How to Pay for Addiction Treatment With Harvard Pilgrim of Massachusetts Insurance Plans
If you’re a member of Harvard Pilgrim of Massachusetts and you’re searching for a place to begin your recovery, there’s a good chance you can get it covered using the plan you already have.
Even if you know coverage is likely, it’s still important to figure out the details of your behavioral health insurance before entering treatment.
Most Harvard Pilgrim plans cover substance abuse treatment, it’s true. But there are exceptions, so you need to know the details—every plan is different.
No one can predict what your coverage will look like, but you can learn how to find out the details and know what to expect from rehab insurance.
Learn how to pay for addiction treatment with Harvard Pilgrim of MA:
Will My Addiction Treatment Be Covered By My Harvard Pilgrim of Massachusetts Insurance Plan?
Harvard Pilgrim of Massachusetts covers most medically necessary addiction treatment.
Like all insurance providers, Harvard Pilgrim is bound by the Affordable Care Act.
This 2010 bill dictates that no insurance company can discriminate (i.e. deny medically necessary coverage) to any person based on a pre-existing condition.
Substance use disorder and all its forms are considered pre-existing conditions. That means insurance companies legally can’t deny you coverage as long as they can verify that the treatment is medically necessary.
That doesn’t mean that all addiction treatment is completely covered. The level of coverage varies depending on the plan’s tier and whether the provider is in-network.
To get coverage, you need to meet Harvard Pilgrim’s standards to show that treatment is medically necessary.
That usually means:
- Visiting your family doctor for a diagnosis
- Getting a referral to treatment
- Completing a prior authorization process, which is usually done by your insurer and treatment center
Exceptions to the Affordable Care Act
The Affordable Care Act does not require the following types of rehab health insurance plans to cover treatment for pre-existing conditions:
- Grandfathered plans: If you bought a plan before the ACA went into effect on March 23, 2010, that plan is not required to cover pre-existing conditions.
- Short-term plans: Policies that cover a short lapse in insurance coverage may not cover pre-existing conditions like substance use disorder, or your out-of-pocket costs could be higher.
If you have one of these types of plans, you might not get coverage for addiction treatment. However, the majority of Harvard Pilgrim plans do cover treatment.
How to Check Harvard Pilgrim of Massachusetts Addiction Treatment Coverage
Addiction treatment coverage can be very different from plan to plan, even within the same provider like Harvard Pilgrim of Massachusetts. The only way you can know your coverage is by checking it!
You can do this in a few ways:
Check Member Dashboard
The Harvard Pilgrim of Massachusetts website features a Member Dashboard that you can log into for exclusive access if you’re a current member.
Here, you can browse specific information about your own plan, including what behavioral health services are covered and which ones aren’t.
Check Find a Provider
You can see if treatment with a local provider is covered without logging in to the Harvard Pilgrim of Massachusetts website. The Find a Provider feature allows you to search by location and specialty.
This feature won’t show you what programs and services are covered, but it will show you which addiction treatment providers in your area work with Harvard Pilgrim. That can give you a starting point to find more information.
Call or Email Behavioral Health Access Center
You can get help from the Member Services team’s Behavioral Health Access Center. These staff members are specifically trained to give expert support on insurance for mental health treatment, including addiction.
As of December 2020, you can reach the Behavioral Health Access Center by phone at (888) 777-4742. You can also visit the Contact Us page on the Harvard Pilgrim of Massachusetts website to send a secure email.
Call or Email Treatment Admissions Office
Most rehab treatment centers have an Admissions office that’s happy to help you navigate your insurance coverage. All you have to do is call or email.
Admissions staff will take your insurance information and get in touch with Harvard Pilgrim of Massachusetts to verify what’s covered. From there, they’ll let you know your coverage and the next steps on your part.
How Does Harvard Pilgrim of Massachusetts Rehab Coverage Work?
Rehab coverage with Harvard Pilgrim of Massachusetts works the same way other types of insurance coverage do. Your treatment provider usually navigates most of the insurance process for you, but it’s good to know what to expect.
