Addiction Treatment

Mental Health Treatment

Geisinger Coverage for Mental Health & Addiction Treatment

When you are enrolled in a Geisinger health plan, you may be eligible for benefits that cover rehab for both mental health and addiction. You can contact us now to check your Geisinger insurance and see what your plan may cover; there is no commitment or cost involved.

What Geisinger members should know

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Verify Insurance Benefits

Does Geisinger Insurance Cover Drug & Alcohol Rehab?

Geisinger provides HMO, PPO, and HMO D-SNP plans to members in Northeastern, Central, and South Central Pennsylvania. As a health plan, Geisinger is bound by the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires it to cover the costs of substance use and mental health services when it offers medical and surgical benefits.

Geisinger handles behavioral health in-house, as there is no carve-out organization to handle mental health and substance use disorder claims. In some cases, you will have to get a referral from your primary care provider (PCP) if you have an HMO plan before you can access behavioral health services, like substance use disorder treatment. If your condition is chronic, your PCP may grant you standing referrals. Members with PPO plans may have more benefits. Geisinger PPO plans are affiliated with Cigna Healthcare for out-of-network benefits.

You must obtain prior authorization, or notification for short-term inpatient stays, before you can access any non-emergency inpatient admission. Most Geisinger plans provide coverage for up to 60 inpatient days. Some plans allow you to waive some of your day limits based on your primary or secondary mental health or substance use disorder diagnosis. Both members and providers can reach out to NaviNet or Geisinger customer service representatives to coordinate your authorization with us.

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What Addiction Treatment Services May Be Covered by Geisinger?

Depending on your Geisinger plan, treatment services at Banyan locations may include evidence-based addiction treatment approaches across the continuum of care:

Medical Detox

Medically managed detox services may be covered during the acute phase of recovery, if medically necessary, before entering further addiction treatment.

Inpatient Rehab

Your inpatient stays for substance use disorder and mental health care may be covered by Geisinger. HMO plans may require you to get a referral from your primary care provider to access your treatment. Prior authorization is mostly required before any non-emergency inpatient admission. Plus, some plans have day limits that you may be eligible for.

Intensive Outpatient Programs (IOP)

You can participate in our intensive outpatient programs by meeting with us for therapy sessions and group counseling at the time slots assigned to you. You may receive coverage if the treatment is medically necessary, based on your type of plan.

Outpatient Treatment

Your Geisinger plan could cover Geisinger behavioral health outpatient and substance use outpatient services. This might include classic outpatient care, intensive outpatient programs (IOP), and continuing therapy.

Telehealth Intensive Outpatient Program (IOP)

Telehealth services may be covered for addiction treatment and mental health treatment under Geisinger plans. Banyan Telehealth provides virtual IOP services, medication management, dual diagnosis treatment, and specialized programming such as faith-based and gender-specific tracks.

Continuing Care

Continued coverage depends on ongoing evidence of treatment need and clinical documentation as reviewed and confirmed by your provider and plan.

Note: Because Geisinger manages behavioral health internally, authorization decisions are coordinated directly between your treatment provider and the plan.

Does Geisinger Cover Mental Health Treatment and Therapy?

Yes. Your Geisinger plan likely includes Geisinger behavioral health outpatient services such as mental health individual therapy, group counseling, and continuing therapy. Because Geisinger takes care of its own behavioral health, authorization reviews are conducted directly between the plan and your treating provider.

Potential benefits include:

Individual therapy
Group therapy
Family therapy
Treatment for depression, anxiety, trauma, and mood disorders
Treatment for integrated co-occurring substance use and mental health needs

Inpatient Mental Health Benefits

Geisinger may cover residential treatment for severe psychiatric conditions and co-occurring substance use disorders when it is medically necessary. Non-emergency inpatient stays require prior authorization, and some plans eliminate day limits for mental health and SUD benefits.

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What will Rehab with Geisinger Cost?

Your out-of-pocket rehab cost with Geisinger will be determined by your plan type, whether your provider is in network, and the level of care. HMO, PPO, and HMO D-SNP plans differ in terms of benefit coverage. PPO members may have additional flexibility, as Geisinger PPO plans are affiliated with Cigna Healthcare for out-of-network benefits.

