Health Coverage Options for Substance Misuse and Mental Health From Highmark Blue Cross Blue Shield of West Virginia

Over 335,000 adults are living with a mental health disorder in West Virginia, with 82,000 experiencing serious mental health conditions. For many, managing their mental health symptoms becomes easier with the support of a mental health professional. Highmark Blue Cross Blue Shield of West Virginia can lower treatment expenses for insured members, making treatment more accessible.


Highmark Blue Cross Blue Shield of West Virginia offers comprehensive coverage for a range of behavioral health conditions, including substance abuse, mental health, and co-occurring disorders. Treatment commonly includes the use of therapies like Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI) to help you cope with your mental health symptoms and maintain motivation for treatment.  Continue reading to learn about the common characteristics of rehabs that accept Highmark Blue Cross Blue Shield insurance.

Find Out What Your Highmark BCBS of West Virginia Benefits Include

What Type of Health Insurance Is Offered by Highmark Blue Cross Blue Shield of West Virginia?

Highmark Blue Cross Blue Shield of West Virginia is an independent licensee of the Blue Cross Blue Shield Association and a subsidiary of Highmark Inc. Highmark has over 7 million insured members across Pennsylvania, Delaware, New York, and West Virginia. Highmark’s history dates back to the Great Depression in Pennsylvania in the 1930s.

West Virginia residents have had access to Highmark BCBS insurance policies since 1999, following the partnership with Mountain State Blue Cross Blue Shield. Since then, it has continued expanding its reach, helping millions of Americans access the medical and mental health services they need. Highmark BCBS of WV has 300,000 insured members and provides access to treatment for many more in West Virginia through the BlueCard program.

Over 330,000 adults in West Virginia are living with mental health disorders. This includes conditions like anxiety, depression, bipolar disorder, ADHD, and trauma-related disorders like PTSD. These conditions can range in severity, with many individuals experiencing severe symptoms that significantly impact their daily lives.

Medicare beneficiaries in WV engage in more depression-related treatment compared to other areas within the country. Over 11% report engaging in excessive drinking, and there is a higher rate for prescription opioids compared to the national average. Twenty-two percent of adults who experienced anxiety or depression in the winter of 2021 were unable to receive the appropriate mental health treatment in WV, many citing the cost of treatment as the primary concern. Mental health conditions are known to contribute to physical health concerns, decline in workplace productivity, and social withdrawal. Access to affordable, effective mental health treatment can improve the health and overall emotional well-being of WV residents.

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How Can I Verify Information on Highmark BCBS of West Virginia Health Plans?

To verify your Highmark or Blue Cross Blue Shield of West Virginia rehab coverage, begin by completing the insurance verification tool provided by checkmyinsurance.co. This free resource clarifies the key details of your insurance policy, which may influence your choice of treatment providers. This can be used for individual family groups and Medicare insurance policies.

Once you have completed the verification form, you will learn about your expected out-of-pocket expenses, coverage, limitations, in-network provider requirements, and other details. This information can help you narrow down nearby treatment providers, allowing you to focus on those that accept Highmark Blue Cross Blue Shield of West Virginia, drug and alcohol rehab coverage.

Do Highmark BCBS of West Virginia Health Plans Pay for Substance Use Disorder Treatment?

Yes, Highmark Blue Cross Blue Shield rehab coverage includes treatment for alcoholism, drug dependency, and poly-substance abuse. This typically includes various treatment options, such as detoxification, inpatient care, and outpatient treatment. Specialized treatments, such as MAT services and dual diagnosis care, are often covered when they are medically necessary.

Depending on your plan type, your coverage may apply to in-network and out-of-network treatment providers. Prior authorization may be required in some cases, such as inpatient care, partial hospitalization programming, and intensive outpatient care. Your Highmark BCBS of WV policy is required to follow the guidelines established by the Affordable Care Act (ACA) and mental health parity laws. This means that the coverage you receive will be comparable to coverage for medical conditions, and you cannot be denied coverage for a pre-existing health condition.

