for eating disorders like anorexia nervosa, bulimia, and restrictive food intake disorder. Treatment recommendations can range from inpatient to outpatient care, depending on the severity of symptoms. Verifying your coverage can help you understand limitations and exclusions for providers outside your insurance network.
Does Highmark Insurance Cover Dual Diagnosis Treatment for Behavioral Health Disorder?
Yes, Highmark does commonly provide coverage for dual diagnosis care. This is an important detail of behavioral health coverage because over 21.5 million adults in the United States are living with a substance use disorder and co-occurring mental health condition. Treatment needs can vary greatly because these are complex and individualized conditions.
Research has indicated that simultaneous treatment for dual diagnosis conditions is the most effective treatment option. Your mental health conditions may affect each other, meaning that your growth would be limited if treatment focused on only one condition. Dual diagnosis care can include additional therapy, support groups, and psychoeducation. Psychiatric care may be necessary in some cases.
Does Highmark Cover Inpatient Behavioral Health Treatment?
Yes, Highmark does cover rehab services in inpatient and residential treatment settings. These programs are used to support those who are unable to manage their symptoms and triggers independently. These programs occur in a live-in treatment facility that offers professional support around the clock.
Inpatient care can be used to treat a range of behavioral health conditions, including alcoholism, drug dependency, eating disorders, mood disorders, PTSD, and more. Your treatment plan will be personalized to your unique needs, ensuring that you receive the support needed to improve your emotional well-being. Your treatment team can help you strengthen your relapse prevention, emotion regulation, and distress tolerance skills before exploring aftercare treatment options.
We encourage you to verify your insurance policy to learn about limitations or exclusions for high-end and out-of-network treatment providers. Insurance providers, like Highmark, commonly have reinsurance to provide themselves with financial support if your treatment costs are higher than expected.
Does Highmark Cover Outpatient Behavioral Health Treatment?
Highmark does cover counseling and other outpatient behavioral health treatment services. Commonly used outpatient treatments include Partial Hospitalization Programming (PHP), Intensive Outpatient Programs (IOPs), and traditional outpatient care. The key differences between these treatment options are in their intensity, frequency, and duration of care.
Outpatient treatment programs can use a range of treatment services to support those experiencing psychological distress. This can include therapy, counseling, family programming, support groups, psychiatric care, and dual diagnosis treatment. Your treatment plan may include programming over a longer period that is modified to reflect the progress you have made in your mental health or sobriety. Your policy may include out-of-pocket expenses like premiums, copayments, and deductibles. Those with an umbrella policy may receive financial support beyond typical Highmark insurance coverages.
Does Highmark Cover Psychiatric Treatment for Behavioral Health Disorders?
Highmark mental health coverage commonly includes coverage for psychiatric services. This can include diagnostic services, therapy services, and medication services. These are commonly used treatment services that can lay the foundation for your treatment plan. As an example, diagnostic services can guide your clinical team in knowing which therapies and interventions are ideal for your symptoms.
Coverage for psychiatric services can vary and is dependent on the details of your insurance policy. You may be required to receive prior authorization or a referral from your primary care physician to initiate the claims process. We encourage you to be mindful of limitations or exclusions for treatment providers because choosing a provider that falls outside the bounds of your policy can increase your out-of-pocket expenses.
Does Highmark Cover Counseling and Therapy for Behavioral Health Disorders?
Yes, Highmark mental health coverage typically provides coverage for counseling and therapy services. While there are differences between counseling and therapy, both can be used to promote emotional health and well-being. Your treatment plan may include a combination of both for whole-person care. You may be responsible for out-of-pocket expenses and need to obtain prior authorization for treatment.
Counseling can occur in group and individual settings and often focuses on helping you develop knowledge and skills that can enhance your recovery. While therapy can also be used in individual and group settings, it tends to address deep-rooted factors that are contributing to your psychological distress. Family therapy is a common approach for mental health and substance abuse concerns. These sessions can focus on rebuilding trust, gaining insight into mental health conditions, improving communication patterns, and nurturing the needs of the family unit as a whole.
How To Get Highmark To Pay For Behavioral Health Treatment
We encourage you to start by verifying your insurance coverage. This can bring your attention to referrals or prior authorizations that you need to obtain before engaging in treatment. Additionally, this allows you to navigate which treatment providers are in-network compared to those outside the Highmark insurance network.
It is important to note that not following the requirements of your Highmark insurance policy can reduce the coverage you receive and may even lead to a denial of your claims. We encourage you to keep a record of authorizations, claim numbers, and approval dates in case you experience any challenges with claim approval down the road.
How To Check Your Highmark Health Insurance Coverage Levels
If you’re ready to learn the details of your Highmark mental health coverage, we encourage you to verify your coverage with CheckMyInsurance.co. Our free and reliable coverage level checker can highlight essential policy details that may affect your coverage. You should use a trusted resource to verify your coverage because the information you receive can shape your next steps.
Try to verify your coverage in the initial stages of your search, before you choose a treatment provider, to ensure that you’re able to receive maximum coverage for treatment. Visit CheckMyInsurance.co today to begin using our simple-to-use and straightforward resource.
How To Find Behavioral Health Treatment Centers That Take Highmark Insurance
There are a few steps you can take to learn about in-network behavioral health treatment facilities. You can call the number on the back of your Highmark insurance ID card and speak with a representative about your needs. They can provide you with a list of in-network providers within your area, often narrowing down their results by the specific programs.
Before engaging in treatment, we encourage you to confirm that the treatment provider you’re considering is in-network. This can reduce your risk of unexpected costs and difficulties. You may need to obtain prior authorizations for intensive care, such as inpatient care, PHPs, and IOPs. If you know that your treatment plan will require specialized treatments like medication-assisted treatment, psychiatric care, or dual diagnosis treatment, you can confirm these benefits when speaking with a Highmark insurance representative.
How Many Times Will Highmark Pay For Rehab Treatment?
Highmark mental health coverage is typically based on the type of policy you have, authorization approvals, and the medical necessity of treatment. In most cases, Highmark policies allow insured members to have multiple treatment episodes within the same year when it is clinically justified. This can include a combination of inpatient and outpatient care, or more than one outpatient program.
It is important to note that some insurance policies may have annual session caps that may affect coverage for long-term treatment. There is a medical review process in place that determines the number of approved sessions or days of treatment for these limits. If you require continued support outside the scope of your insurance policy, your policy may require additional approval and documentation. This appeals process can help insured members access coverage when their coverage is denied or reduced due to session caps.
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Statistics in Behavioral Health Disorders and Highmark Treatment Coverage
- An estimated one in five adults in the United States experiences a mental illness each year, with one in twenty experiencing serious mental illnesses. Half of these individuals began experiencing symptoms by age 14, while 75% of adults who have mental health concerns had symptoms by the age of 24.
- The National Institute of Mental Health (NIH) estimated that half of the adults who were experiencing a mental illness in 2022 sought treatment. Over 66% of those living with a serious mental illness received treatment during the same period.
- Highmark Health Plans has over 154,000 in-network physicians and processed over 214 claims on behalf of their members during 2022.
- 46% of Americans will meet diagnostic criteria for a mental health disorder during their lifetime.
- The National Center for Drug Abuse Statistics (NCDAS) indicated that over 28 million adults in the U.S. are living with an alcohol use disorder. One in four adults who use illicit drugs meets criteria for a drug use disorder.
