Does Harvard Pilgrim Cover Treatment for Substance Use Disorder?
Getting treatment for substance use disorder is relatively straightforward for those with a Harvard Pilgrim insurance plan. This insurance provider offers many different coverage options so that policyholders aren’t totally left to their own devices to pay for addiction recovery care.
However, it’s important to make sure that your health insurance plan covers the facility and treatment program that you’re seeking to enroll in. You should also learn more about the general types of addiction treatment that may be available and how to navigate the process of selecting an addiction treatment program with your specific Harvard Pilgrim policy.
More Information About Harvard Pilgrim
Harvard Pilgrim was founded by doctors more than five decades ago. It now operates as a leading not-for-profit provider of health insurance services. Harvard Pilgrim is primarily based out of New England and currently serves more than 3 million customers across the region.
Harvard Pilgrim offers individual and family plans to customers living in New Hampshire, Massachusetts and Maine. Coverage includes HMO, PPO, and POS member health insurance plans. It offers Medicare plans as well.
Seeking Coverage From Harvard Pilgrim for Substance Abuse Treatment
The most important thing to remember about working with your health insurance company to get your addiction treatment program covered is that the program must be pre-authorized by your insurer. This means that you have to check to make sure that it is a covered program before enrolling at the addiction recovery center. This is typical regardless of the health insurance company you have.
During the pre-authorization phase, the insurance company makes an initial determination that the addiction treatment you are seeking is medically necessary. The insurer may require a referral for an addiction treatment program from your primary care doctor.
The amount of coverage that a Harvard Pilgrim insurance plan will provide can vary greatly. Almost all plans have a set deductible, which means that your treatment cost must exceed that amount before insurance kicks in to pay the remaining portion of the bill. Your deductible is essentially the amount that you’ll have to pay out of your own pocket to cover addiction treatment.
Once your deductible is hit, the insurer will start paying for a portion of the treatment bill. However, some patients have coinsurance, which is a percentage of the medical bill that you’re responsible for paying out of your own pocket in addition to the deductible. Another fee included in some Harvard Pilgrim health insurance plans is a copay. Your copay is a fixed amount that you pay directly to the medical provider upon seeking treatment.
What Are the Differences Between In-Network and Out-of-Network Treatment Centers?
One of the major factors of insurance coverage is whether your facility is in the Harvard Pilgrim network or outside of the network. In general, insurance companies negotiate more favorable rates for facilities and medical providers that they deem “in-network.” You want to be sure that the addiction recovery center that you choose to attend is considered “in-network” by your insurance provider.
The danger of seeking treatment from an addiction recovery center that is not within the Harvard Pilgrim network of facilities and providers is that you may have to cover more of the bill out of pocket. You may be able to negotiate a payment plan or coverage options with your provider if you are interested in attending an addiction treatment center that is outside of the Harvard Pilgrim network. This is something that you should take care of as early as possible when selecting an addiction treatment center.
Types of Conditions Covered by Harvard Pilgrim for Treatment
The addiction treatment programs covered by Harvard Pilgrim health insurance address a long list of substance use disorders. Many patients find that they are struggling with substance use disorders involving multiple substances. With your Harvard Pilgrim plan, you can get professional medical care for dealing with multiple addiction issues at once.
One of the first steps in almost every substance abuse recovery program is the detox stage. This is the process of flushing out the abused substances from your body. Depending on the severity of your condition and history of substance abuse, you may either complete the detox phase of your substance abuse treatment in an inpatient program or at your own home.
You may need to be monitored closely by a medical professional if you experience any extreme symptoms of withdrawal during the detox phase or any other part of your treatment plan. The severity and duration of any withdrawal symptoms vary by individual and according to each person’s history with substance abuse. It is important to let your medical provider know of any issues that you are experiencing during detox so that your withdrawal symptoms can be effectively managed as early as possible in your treatment program.
Whether you are struggling with an addiction to alcohol, a controlled substance or both, there are viable addiction treatment programs available to address your individual recovery needs. Whether detox is covered by your Harvard Pilgrim plan will depend on your level of dependency. If doctors don’t think a medical detox is necessary for your type of addiction, you may be denied coverage for this.
Common Types of Addiction Treatment Programs
Each substance abuse recovery center has a different program that they administer to patients, but there are several main categories of treatment programs that are generally available.