Yes, Highmark Blue Cross Blue Shield of West Virginia covers rehab for both mental health and substance use disorders. This coverage can include inpatient and outpatient care, depending on the severity of your symptoms. Crisis services and detoxification may be included in coverage options for those who require specialized care.

It is essential to recognize that insurance policies with Highmark BCBS of WV can vary significantly in their coverage for behavioral health conditions. That said, you may be responsible for out-of-pocket costs, such as premiums, deductibles, and copayments. These costs may increase if you choose an out-of-network provider or fail to submit the necessary documentation for the claims process. This can include documentation from a qualified mental health professional indicating your diagnosis and treatment recommendations.

Medication-assisted treatment services are an essential treatment option for those who are struggling with drug dependency and alcoholism. Medications are commonly used in detoxification programs to minimize the health risks associated with the withdrawal process; some outpatient treatment facilities offer detox services for mild to moderate symptoms.

 MAT services can also be used to promote long-term sobriety for those struggling with an opioid or alcohol use disorder. The FDA has approved medications for these disorders, such as methadone and naltrexone. These medications can help decrease the intensity and frequency of cravings and minimize the risks associated with a relapse. These medications may be used on a long-term basis in addition to traditional therapy methods to promote long-term recovery.

Treatment for co-occurring mental health and substance use disorders is commonly included in Highmark Blue Cross Blue Shield of West Virginia’s alcohol and drug rehab coverage. This can include detoxification, inpatient care, and various forms of outpatient treatment that offer dual diagnosis treatment options. Your treatment plan may incorporate psychiatric care and medication-assisted treatment, depending on your symptoms.

Dual diagnosis treatment is the gold standard for co-occurring mental health disorders and substance use disorders. These treatment options provide simultaneous care, focusing on all the symptoms you were experiencing. Many people find that their symptoms for their co-occurring disorders are intertwined, meaning that focusing on one in treatment limits the progress they could make in their recovery. Your treatment may include therapy, counseling, group support, and educational sessions to help you develop positive coping and relapse-prevention skills.

What Treatments for Substance Use Disorder and Mental Health Disorder Are Covered by Highmark BCBS of WV?

Residential treatment programs are ideal for those experiencing moderate to severe symptoms that are challenging to manage on their own. Inpatient care provides medical supervision and support around the clock to ensure that you can cope with triggers, cravings, and stressors you experience. Treatment can include support groups, therapy, and counseling.

Highmark and Blue Cross Blue Shield of West Virginia cover inpatient rehab services when medically necessary. You may be required to submit paperwork for prior authorization as part of the claims process. This step is often something treatment providers can assist you with.

Partial hospitalization programs provide you with a full day of structured care while allowing you to live at home. These programs may be recommended for moderate to severe symptoms that do not require overnight support. Treatment can include dual diagnosis care, MAT services, and psychiatric care so that you can stabilize your symptoms before transitioning to an aftercare program.

Highmark Blue Cross Blue Shield of West Virginia’s rehab options commonly include partial hospitalization and day treatment programs for those who meet the requirements for this level of care. You may be responsible for out-of-pocket expenses, such as premiums and copayments, at the time of service.

Intensive outpatient programs typically include 3 to 5 days of treatment, consisting of support groups and individual therapy sessions. IOPs often provide dual diagnosis, MAT services, and psychiatric care options when necessary. Treatment focuses on developing relapse prevention skills that can help you navigate everyday life, cravings, and triggers.

IOPs are commonly included in Highmark Blue Cross Blue Shield of West Virginia drug rehab coverage. It is not uncommon for coverage to be dependent on a prior authorization or referral from a primary care physician. You can learn about these and other requirements when you verify your insurance policy with checkmyinsurance.co today.

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How Can I Check That A Treatment Center is In-Network With Highmark Blue Cross Blue Shield of WV?