The steps include:
- Confirming your coverage
- Getting referrals or prior authorizations
- Submitting insurance claims
- Finding your out-of-pocket cost
Checking Addiction Treatment Coverage With Harvard Pilgrim of Massachusetts
Before you start the process of getting your treatment covered, you’ll need to know the details about your coverage. You can check your insurance coverage by:
- Calling the phone number on your insurance card
- Talking to your treatment center
- Logging in to the Members Portal on the Harvard Pilgrim of Massachusetts website
Referrals and Prior Authorizations With Harvard Pilgrim of Massachusetts
Insurance companies usually require prior authorizations and referrals before paying for addiction treatment, and Harvard Pilgrim is no different.
A prior authorization is a form that your doctor submits to the insurance company stating that your treatment is medically necessary and showing why.
If your Harvard Pilgrim plan requires a prior authorization, your treatment provider will most likely handle the process.
You may need to have referrals to treatment from a behavioral health specialist or family doctor. These referrals serve as proof of medical necessity, which helps Harvard Pilgrim decide to approve your prior authorization.
Submitting Claims to Harvard Pilgrim of Massachusetts
Once Harvard Pilgrim approves your prior authorization, the next step is submitting a claim so your insurance provider can pay for the services you received.
A claim is a form describing the medical treatment that you received and the reason you needed it.
In most cases, your treatment provider handles the claim submission process. If you need to take any action, your treatment provider will let you know.
Finding Your Out-of-Pocket Cost After Harvard Pilgrim of Massachusetts
When your claim is approved, you have enough information to find your out-of-pocket cost of treatment.
Harvard Pilgrim will let you know the extent of your coverage by sending you an Explanation of Benefits in the mail. This document describes which services Harvard Pilgrim covered, at what rate, and whether there’s a balance.
If you have partial coverage, your provider will let you know so you can plan around your out-of-pocket cost.
Do Harvard Pilgrim of Massachusetts Insurance Plans Cover Addiction Treatment?
Most Harvard Pilgrim insurance plans cover addiction treatment. The amount of coverage and types of plans covered might vary from plan to plan.
To find out the specifics of your plan, call the phone number for Member Services on your insurance card.
Does Harvard Pilgrim of Massachusetts Cover Detox Programs?
Most Harvard Pilgrim of Massachusetts plans cover detox programs. That’s because detox is usually considered a medically necessary part of addiction treatment.
Whether Harvard Pilgrim covers a detox program depends on:
- If the rehab is an approved treatment provider
- If the treatment provider is in or out of network
- If the detox program uses medically proven treatment
As long as you follow the process for getting detox covered, it’s likely that Harvard Pilgrim will pay for your program.
Depending on your plan, your coverage could be partial or full. To get the details for your policy and plan, call Member Services at the phone number on your insurance card.
Does Harvard Pilgrim of Massachusetts Cover Inpatient Treatment Programs?
In most cases, Harvard Pilgrim of Massachusetts covers inpatient treatment programs. Like detox, inpatient is medically necessary for many people with substance use disorder.
Harvard Pilgrim makes decisions about inpatient rehab insurance coverage based on:
- Your diagnosis and medical need for treatment
- Any referrals to treatment that you have
- Whether you selected an approved rehab and program
Like always, you need to follow the prior authorization and claims process to ensure your inpatient treatment is covered.
If your plan does cover treatment, that coverage could be partial or full. Confirm your Harvard Pilgrim of Massachusetts addiction coverage by calling the phone number for Member Services on your insurance card.
Does Harvard Pilgrim of Massachusetts Cover Medication-Assisted Treatment?
Harvard Pilgrim of Massachusetts policies usually cover medication-assisted treatment, but you should check your plan to be sure.
For many people with addiction, medication-assisted treatment is a medically necessary part of treatment and recovery. Your medication-assisted treatment is likely to be covered if it’s considered medically necessary.
What Types of Addictive Substances Are Covered by Harvard Pilgrim of Massachusetts Insurance?
When it comes to covering addiction treatment with Harvard Pilgrim of Massachusetts, your diagnosis is more important than the substance you’re recovering from using.
As long as you have a diagnosis of substance use disorder or a similar disorder like stimulant use disorder, it’s likely that Harvard Pilgrim will cover your treatment regardless of the type of substance.
