Harvard Pilgrim Insurance Coverage for Substance Abuse
Coverage Details
Harvard Pilgrim Insurance plans vary in their coverage details for addiction treatment. Most plans have a deductible, which is an amount the member must pay out-of-pocket before the insurance starts covering treatment costs. After meeting the deductible, the member may be responsible for coinsurance, a percentage of the treatment cost. Copays, fixed amounts paid for covered services, may also apply before or after the deductible is met.
Plans typically have a network of providers, including addiction treatment centers, who offer services at pre-negotiated rates. Using an in-network provider may result in lower out-of-pocket costs for the member. Out-of-network providers may work with the insurance company or the member to arrange coverage or payment plans.
Covered Addictions
Harvard Pilgrim Insurance plans commonly cover treatment for various substance addictions, including marijuana, prescription drugs, cocaine, methamphetamine, opioids like fentanyl and OxyContin, heroin, benzodiazepines like Xanax and Valium, and alcohol. Rehab centers may specialize in certain addictions, but most facilities treat multiple substance use disorders and provide comprehensive care.
Treatment Options
Different types of rehab are typically covered by Harvard Pilgrim Insurance plans, with varying copays or coinsurance rates. Coverage may also limit the number of outpatient visits or inpatient days per year. Treatment options include:
- Detox: Medically supervised process to eliminate substances from the body and manage withdrawal symptoms before treatment.
- Inpatient/Residential: 24-hour supervision and therapy at a treatment center.
- Partial Hospitalization: Intensive treatment during the day, with evenings at home.
- Intensive Outpatient: Group or individual therapy sessions for several hours per day, multiple days per week.
- Standard Outpatient: Individual or group counseling sessions, typically once or twice per week.
