Harvard Pilgrim Insurance Coverage for Drug and Alcohol Rehab & Detox Centers Near Me

Does Harvard Pilgrim Cover Alcohol and Drug Rehab?

With a Harvard Pilgrim health plan, you can count on robust coverage for all aspects of behavioral health. The behavioral health benefits, including Harvard Pilgrim Health Care rehab coverage, are administered through United Behavioral Health, also known as Optum. You can access a range of drug and alcohol treatment services using Harvard Pilgrim insurance.

What Is Harvard Pilgrim Health Care?

Harvard Pilgrim provides healthcare benefits, plans, and services to customers in Connecticut, Maine, Massachusetts, New Hampshire, and beyond.2 They are a leading not-for-profit health services company with over 3 million clients.3

Harvard Pilgrim Health Care was founded about 50 years ago by doctors.3 By partnering with a large network of doctors and health facilities, they continue to build and expand.3

Harvard Pilgrim offers the following categories of plans:4

  • Standard plans
  • Tiered plans
  • Limited network products
  • Senior plans
  • National plans

Harvard Pilgrim HMOs and PPOs

Harvard Pilgrim Health Care’s standard network plans provide members with 4 different HMO options and a PPO plan. These plans are:

  • HMO
  • HMO Open Access
  • SimplyVirtual HMO
  • Virtual Choice HMO
  • PPO

Harvard Pilgrim, Medicare, and Medicaid

Harvard Pilgrim Health also provides Medicare plans that include:4

  • Medicare Advantage Plans: These are offered to individuals who are eligible and live in New Hampshire.
  • Medicare Supplement Plans: Eligible participants who reside in Massachusetts and New Hampshire may have this plan.
  • Medicare Enhance Plans: This “gap” insurance for Medicare is offered through employer groups in Connecticut, Massachusetts, New Hampshire, and Maine.

What Does Harvard Pilgrim Health Care Insurance Cover in Addiction Treatment?

Determining the type of Harvard Pilgrim drug rehab treatment that you need is a vital step to healing. An admissions navigator can point you in the right direction for an assessment to get started.

There are various levels of care for addiction treatment that you can participate in, from closely supervised and intense to supportive and less intense. Many people move through the continuum of treatment levels until they are able to function independently.

Your Harvard Pilgrim Health Care insurance substance abuse treatment coverage may pay for some or all of the following treatments:

Inpatient or residential rehab: An inpatient treatment program is sometimes referred to as a residential rehab program because you will set up residence at the facility. Doctors, nurses, or clinicians will give you around-the-clock care. You will stay overnight at the facility during the duration of the program. During the treatment program, you’ll receive therapy, detox, and medication-assisted treatment if needed. The length of time that an inpatient program lasts varies, but it can be up to 90 days to start.5

Partial hospitalization program (PHP): A PHP is similar to an inpatient program, except you won’t be staying overnight. You will receive therapy for much of the day while in a residential/hospital setting.6

Intensive outpatient program (IOP): An IOP is an intensive level of outpatient treatment. During this treatment, you will receive several hours of therapy during the week. The exact amount varies depending on your Harvard Pilgrim Health Care drug treatment plan. However, it will be more therapy than a regular outpatient program.5

Outpatient treatment program and therapy: Once you gain some coping strategies to handle the stress and triggers of the outside world, you will be prepared for the standard outpatient treatment program. This usually occurs about once or twice a week.5

You can inquire with your insurance carrier about the specific coverage you have with your plan. Your policy tier and specific insurance details will be important in determining what will be covered and for how long.5

Does Harvard Pilgrim Health Care Cover Mental Health Facility & Co-Occurring Disorder Treatment?

If you’re wondering about treatment for a co-occurring disorder, you may want to get an assessment to see if you have a dual diagnosis. You can use your Harvard Pilgrim Health Care Insurance drug treatment plan to begin an evaluation to determine whether a co-occurring disorder exists.

Researchers have established a link between substance use disorder and mental illness. 7 People who have either substance use disorder or mental illness are predisposed to a dual diagnosis. Although there is a correlation between mental health and substance use disorders, there is no evidence that one causes the other. 7

Some mental health conditions co-occur more commonly with substance misuse. These are: 8(part1)

  • Generalized anxiety disorder as well as panic disorder.
  • Post-traumatic stress disorder (PTSD).
  • Attention deficit hyperactivity disorder (ADHD).
  • Major depressive disorder.
  • Psychotic disorders.
  • Borderline personality disorder.
  • Antisocial disorder.

To help minimize a relapse, you can seek Harvard Pilgrim Health Care mental health and substance use coverage simultaneously. 7 Due to the Affordable Care Act, insurance providers must allow patients to have full access to essential benefits, which include co-occurring mental health and substance use disorders.9

The amount of your Harvard Pilgrim Health Care drug coverage depends on what policy and tier you have. You can verify your benefits by contacting the number on the back of your card or calling a Harvard rehabilitation center.

How Long Does Harvard Pilgrim Health Care Cover Inpatient Alcohol and Drug Rehab Programs?

Everyone has a unique situation and may require a length of time in Pilgrim rehab that is different from the next person. The length of your Harvard Pilgrim Health Care Insurance rehab coverage may vary too. The first step is to determine how much time you need in rehab and then find out what your insurance will pay for.

Professionals recommend that patients stay in an inpatient program for at least 90 days.10 This is because addiction is a chronic and complex condition.10 Substance misuse over time changes brain function. So, time is needed to create change.10

What if My Harvard Pilgrim Health Care Policy Does Not Cover an Inpatient Drug Rehab Program?

Some people become concerned, thinking that their Harvard Pilgrim Health Care Insurance rehab coverage won’t be enough to cover the expenses associated with an inpatient drug treatment program. Or they may worry that it won’t be covered at all. However, there are ample options for people to get the help they need. Some Harvard Pilgrim centers offer financing, scholarship, or a reduced fee. It’s worth checking with them to find out what your options are. You don’t want to push off getting help to a later time.

Harvard Pilgrim Health Care In-Network vs. Out-of-Network Inpatient Rehab Centers

In-network providers have contracts with insurance companies like Harvard Pilgrim. When using the doctors and rehab facilities that are within the network of providers for Harvard Pilgrim, members receive the discounted cost for services.

Out-of-network providers will be more costly because they won’t have a contract with the insurer.

How To Find Harvard Pilgrim Health Care Coverage for Inpatient Drug Rehab Centers in New England

Contact American Addiction Centers (AAC) for a quick and seamless way to verify your Harvard Pilgrim Health Care coverage. Someone will give you an answer right away about whether Harvard is in-network with AAC facilities.

AAC has many top-quality rehab centers across the country, including in the northeast region of the United States, such as:

AdCare Treatment Hospital in Massachusetts: This facility has some of the region’s top physicians and staff. They offer co-occurring disorder treatment, medication-assisted treatment, specialized treatment tracks, and more.

AdCare Rhode Island: A partner with the community’s veterans, this facility is a top-notch rehab that offers a wealth of programs and treatments.

Call the helpline at AAC today for more details about starting the journey to recovery.