You can learn about a treatment center’s network status by utilizing the provider search tool in your member portal. This resource lets you search for nearby providers based on your location. You may also call the number on the back of your insurance ID card and speak with a representative about local treatment options.

Before you begin treatment, it is encouraged that you have your treatment provider confirm their network status and the details of your insurance policy. This can help reduce your risk of increased out-of-pocket expenses and claim delays.

Does Highmark Blue Cross Blue Shield of West Virginia Health Insurance Cover Vets?

Yes, Highmark Blue Cross Blue Shield of West Virginia does provide coverage for veterans who are experiencing mental health and substance use disorders. Veterans may have individual, family, group, employer, sponsored, or Medicaid insurance policies. Coverage options typically include inpatient and outpatient services.

Marketplace insurance plans, including Highmark and Blue Cross Blue Shield, differ from VA benefits through the U.S. Department of Veterans Affairs. Qualifying veterans can receive medical and mental health treatment from their local VA or from Community Care Network (CCN) providers. These two coverage options typically include different treatment providers for mental health and substance use disorders.

WV Mental Health and Addiction Treatment: What’s the Price of Treatment Without Health Insurance?

West Virginia is the 36th most affordable state to receive residential drug treatment in. On average, a West Virginia resident pays $57,881 for residential care. The average cost of outpatient treatment in West Virginia is $1,702. These costs can vary depending on your use of specialized services, such as MAT, psychiatric care, and dual diagnosis treatment.

Residential and other private treatment centers tend to cost more than public and nonprofit healthcare treatment centers. Some Highmark Blue Cross Blue Shield of West Virginia insurance policies may have limitations or exclusions on high-end and luxury rehab centers. Those who experience chronic mental health distress may find that their treatment expenses are higher due to their use of extended support services. If you would like a personalized quote for addiction or a mental health treatment, you can contact a nearby behavioral health facility and inquire about available treatment services.

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A Guide to Getting Highmark BCBS of WV to Cover Mental Health and Alcohol/Drug Addiction Treatments

The first step to having Highmark Blue Cross Blue Shield of West Virginia cover your mental health treatment is to verify your insurance policy. The information you receive can help guide your search for nearby treatment providers, ensuring you choose a provider that offers the maximum coverage for treatment.

Once you are aware of your policy’s limitations and exclusions, you can narrow your treatment options based on the services available from potential providers. If you require inpatient care, you can review the available amenities and holistic approaches to determine which one best suits your needs. If you require a dual diagnosis or psychiatric care, you can exclude providers that do not offer these services. Make sure that you have submitted the necessary documentation and obtained the required authorization for coverage. Missing these steps can increase your treatment costs and delay coverage.

WV Mental Health and Addiction Treatment: What’s the Price of Treatment With Highmark BCBS of West Virginia Health Insurance?

Highmark BCBS of WV members have varying out-of-pocket expenses for mental health and substance use disorder treatments. This is due to variations in their insurance policy location and treatment needs. You may be responsible for a monthly premium, deductibles, and copayments. Umbrella policies may be available to those seeking additional financial protection beyond the scope of their primary insurance policy.

Policy options available with Highmark BCBS of WV are determined by an actuary who evaluates the current health trends, liabilities, and risks associated with behavioral health conditions. Once these plans are outlined, they are then customized during the underwriting process for each member. Plan variations are what contribute to the varying out-of-pocket expenses that insured members experience when accessing behavioral health treatment.

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Are Out-of-State Drug/Alcohol Addiction Treatments and Mental Health Treatments Included in Highmark BCBS of West Virginia Health Coverage?

Highmark Blue Cross Blue Shield of West Virginia may cover treatment facilities located outside of the state. Coverage is dependent on the details of your plan and may include detox, inpatient, and outpatient treatment. You may be required to choose a provider within the Blue Cross Blue Shield Association network.