Some substance treatment types that people get coverage for include:
- Alcohol addiction treatment
- Cocaine addiction treatment
- Meth addiction treatment
- Prescription drug addiction treatment
- Heroin addiction treatment
Always check with Harvard Pilgrim of Massachusetts to find your exact coverage before selecting a program!
Does Harvard Pilgrim of Massachusetts Cover Alcohol Addiction Treatment?
Most Harvard Pilgrim of Massachusetts insurance plans cover alcohol addiction treatment.
Alcohol addiction is also called alcohol use disorder, which is a pre-existing condition. That means long-term plans (i.e. nearly all plans) are required to cover medically necessary treatment for alcohol addiction.
Check with Member Services to find your exact coverage for alcohol addiction treatment. Some plans offer full coverage for alcohol treatment, but many policies include partial coverage, so it’s important to know what to expect.
Many plans cover:
- Alcohol detox programs
- Alcohol inpatient residential programs
- Medication-assisted treatment for alcohol addiction
Does Harvard Pilgrim of Massachusetts Cover Cocaine Addiction Treatment?
Harvard Pilgrim of Massachusetts usually covers cocaine addiction treatment.
If you have a diagnosis of stimulant use disorder or substance use disorder, then your provider can most likely justify treatment as medically necessary. That means it’s covered under the Affordable Care Act.
Of course, check with Harvard Pilgrim of Massachusetts to find your exact coverage. It varies from plan to plan, but you may be eligible for full or partial coverage.
Your treatment coverage may include:
- Cocaine detox programs
- Inpatient treatment for stimulant addiction
Medication-assisted treatment is not usually covered for cocaine addiction. As of 2020, there are no medications available that are approved to treat stimulant use disorder.
Does Harvard Pilgrim of Massachusetts Cover Heroin Addiction Treatment?
Most plans with Harvard Pilgrim of Massachusetts cover heroin addiction treatment. There are always exceptions, so be sure to check with Member Services about your full coverage details.
Many types of heroin addiction treatment are considered medically necessary if you have an opioid use disorder. That means many (but not all) Harvard Pilgrim plans must cover your treatment.
That coverage could be full or partial, depending on what’s included on your policy. There are plans that offer full coverage, but partial coverage for addiction treatment is more common.
The substance abuse treatment that’s covered varies from plan to plan, but it might include:
- Medical detox from heroin
- Inpatient heroin treatment
- Medication-assisted treatment for heroin addiction
Does Harvard Pilgrim of Massachusetts Cover Prescription Drug Addiction Treatment?
Most plans with Harvard Pilgrim of Massachusetts cover prescription drug addiction treatment. Some grandfathered plans and all short-term plans are unlikely to cover treatment, but these plans are rare and you probably don’t have one.
If you live with prescription drug addiction, you might have stimulant use disorder or opioid use disorder. Harvard Pilgrim of Massachusetts is required to cover medically-necessary treatment for people with pre-existing conditions, including substance use disorders.
Some plans offer full coverage, but partial coverage is more likely. The treatment programs that are covered could include:
- Opioid or stimulant detox programs
- Residential treatment for opioid or stimulant addiction
- Medication-assisted treatment for opioid addiction
Does Harvard Pilgrim of Massachusetts Cover Meth Addiction Treatment?
Harvard Pilgrim of Massachusetts may cover meth addiction treatment.
The Affordable Care Act says that insurance companies must cover treatment for people with pre-existing conditions. Substance use disorders count as pre-existing conditions, so as long as your plan doesn’t have an exception, it’s likely that your treatment will be covered.
Some of the programs covered include:
- Methamphetamine detox programs
- Residential or inpatient programs for stimulant addiction
However, Harvard Pilgrim does not cover medication-assisted treatment for meth (though they do for alcohol and opioids). MAT is not an evidence-based treatment for stimulant use disorder, and insurance companies only cover proven treatment methods.
The amount of coverage varies depending on your plan. You can find out whether you have full or partial coverage for meth addiction treatment by calling the Member Services phone number on your insurance card.
Do Treatment Centers Need to Be In-Network?
Depending on your exact plan with Harvard Pilgrim of Massachusetts, you may need to choose a treatment center that’s in network.
In-network simply means that the treatment center is part of Harvard Pilgrim’s approved system of providers.