Long-Term Residential Addiction Treatment Programs
This is a fairly intensive option for addiction treatment. It typically involves 24/7 care from medical staff and approximately one month of overnight stays at a treatment center. These facilities are generally not hospital settings, but they do offer immediate access to trained medical professionals if patients experience any type of medical complication during recovery.
The programs offered in these types of facilities generally focus on comprehensive recovery. This often includes incorporating social skills and coping mechanisms for long-term recovery strategies. Patients may stay in these programs for as long as a year. They are well-suited for patients who have special needs or suffer from a complex medical history.
Short-Term Residential Addiction Treatment
Patients in a short-term residential addiction treatment program stay overnight at a recovery center for a much shorter period of time than those who attend a long-term residential treatment program. These recovery programs tend to adopt a modified version of the 12-step program to get patients started on their path to sobriety. After completing the entire short-term residential program, some patients may need to follow up on their treatment with outpatient programs.
Outpatient Addiction Treatment Programs
These programs allow the patient to complete the treatment away from a residential facility. This tends to be a viable option for those patients who are still attempting to keep up with their work schedule or other necessary commitments during their addiction treatment program. There are still options for intensive therapy or counseling through an outpatient recovery program. Group counseling sessions are also a popular form of therapy in many outpatient addiction recovery programs.
Individual Counseling Sessions
One-on-one therapy is a crucial component of most addiction treatment programs. It gives the patient an opportunity to focus on their unique issues and work with a trained therapist to identify coping strategies for maintaining sobriety.
Group Therapy Sessions
Group therapy is a successful component of so many addiction treatment programs because it allows patients to socialize and reinforce their commitment to recovery with others in a relatable position. Group therapy is often used alongside individual therapy sessions to maximize the long-term efficacy of addiction treatment strategies.
Treatment Services Covered Under Harvard Pilgrim
If you suffer from clinically recognized substance use disorder, Harvard Pilgrim will cover the standard parts of drug rehab treatment. This could include an inpatient or outpatient program; however, certain residential rehab facilities will not be in-network. Your policy could cover physical exams, medical assessments, anti-addiction medicines like methadone, group and individual therapy, and the cost of lodging and food while staying at a clinic. As noted earlier, the percentage you’ll have to contribute to the treatment costs will be affected by many factors, including your deductible and type of insurance plan.
Finding the Right Addiction Treatment Center for Your Needs
According to the National Institute on Drug Abuse, there are now more than 14,500 addiction treatment centers across the country. The good news is that those with Harvard Pilgrim coverage are likely to find a high-quality addiction treatment center that is conveniently located. However, it’s important to be sure that the addiction treatment center that you decide to use is covered by your health insurance plan. That’s why you may want to consider working with an addiction treatment specialist ahead of time to match up your addiction recovery needs with your specific health insurance coverage.
Rather than taking a one-size-fits-all approach to addiction treatment, it is wise to consider all of your unique needs before selecting an addiction treatment program to attend. You will want to consider how close the center should be to your work, school or home. Some patients find that the more convenient it is for them to arrive at scheduled treatment sessions, the more likely they are to stick with the entire program and remain sober. On the other hand, you might find that you can focus on your recovery more easily by attending an addiction treatment center that is outside of your typical professional, personal or social network.
In addition, you should consider what types of treatment options are available at the recovery center you’re interested in attending. If you are interested in trying a certain type of therapy or program structure, you should check to make sure that it is offered at your choice recovery center before enrolling in a treatment program there. You might find that a certain number of sessions or weeks of therapy or counseling are covered by your Harvard Pilgrim health plan.
Getting Started on Your Path to Recovery and What to Do Next
When you are ready to see what your specific addiction treatment options are through your Harvard Pilgrim insurance plan, call us right away to speak with one of our trained and competent addiction recovery specialists. We can help locate addiction treatment programs that are covered by your policy from Harvard Pilgrim and are conveniently located near you.
We know that starting on your path to addiction recovery can be overwhelming and intimidating. Our helpful addiction recovery team is available to help you navigate the most complex parts of lining up treatment options that are covered by your insurance plan. The sooner you connect with one of our knowledgeable addiction recovery specialists, the sooner you’ll be on your way to getting professional treatment for your substance use disorder.