Addiction Treatment

Mental Health Treatment

Keystone First Coverage for Mental Health & Addiction Treatment

If you are enrolled in Keystone First, your plan may help cover addiction treatment and mental health care services. This page outlines what Keystone First members should know about coverage for detox, inpatient/residential, and outpatient care, and how to verify benefits.

What Keystone First members should know

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Does Keystone First Cover Drug & Alcohol Rehab?

Keystone First health insurance may offer drug and alcohol treatment as part of its behavioral health benefits. Under the Mental Health Parity and Addiction Equity Act (MHPAEA), mental health and substance use treatment must be covered at levels comparable to medical care.

As a Medicaid managed care plan in Pennsylvania, Keystone First provides behavioral health services through in-network providers.

Key considerations include:

In-network requirements: Keystone First operates as an HMO, so members must use in-network providers for non-emergency care
Primary Care Provider (PCP): Members must select a PCP who coordinates care and provides referrals
Referral requirements: A PCP referral is typically required for behavioral health services
Plan variability: Coverage depends on eligibility and specific Medicaid plan details

Coverage is based on medical necessity and plan guidelines, so verifying your benefits before starting treatment is recommended.

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What Addiction Treatment Services May Be Covered by Keystone First?

Depending on your plan and clinical needs, Keystone First may cover multiple levels of addiction treatment:

Medical Detox

Supervised care to manage withdrawal symptoms. Coverage depends on medical necessity and authorization.

Inpatient / Residential Rehab

Residential Rehab: Structured, 24/7 care for substance use and co-occurring mental health conditions. May require pre-authorization and referral.

Partial Hospitalization Programs (PHP)

Day treatment with clinical support while returning home at night, when approved.

Intensive Outpatient Programs (IOP)

Structured therapy several times per week, including telehealth-based IOP options.

Standard Outpatient Treatment

Therapy, counseling, and scheduled appointments for substance use and mental health care.

Aftercare / Continuing Care

Ongoing therapy, relapse prevention, and long-term recovery support

Note: Length of stay and level of care are typically based on medical necessity and Medicaid guidelines.

Does Keystone First Cover Mental Health Treatment and Therapy?

Keystone First plans generally include behavioral health services for mental health and co-occurring disorders.

Covered services may include:

Therapy and counseling: Individual therapy, group therapy, and mental health support
Psychiatry and medication management: Services that support diagnosis and treatment of mental health conditions, including medication-assisted treatment when appropriate

Inpatient Mental Health Coverage

Keystone First may cover inpatient or residential mental health treatment depending on medical necessity and plan eligibility. Authorization and PCP referral are often required.

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How Much Does Rehab Cost With Keystone First?

The cost of rehab with Keystone First depends on your Medicaid eligibility and plan coverage. Many services may be covered when they meet medical necessity requirements.

Factors That Affect Your Out-of-Pocket Cost

In-network provider requirements
Medicaid eligibility and plan structure
Referral and authorization requirements
Level of care (detox, inpatient, outpatient)
State-specific Medicaid guidelines

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 any potential costs before starting treatment

Questions? Get help now

If You Call Keystone First Directly, Ask:

Is detox covered? Inpatient/residential care? PHP or IOP?
Do I need a referral from my PCP?
Do I need pre-authorization?
Am I in-network at this facility?
What services are covered under my plan?
Are there limits on treatment duration or visits?

Or, We Can Verify for You (Recommended)

Provide your Keystone First member ID and plan details
Banyan verifies your coverage, including referral and authorization requirements
Get guidance on next steps and the appropriate level of care

How to Find Treatment That Accepts Keystone First

“Accepting” Keystone First typically means working with in-network providers and meeting referral and authorization requirements under Medicaid guidelines.

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 Keystone First cover detox?

Keystone First may cover detox services when they are medically necessary and approved under Medicaid guidelines.

2Does Keystone First cover inpatient rehab?

Depending on your plan and medical need, Keystone First may cover inpatient or residential rehab, often requiring referral and authorization.

3Does Keystone First cover outpatient rehab (PHP/IOP)?

Keystone First typically covers outpatient behavioral health services, including IOP and therapy programs.

4Does Keystone First cover therapy and counseling?

Yes, Keystone First includes therapy and counseling as part of its behavioral health coverage.

5How long will Keystone First pay for rehab?

Coverage duration is based on medical necessity and Pennsylvania Medicaid guidelines, with treatment authorized in stages.

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

6Do I need prior authorization for rehab?

Yes, authorization is typically required, along with a referral from your PCP in many cases.

7What’s the difference between in-network and out-of-network costs?

Keystone First primarily covers in-network care, with out-of-network services generally limited to emergencies.

8Can I use Keystone First for mental health treatment?

Yes, Keystone First provides coverage for mental health and co-occurring disorder treatment.

9Can I get virtual/telehealth services with Keystone First?

Telehealth services, including virtual IOP and therapy, may be available through approved providers.

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

Verify Your Keystone First Coverage for Treatment

You don’t have to navigate this process on your own. Our team can review your Keystone First benefits with you, explain what treatment options may be available, and help you understand any requirements for care. We’re here to guide you through the next steps so you can move forward with confidence.

Questions? Get help now