Addiction Treatment

Mental Health Treatment

MaineHealth Healthy Select Plan Coverage for Mental Health & Addiction Treatment

If you receive health care from the MaineHealth network or are enrolled in a plan such as the Healthy Select Plan, then it’s possible that you will be able to get treatment options such as substance abuse treatment, mental health care, and rehabilitation treatment. You need to ensure that you check your plan first before you begin treatment because your plan may cover some or all of these treatments.

MaineHealth is a regional health care organization providing health care services throughout the state of Maine. They provide various health care options including behavioral health care services, which you can get by being part of their insurance plan.

MaineHealth Healthy Select Plan patients should know this:

Coverage check made easy – our admissions department will confirm your insurance cover with Aetna in no time.
No commitment – your insurance check will be done at zero cost and does not bind you to any treatment.
Privacy – we ensure all your information remains confidential.

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Verify Insurance

How Behavioral Health Benefits Work with MaineHealth Coverage Plans

Since most MaineHealth insurance policies including Healthy Select operate under Aetna’s guidelines, their behavioral benefits like therapy, mental health medications, and addiction recovery treatment apply Aetna’s guidelines.

With the Mental Health Parity and Addiction Equity Act (MHPAEA), your coverage plan should be required by law to cover both the mental health and addiction recovery as any other medical issues.

Some of the things that could affect the behavioral benefits coverage include:

Type of plan (HMO, PPO, POS, and self-funded plan)
Network restrictions (in-network and out-of-network)
Prior authorization
Criteria for medical necessity

When considering inpatient or residential treatment, the plan requires you to get prior authorization, and verifying whether your doctor or facility is in the plan's network would make everything easier.

For individuals residing in Maine and seeking behavioral health care, it is critical to begin by analyzing your plan thoroughly.

Verify Insurance

What Substance Abuse Treatment Services Are Covered?

Substance abuse treatment services available under MaineHealth affiliated plans can depend on your specific coverage and need, but here is what is often covered:

Inpatient & Residential Rehab

24-hour care for substance use disorders and psychiatric conditions provided at facilities such as Clearbrook Pennsylvania.

Outpatient Treatment

Structured outpatient therapy sessions and other treatment provided at Banyan Philadelphia and Clearbrook Pennsylvania for those transitioning from higher care settings and initiating outpatient treatment.

Aftercare & Continuing Care

Even after the primary treatment phase is complete, you will still have access to aftercare services, which will include relapse prevention and assistance accessing community-based support services.

Note: Keep in mind that your specific treatment setting and length of stay depend on medical necessity and authorization.

Are Mental Health and Therapy Covered by the MaineHealth Healthy Select Plan?

Absolutely! If you have a plan under the MaineHealth umbrella, chances are mental health coverage is included in it. It addresses depression, anxiety, trauma, drug abuse, and even the more complicated cases involving overlapping issues.

These include:

Individual counseling sessions
Group counseling sessions
Family therapy
Dual Diagnosis
Mental health services

Inpatient Mental Health Coverage

When it comes to inpatient treatment, you are covered by the same policy provided that your case warrants this type of treatment and your insurance plan approves it.

If you have an HMO plan, you may have to seek a referral from your doctor before proceeding. At Clearbrook Pennsylvania, we admit clients who require inpatient mental health treatment.

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How Much Will My Rehab Services Cost With a MaineHealth-Related Insurance Plan?

Depending on your insurance plan, choice of facilities, and level of care, rehab services can cost significantly. Even if you have insurance coverage, you will likely incur some expenses during your stay in our facility.

Factors that determine the cost include:

Use of in-network versus out-of-network providers
Deductibles, copays, and coinsurance
Medical necessity and prior authorization
Care level (detoxification, inpatient, and outpatient)
Type of insurance planIn-network vs. out-of-network providers

What You Can Do Right Now

The ideal step is to assess your insurance coverage. Our admissions specialists will be able to review your insurance policy and discuss your benefits.

Questions? Get help now

If You Contact Your Plan Administrator, 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 with the MaineHealth Healthy Select Plan

Banyan accepts the following insurance plans at two facilities:

Clearbrook Pennsylvania — Laurel Run, PA
Banyan Philadelphia — Langhorne, PA

Services include:

Substance use inpatient treatment
Mental health inpatient and outpatient care

If you want to see what other options are available, check out our facility finder online.

Admissions will help with verifying insurance coverage and providing a treatment plan based on your unique requirements.

In the verification process, there will be a clinical assessment. The clinical assessment will evaluate your history of substance use, mental health condition, and insurance coverage for inpatient treatment, detoxification, or residential care.

For HMO plans, a referral from your primary physician may be necessary.

Getting Matched to the Right Level of Care

The appropriate level of care begins with the clinical assessment. This will determine which form of care is best for your situation.

Next Steps: Verify your Harvard Pilgrim coverage or call admissions to speak with a specialist today.

Questions? Get help now

Frequently Asked Questions

1Is therapy included in the MaineHealth Healthy Select Plan?

Typically yes. When it is considered medically necessary, you should find that individual therapy, group therapy and family therapy are covered by the plan.

2Is telehealth addiction treatment included in the MaineHealth Healthy Select Plan?

Telehealth addiction treatment is often available, but it will depend on your plan. Banyan Treatment Centers, for example, utilize telehealth as a part of treatment.

3Is psychiatric care included in the MaineHealth Healthy Select Plan?

Yes. It can often include psychiatric assessments, medication management, inpatient psychiatric care when medically necessary, among others.

4How do I verify a provider accepts the MaineHealth Healthy Select Plan?

Search your plan administrator's network or contact Banyan’s admissions team for verification.

5Which rehabs accept the MaineHealth Healthy Select Plan?

Clearbrook Pennsylvania and Banyan Philadelphia accept the MaineHealth Healthy Select Plan at the facilities.

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

6Does the MaineHealth Healthy Select Plan cover inpatient rehab?

Inpatient rehab is typically covered as long as it is considered medically necessary and goes through the process of approval through the plan.

7How long will the MaineHealth Healthy Select Plan pay for rehab?

There is no set length of stay, but rather ongoing clinical reviews. The time in treatment is determined by the need for medically appropriate treatment.

8Verify your MaineHealth Healthy Select Plan Benefits Today

Your actual coverage will depend on the specific plan you hold, your eligibility, your specific medical need. Banyan Treatment Centers is able to help you with verifying coverage for you if you have a MaineHealth Healthy Select Plan.