If you would like to learn about coverage options for out-of-state treatment providers, contact Highmark by calling the number on the back of your insurance ID card. You can ask your representative if your specific plan covers the out-of-state treatment facility that you are considering. You may also ask about out-of-pocket expenses, such as deductibles and premiums associated with out-of-state providers.

Highmark BCBS of WV Options for Addiction Treatment Centers

Highmark Blue Cross Blue Shield of West Virginia provides coverage for a range of addiction providers within the state. This allows insured members to access top-tier care in various regions of the state. Examples of rehabilitation programs that accept Highmark BCBS of WV policies include:

  1. Aurora Psychiatric Hospital – Dewey Center: 1220 Dewey Avenue, Wauwatosa, WI 53213
  2. Mendota Mental Health Institute: 301 Troy Drive, Madison, WI 53704
  3. Rogers Behavioral Health – Oconomowoc Campus: 34700 Valley Road, Oconomowoc, WI 53066
  4. Willow Creek Behavioral Health: 1351 Ontario Road, Green Bay, WI 54311
  5. Winnebago Mental Health Institute: 4100 Treffert Drive, Oshkosh, WI 54901
  6. Rogers Behavioral Health – Silver Lake Outpatient Center: 1205 Corporate Center Drive, Oconomowoc, WI 53066
  7. Rogers Behavioral Health – Wausau Outpatient: 500 North 3rd Street, Suite 600, Wausau, WI 54403
  8. Aurora Psychiatric Hospital (Inpatient Services): 1220 Dewey Avenue, Wauwatosa, WI 53213
  9. SSM Health Behavioral Health – Fond du Lac Day Treatment: 40 Camelot Drive, Fond du Lac, WI 54935
  10. SSM Health Specialty Services – Sun Prairie PHP/IOP: 10 Tower Drive, Sun Prairie, WI 53590

Highmark BCBS of WV Options for Mental Health Treatment Centers

Mental health rehab centers that take Highmark Blue Cross Blue Shield of West Virginia can provide inpatient and outpatient treatment services. During your provider search, consider available services, amenities, and other features in their treatment program. Examples of mental health providers that may accept your Highmark BCBS of WV rehab coverage include:

  1. Wood Violet Recovery: 938 S Front Street, Dodgeville, WI 53533
  2. Wellbrook Recovery: 355 S Moorland Road, Brookfield, WI 53005
  3. Rogers Behavioral Health – Oconomowoc Campus: 34700 Valley Road, Oconomowoc, WI 53066
  4. Burkwood Treatment Center: 1102 Plum City Road, Hudson, WI 54016
  5. Wausau Comprehensive Treatment Center (CTC): 1000 Sherman Street, Wausau, WI 54403
  6. Manitowoc Comprehensive Treatment Center (MAT): 1601 S 17th Street, Manitowoc, WI 54220
  7. WisHope Recovery – Waukesha: 223 Wisconsin Avenue, Unit A, Waukesha, WI 53186
  8. SSM Health Behavioral Health – Fond du Lac Day Treatment: 40 Camelot Drive, Fond du Lac, WI 54935
  9. SSM Health Specialty Services – Sun Prairie PHP/IOP: 10 Tower Drive, Sun Prairie, WI 53590
  10. Rogers Behavioral Health – Silver Lake Outpatient Center: 1205 Corporate Center Drive, Oconomowoc, WI 53066
  • An estimated 92,000 adults in WV who were experiencing mental health symptoms did not receive the treatment they needed in 2021. Nearly half of them noted that the cost of treatment was their main barrier.
  • 35% of adults who received SMHA services used Medicaid.
  • A study focused on West Virginia residents found that 37% of participants were living with a mental health disorder, and that over 80% knew someone who was living with a mental illness.
  • The rate of suicide in West Virginia is approximately 27% higher compared to the national average, according to the Appalachian Regional Commission (ARC).
  • West Virginia ranked 46th among states in mental health and overall well-being.