Addiction Treatment

Mental Health Treatment

Highmark Coverage for Mental Health & Addiction Treatment

If you carry a Highmark health plan, your policy may help cover addiction treatment and mental health services. This page outlines what Highmark members should know about coverage for detox, inpatient/residential, and outpatient care, and how to verify benefits.

What Highmark members should know

Verify Coverage Quickly
No Obligation
Confidential

Call Admissions

Verify Insurance Benefits

Does Highmark Cover Drug & Alcohol Rehab?

Highmark plans may include coverage for drug and alcohol rehab as part of behavioral health benefits. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), plans that offer mental health and substance use disorder services must provide comparable coverage to medical care.

Highmark offers multiple plan types, which can affect coverage:

PPO plans: Typically cover a percentage of in-network care after the deductible is met and may allow out-of-network options
HMO plans: Require use of in-network providers and may require referrals
EPO plans: Require in-network providers except in emergencies
POS plans: Combine features of HMO and PPO plans, often requiring referrals with limited out-of-network access

Pre-authorization is generally required for inpatient and hospital-based treatment. Coverage varies by plan and is based on medical necessity.

Verify Insurance

What Addiction Treatment Services May Be Covered by Highmark?

Depending on your plan and clinical needs, Highmark may cover several levels of addiction treatment:

Medical Detox

Supervised care to manage withdrawal symptoms. Coverage is typically based on medical necessity and authorization.

Inpatient

/ Residential Rehab 24/7 structured care for substance use and co-occurring mental health conditions.

Partial Hospitalization Programs (PHP)

(PHP) Daytime treatment with structured clinical support.

Intensive Outpatient Programs

(IOP) Therapy several times per week, including virtual treatment options.

Standard Outpatient Treatment

Ongoing therapy, counseling, and behavioral health services.

Aftercare / Continuing Care

/ Continuing Care: Long-term recovery support and relapse prevention services.

Note: Length of stay and level of care are typically determined by medical necessity and ongoing clinical review.

Does Highmark Cover Mental Health Treatment and Therapy?

Highmark plans generally include coverage for mental health services as part of behavioral health benefits.

Covered services may include:

Therapy and counseling: Individual therapy, group therapy, and ongoing mental health support
Psychiatry and medication management: Evaluation, diagnosis, and medication support when clinically appropriate

Inpatient Mental Health Coverage

Highmark may cover inpatient or residential mental health treatment, including care for co-occurring disorders, when medically necessary. Pre-authorization is typically required.

Call Banyan Today

How Much Does Rehab Cost With Highmark?

The cost of rehab with Highmark depends on your plan type, coverage level, and treatment needs.

Factors That Affect Your Out-of-Pocket Cost

In-network vs. out-of-network provider status
Deductibles, copays, and coinsurance
Pre-authorization and medical necessity review
Level of care (detox, inpatient, outpatient)
Plan type (PPO, HMO, EPO, POS) and location

What You Can Do Right Now

Use Banyan’s insurance verification form or call admissions
Speak with a team member to understand your benefits and estimated costs before admission

Questions? Get help now

If You Call Highmark Directly, Ask:

Is detox covered? Inpatient/residential care? PHP or IOP?
Do I need pre-authorization?
Do I need a referral?
Am I in-network at this facility?
What are my deductibles, coinsurance, and copays?
Are there limits on treatment duration or on the number of visits?

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 Highmark

“Accepting” Highmark may mean working with in-network providers or using out-of-network benefits, depending on your plan type.

Getting Matched to the Right Level of Care

Treatment begins with a clinical assessment to determine the appropriate level of care based on your needs.

Next Steps: Verify your insurance benefits or call admissions to begin the process.

Questions? Get help now

Frequently Asked Questions

1Does Highmark cover drug and alcohol rehab?

Highmark may cover drug and alcohol rehab as part of its behavioral health benefits when treatment is medically necessary. Coverage depends on your specific plan and may require authorization.

2Does Highmark cover inpatient rehab?

Highmark plans may cover inpatient or residential rehab when it is approved and considered medically necessary. Pre-authorization is typically required before starting treatment.

3Does Highmark cover outpatient rehab (PHP/IOP)?

Highmark typically covers outpatient behavioral health services, including intensive outpatient programs (IOP) and therapy. Coverage varies based on your plan and level of care.

4How long will Highmark pay for rehab?

Highmark usually approves treatment in stages, with continued coverage based on medical necessity. The length of care depends on your clinical needs and ongoing review.

5What’s the difference between in-network and out-of-network costs?

In-network care generally has lower out-of-pocket costs, while out-of-network coverage varies by plan and may result in higher expenses.

Banyan Boca
1000 NW 15th Street
Boca Raton, FL 33486
888-422-1651
Banyan Pompano
950 N Federal Hwy
Pompano Beach, FL 33062954-866-4486
Banyan Stuart
201 SE Osceola St
Stuart, FL 34994
888-422-2139
Banyan Sebring
1062 Lake Sebring Dr
Sebring, FL 33870
888-659-7463
Banyan Gulf Breeze
4400 Hickory Shores Blvd
Gulf Breeze, FL 32563
800-508-0119
Behavioral Health of the Palm Beaches
7859 Lake Worth Rd
Lake Worth, FL 33467 888-432-2467
Clearbrook Pennsylvania
1100 E Northampton St
Laurel Run, PA 18706 570-405-9934
Banyan Philadelphia
100 N Buckstown Dr, Suite 100E
Langhorne, PA 19047 888-219-0442
Clearbrook Massachusetts
83 Hospital Road
Baldwinville, MA 01436 978-307-6964
Banyan Castle Rock
1055 S Perry Street
Castle Rock, CO 80104
877-593-2912
Banyan Heartland
1237 E 1600 North Rd
Gilman, IL 60938
877-973-7262
Banyan Chicago
2525 Cabot Drive, Suite 300
Lisle, IL 60532
888-245-0974
Banyan Delaware
21 W Clarke Ave, #4001
Milford, DE 19963
888-900-9681
Banyan Palm Springs
67580 Jones Road
Cathedral City, CA 92234
760-642-1112
Banyan Texas
4168 Co Road 444
Waelder, TX 78959
844-611-5705
Banyan Alaska
4700 Begich Circle
Wasilla, AK 99654
888-966-9142