Some insurance policies allow you to choose treatment providers that are out-of-network, but you might pay higher copays or coinsurance costs as a result.
Other insurance plans require that you choose a provider that’s in-network without any exceptions.
PPO Treatment Networks with Harvard Pilgrim of Massachusetts
Preferred Partner Organizations are flexible health insurance plans that give you the option to choose a treatment center that’s out of network.
PPO plans typically cost more than HMO plans in premiums and out-of-pocket costs, and you don’t need a referral for coverage in most cases (but you might still need a prior authorization).
If you choose a treatment center that’s out of network, the coinsurance or copay will be higher and there might be a separate deductible. You might also need to file your own claims, which means paying the treatment center directly and getting reimbursed.
Check with Member Services to confirm your out-of-pocket costs if you’re considering an out-of-network treatment center.
HMO Treatment Networks with Harvard Pilgrim of Massachusetts
Health Maintenance Organizations are affordable health insurance plans that require you to choose an in-network treatment center.
With an HMO, you need a referral for every specialty service, including addiction treatment. That means you need to see your primary care doctor before coordinating a rehab stay.
These plans have low monthly premiums and low out-of-pocket costs. The only downside is that you can’t get coverage for out-of-network treatment at all.
How Can I Pay the Costs Not Covered By My Harvard Pilgrim of Massachusetts Plan?
A few Harvard Pilgrim of Massachusetts policies may cover addiction treatment in full, but it’s far more common to have partial coverage, which means out-of-pocket costs.
You can request an Explanation of Benefits from Harvard Pilgrim to see the full details of what’s covered and to what extent. Once you know your financial responsibility, you can start deciding how to handle it.
Some resources include:
Rehab scholarships are private gifts or grants for addiction treatment. These scholarships place you with an approved treatment center and cover the cost of your rehab stay. Because it’s a grant, you don’t have to pay it back!
Because so many people need help, rehab scholarships are very competitive. It’s common for there to be specific guidelines to narrow down who can apply.
The guidelines are different for every scholarship, but may include:
- You’re currently living with addiction
- You want to be in recovery
- You’re ready to attend treatment
- You’re committed to attending the full 90 days (or whatever length) of treatment
- You have a support system waiting for you after treatment
There are many rehab scholarships that come from private organizations, including recovery groups and religious groups. 10,000 Beds is the most well-known rehab scholarship, but applications are limited to certain days, so it can be hard to get your foot in the door.
It’s important to apply for rehab scholarships as early as possible, since you need treatment right away. You might not hear back from a private scholarship for weeks or months, so you should have a backup plan in case you can’t wait longer.
State Addiction Resources
Most states have their own network of addiction resources, which can be very different from state to state.
Your state may offer publicly-funded rehab treatment at a state-run facility—at no cost.
The only downsides (which can be major) are:
- State rehabs can be understaffed and underfunded, which means the treatment experience is probably not ideal; and
- State rehabs can have a long waiting list, and you might not be able to wait that long to start recovery. In fact, you should get treatment as soon as you feel ready!
Other state addiction resources can include:
- Addiction crisis hotlines
- Opioid overdose prevention programs and kits
- Referrals to local addiction centers with affordable treatment
To find your own state’s resources, check the Department of Health or Mental Health & Addiction Services Department.
Local Recovery Communities
It’s common for your city or region’s local recovery community to help people who need treatment, whether it’s directly or by connecting them with a resource.
The exact resources depend on your area and the organizations that have a presence there.
For starters, most cities have 12 Steps, Alcoholics Anonymous, YMCA, YWCA, and religious communities that are welcoming to people who need addiction treatment resources.
Get Treatment at Bedrock Recovery Center
Located in Canton, MA, the Admissions team at Bedrock Recovery Center can verify your Harvard Pilgrim of Massachusetts insurance coverage.
When you choose Bedrock to start your recovery, you get access to:
- A team of experienced addiction professionals
- A homelike campus in Canton, MA
- Close proximity to Boston
- Close proximity to Boston Amenities including on-site laundry, outdoor recreation, and yoga
- Five-star food services, plus an on-site Starbucks
Call Bedrock Recovery Center today so we can help you verify your coverage!