Geisinger Rehab Cost Factors

Whether your provider is in or out of network
The terms of your deductible, coinsurance, and copay
Whether you need pre-authorization
Level of care: medical detox, inpatient, partial hospitalization, intensive outpatient, or outpatient
Your plan type: HMO, PPO, POS, employer, or individual coverage

What You Can Do Right Now

The simplest way to find out your out-of-pocket cost is to verify your insurance benefits with Geisinger. Our admissions staff can review your Geisinger plan for you, explain what may be covered, and work with you on a budget before treatment starts.

Questions? Get help now

If You Call Geisinger Directly, Ask:

Is medical detox covered?
Are inpatient or residential programs covered under my plan?
Are PHP or intensive outpatient programs covered?
Do I need prior authorization?
Is this facility in-network?
What are my deductibles, copays, and coinsurance?
Are there limits on the number of treatment days or sessions?

Or, We Can Verify for You (Recommended)

We contact your insurance provider directly
We review coverage details and medical necessity requirements
We explain the benefits clearly and confidentially

How to Find Treatment That Accepts Geisinger

Banyan has physical rehab centers in both Northeastern and Southeastern Pennsylvania, so Geisinger members can access in-person treatment in Geisinger's primary service area. Banyan also provides Telehealth to qualified members. The admissions team will assist members in transitioning from checking benefits to receiving the appropriate level of care.

Determine the Right Level of Care

A clinical assessment is completed to assist in recommending the best level of care. Geisinger HMO members will need a referral from their primary care doctor prior to beginning behavioral health treatment. You can ask them about obtaining a standing referral if you expect to require care for an extended period. Prior authorization is needed for non-emergency admission to an inpatient facility, no matter the type of plan you have, and the admissions team will work to coordinate the prior authorization process.

Next Steps: Verify your Geisinger coverage or speak with an admissions specialist today.

Questions? Get help now

Frequently Asked Questions

1What types of Geisinger mental health therapy are covered?

Geisinger mental health outpatient services may include one-on-one, group, and family therapy. Whether treatment is covered or not is determined by your Geisinger plan type and medical necessity. Geisinger HMO plan members will also require a PCP referral prior to treatment.

2What types of addiction treatment are covered by Geisinger?

Geisinger plans may cover telehealth services for addiction and mental health treatment. Banyan Telehealth offers virtual IOP programs, medication management, dual-diagnosis care, and specialty programming, including Faith in Recovery and gender-specific tracks.

3Does Geisinger cover inpatient psychiatric care?

Yes. Geisinger inpatient psychiatric care, medication management, and inpatient psychiatric evaluations may be covered. HMO members will need a PCP referral, and inpatient treatment requires a prior authorization for non-emergency admissions.

4How can I find in-network rehab facilities?

You can visit NaviNet and contact customer service, or search Geisinger's provider directory to search for in-network rehab centers. The Banyan admissions team can also assist with benefits verification and placement at Clearbrook Pennsylvania, Banyan Philadelphia, or remotely through Telehealth.

5Which rehab centers are covered by Geisinger insurance?

Banyan accepts Geisinger at Clearbrook Pennsylvania in Laurel Run, PA, and Banyan Philadelphia in Langhorne, PA, in addition to statewide accessibility via Banyan Telehealth. Both rehab locations are located in Geisinger's primary service area.

Coverage varies by America’s Choice plan and state. Insurance verification is required to confirm eligibility and benefits.

6How long does Geisinger pay for rehab?

Geisinger authorizes inpatient treatment after both notification and medical necessity criteria have been met, and the physician must notify the plan prior to the non-emergency admission. Some Geisinger plans will provide coverage for up to 60 days in an inpatient facility, and these limits may be waived for substance use disorder and mental health diagnoses. Continued care and services will remain covered as long as clinical documentation is provided for care that is still clinically necessary.

7Verify Your Geisinger Insurance Benefits Today

We'd be happy to help you review your Geisinger behavioral health benefits and assist you in starting treatment at Clearbrook Pennsylvania, Banyan Philadelphia, or Banyan Telehealth, which is completely confidential and without any obligation.

Coverage varies by Geisinger plan and state. Insurance verification is required to confirm eligibility and benefits.

Verify Your Geisinger Coverage for Treatment

Coverage details vary by insurance carrier, plan type, and location. Banyan Treatment Center is available to help you understand your Geisinger insurance benefits and explore treatment options.

Questions? Get help now