GUARDIAN RECOVERY NETWORK Highmark
Parents of adolescents and, in some cases, the spouses or families of adults may be able to begin the pre-authorization process for their loved one without their consent. If the patient’s plan is a Managed Healthcare plan (HMO), Highmark coverage is maximized when patients stay within the preferred network of doctors and rehab centers. If the patient’s plan is a Preferred Provider plan (PPO), there may be fewer restrictions on the choice of treatment provider.
The Guardian Recovery Network provides world class recovery services and facilities, including detoxification programs, inpatient and outpatient care. Our continuum of care includes aftercare planning and case management services as well as a host of additional services. We understand that when choosing a recovery facility for yourself or your loved ones, covering the costs of recovery is of utmost concern.
With over 4.5 million members insured, Highmark Health understands that providing coverage for addiction recovery services is in the best interest of both the patient and the insurer. Highmark provides coverage for alcohol and drug addiction treatment under the arm of Highmark Behavioral Health Care Management. These benefits extend to a variety of mental health services, including coverage for those affected by trauma and PTSD.
Highmark may operate under a different brand name in your state. Highmark includes several blue-branded health insurance programs such as Highmark Blue Shield, Highmark Blue Cross Blue Shield and Highmark Inc. Plans are predominantly available for residents of Pennsylvania, Delaware and West Virginia.
State law also impacts the regulations surrounding your Highmark health care plan. For example, while some rehab facilities may require pre-authorization for substance abuse treatment, others are required by law to provide up to six months of treatment without pre-authorization for detox services and treatment deemed medically necessary. Parents of adolescents and, in some cases, the spouses or families of adults may be able to begin the pre-authorization process for their loved one without their consent.
Members of Highmark Health should contact their provider for specific information on coverage, which varies depending upon several factors, including the type of addiction being treated, the length of stay in the rehab facility, the length of outpatient or aftercare services, and the individual’s deductible and co-pay.
If the patient’s plan is a Managed Healthcare plan (HMO), Highmark coverage is maximized when patients stay within the preferred network of doctors and rehab centers. If the patient’s plan is a Preferred Provider plan (PPO), there may be fewer restrictions on the choice of treatment provider.
Highmark offers individual and family plans through employers, Medicare and Medicaid, and the Health Insurance Marketplace. You may also be eligible for short term insurance of up to 360 days if you need coverage during a transition period in your life. While employer plans may differ, all Health Insurance Marketplace plans cover substance abuse treatment as an essential health benefit. This means that pre-existing conditions are covered, and spending limits are not allowed.
Parity protections for substance abuse treatment ensure that benefit limits must be the same as they are for your plan’s medical and surgical coverage. For example, there can be no less favorable limits on deductibles and co-pays; the number of days or visits covered; and pre-authorization requirements can be no more strict than those for general medical care.
We know that choosing the right rehab facility can be daunting. At the Guardian Recovery Network, our goal is to help you begin your treatment as soon as possible. Should you need any assistance navigating our facility offerings, our individualized programs, or our insurance guidelines, we’re here to help. Together, we’ll secure a thriving future for you and your family.
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At Guardian Recovery Network, we provide support for today—and hope for tomorrow. Cleansing your body of the toxic effects of addictive drugs and alcohol is the start of your path to self-awareness and fulfillment. Once physical symptoms are halted, you’ll sort through painful emotions and deconstruct false narratives with new clarity of mind. Along the way, you’ll learn to access your authentic emotions and thoughts: reawakening your purpose and joy in living.
Guardian Recovery Network is your advocate for clinically centered care, and we believe every individual deserves a thriving future. Call 877-301-4673 to speak with a caring Guardian team member now. For your privacy and convenience, you can also connect with us online, 24 hours a day.