Highmark Insurance for Addiction Treatment

The Guardian Intensive Outpatient Program in Delray Beach Florida offers comprehensive gender-specific and age-specific treatment programs for adults recovering from substance abuse. The Intensive Outpatient Program (IOP) offers structure and programming similar to residential treatment facilities, while allowing clients to return to their home, or a sober living facility each evening.

Although choosing an IOP can often be a much less expensive option than residential treatment, Guardian IOP programs may still be covered by your insurance provider, and in some cases, an outpatient program may be required before an insurance provider will provide coverage for residential treatment. For assistance clarifying your coverage and payment options, please contact a Guardian IOP Recovery Specialist who can help you understand your specific insurance benefits.

At Guardian IOP, Highmark Health is one of many insurance providers we work with to ensure an affordable, stress-free recovery plan. Cost should never be a barrier to life-changing treatment, which is why we accept most major insurance plans, including Highmark. Highmark Health was founded in 1977 and offers coverage for a wide range of personal issues, including substance abuse treatment, through Highmark Behavioral Health benefits. Your Highmark policy may operate under a different brand name depending on your home state or particular plan. Highmark Inc, Highmark BCBS, and Highmark Blue Shield are all plans under the Highmark Health network.

 

Highmark Behavioral Health Services cover the cost of some, or all, treatments associated with your Guardian IOP treatment plan, including group and individual therapy, family therapy, cognitive behavioral therapy and dialectical behavioral therapy, as well as relapse prevention training. The Highmark Behavioral Health benefit offers substance abuse treatment and counseling for a variety of stressful and challenging situations including depression, PTSD, anxiety and/or anger issues, and help coping with loss/grief. Benefits frequently extend to sober living facilities, as well as Intensive Outpatient Programs, such as those offered by Guardian IOP.

Depending on the specifics of your Highmark plan, whether HMO or PPO, and the details of your individualized treatment plan, you may be responsible for a deductible and/or co-pay. Typically, HMO plans have more restrictive referral requirements and benefits are maximized when patients remain within the network of preferred providers. Highmark insures over 4.5 million Americans world-wide, and their network includes the Blue Cross Blue Shield network of hospitals, doctors and care providers.

Plans offered through the Healthcare Marketplace must cover behavioral health treatment, cannot deny you coverage due to pre-existing conditions, and have no yearly or lifetime dollar limits on substance abuse treatment. In addition, pre-authorization or referral requirements can’t be any more restrictive than those in place for any other medical or surgical procedure. In fact, some health insurers prefer patients seek treatment at an Intensive Outpatient Program if deemed appropriate. A Guardian IOP pre-admissions specialist can ensure that an IOP program is right for you with just a 20-minute phone call.

The specifics of your Highmark Health plan are outlined in the ‘Summary of Benefits and Coverage’ (SBC) provided to you by Highmark. This includes an overview of what’s covered, deductible and co-pay or co-insurance requirements, and statements on whether or not your plan meets the minimum Affordable Care Act (ACA) requirements for essential coverage, including substance abuse treatment and minimum coverage – defined as 60% of medical costs.

The quickest and easiest way to find out if your Highmark plan can reduce the financial burden of your Intensive Outpatient Program is to speak with a Guardian IOP Specialist today. A Guardian IOP Recovery Specialist can help you understand your Highmark coverage and determine your financial responsibilities, if any. Contact us online or call (877) 412-9068. With just a 20 minute phone conversation, we can determine if our Intensive Outpatient Program is right for you, if your needs include treatment for any co-occurring mental health disorders, and what your financial responsibility will look like while in our care at our Delray Beach location.