Harvard Pilgrim Health Care Coverage for Drug Rehab
Discover how Harvard Pilgrim Health Care covers addiction rehab and mental health services. Find the right plan for your needs today.
Harvard Pilgrim Health Care Coverage for Drug Rehab
Discover how Harvard Pilgrim Health Care covers addiction rehab and mental health services. Find the right plan for your needs today.
Harvard Pilgrim Health Care came into being after the merger of Harvard Community Health Plan and Pilgrim Health in 1994. They offer plans in Massachusetts, Maine and New Hampshire. You can get individual and family plans from Harvard Pilgrim directly or through your employer. They also have Medicare Advantage and Medicare Supplement plans for people who are eligible.
Does Harvard Pilgrim Health Care Cover Addiction Rehab?
Yes, may Harvard Pilgrim plans cover addiction rehab and the company has a number of treatment centers in their network. They also make it easy to find out what care providers they cover through their substance use services webpage. There are many levels of addiction treatment included in their network.
However, every insurance plan is different so be sure to verify your coverage details before you start treatment. You’ll want to get a treatment plan from your doctor as well because that will let you know what’s medically necessary in your case.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse
Adult ProgramYoung Adult Program
MonthlySelf-Pay OptionsPrivate insuranceFinancial Aid
I m writing this as a parent. After researching several residential facilities it became apparent Peaks in Colorado Springs stood out from the others. We were specifically looking for mental health treatment. From start to finish at their facility there was always involvement in what was going on, (with my adult daughter s permission of course). Having caring and knowledgeable people to help through an incredibly hard time was needed and so appreciated. Through different stages of her care there was visitation, phone calls and weekly Zoom type meetings where families of clients could talk together with a therapist about highs, lows or concerns. The hardest thing to do was feeling like you are handing over your loved one at such a vulnerable time and not knowing what s going on. Peaks has so much compassion in knowing that. Thank you to all who went above and beyond. From inquiring to admissions to all the financial stuff to treatment to food.Thank you for your tenderness and kindness.
Julie H
2 months ago
IT'S A YES. JUST GO.Unfortunately, an issue at home meant my stay ended early - there was a tragic miscommunication amongst staff the day before as well, which they handled with the utmost integrity. It was certainly the only snafu in my experience, and it rightfully belongs in the "sh*t happens" category. Staff had the humility and courage to own the mistake, and that willingness alone was enough to know that I had come to a place full of people who are truly the real deal when it comes to mental health.I left because I had to - not because I wanted to. In fact, I was planning on extending 30 days to complete their PHP, but life called me back home.Make no mistake - were it not for having to leave to handle something horrific back home (I'm from the other side of the country), I would still be there. I woke up this morning aching to go back to the safety, the compassion, the grace, and the mercy of Peaks. The staff are beyond wonderful. They sat with me through the darkest day of my life, and did nothing but love me. I can't describe how supported I felt. I could literally *feel* the empathy of the clinicians, nurses, and medical providers who sat with me and held space through the worst two panic attacks I've ever had.My housemates and I, and especially my roommate, wove a web of support and belonging I had never experienced. (Prior to admission, I literally could not get out of bed or do anything remotely social - I was even finding it hard to leave the house). I had the BEST time being part of a community, which gave me new confidence, and reassurance that I could get back into the game of life.I'm a therapist myself and I would 100% recommend Peaks as a committed, compassionate, caring healing space of the very highest quality. These people have their sh*t together.I have never encountered a place full of people who truly WANT to be there for you. Imagine being asked multiple times per day by staff if there is anything you need to feel supported. Being surrounded by people who know and care whether you've eaten that day, how you slept last night, and whether you need anything else to feel safe was pretty mind-boggling.I would trust Peaks to treat my nearest and dearest with zero hesitation. It will be the only mental health treatment center to which I refer my clients. Thank God for Peaks.Certainly I will forget to name some of the incredible staff, but Faith, Kinnley, Clint, Kara, Holly, Angela, Dr. Nichols, Sasha, JUDY, Cindy, Kyle, Pema, Julia, Chef, Taylor, Tara, Logan (x2), Heather, Eric, Marissa, the various therapists who led group, Bobby, Max in admissions, and Rachel - thank you for giving me a home, and at long last, an accurate mirror. Thank you also for tolerating my dirty blue hair and my massive disco fruit snuggie. I miss everyone already.Although I only got to stay for 10(ish) of the 30 days I had planned, the changes in me are real. I came into Peaks as a 47 year-old adult child, and left as a grown-up.Thank you, Peaks, for turning me back into me. Thank you for restoring my dignity. I will carry a piece of you in my heart always with immense gratitude. There is something spiritual in the particles and energy at this place that truly brought me back to life.
I loved it here. Such a great experience!! They are so nice and very helpful!!
Hailey Pyenta
1 week ago
A wonderful experience, the entire staff attended to all of my needs so I could focus on me while I was here. ❤️🩹 I’m fortunate to have found Spring Hill, they helped guide me in my treatment and getting ready for the next step. Thank you all!!!!!
Ryan O'Connell
4 weeks ago
This is an excellent residential program where you are not locked onto a unit. There is full access to the absolutely stunning campus. The staff is kind and can relate as most are also in recovery. The food is fantastic with home cooking by Matt, Jon & Eric. I received the best treatment through group therapy, individual therapy, family therapy & case management. The nursing staff is top notch & available 24/7. I highly recommend Spring Hill for the best substance abuse recovery experience out there.
I inquire about speaking to someone about an alcohol abuse evaluation. Within 5 min, Leslie called me back and we had a very informative conversation. Casco Bay wasn't the right fit for me, but Leslie pointed me in the right direction of who to contact. THANK YOU LESLIE!!
Scott Pinney
2 months ago
Staff is staked with heavy hitters in the recovery community. They go above and beyond to help their clients. If it s not the right fit, they will help you find somewhere else that is. If you re struggling with addiction I highly recommend giving them a call and seeing what they have to offer.
Markus
3 months ago
I am grateful for this program. It saved my life, now more than once. The connection, testimonies & struggles of others have helped me see myself in a brighter light in reference to my addiction to alcohol. The why's, The ifs, & all the questions my heart has are slowly being answered one step & one day at a time. Thank you Casco Bay Recovery & a special shout out to Jason who so promptly answered my text when I needed him most! Love you guy's
Any good story should start so there I was. So there I was, I was a meth user for 30 plus years and an alcoholic. I don't know we're to begin on how much starbridge helped me.. my mental health was shot by body was shot and my pride was shot I had been to countles facilities and programs during my 30 years of use and soon as i left I knew I was getting high. Something clicked here at starbridge recovery for me yes I have a 1 year old and a partner at home that I was trying to get clean for but the staff and faculty had me realize that I need to do first and for most for me than my family will reap the benefits of the real Tyson. I can go on and on about the good food from the private chef the heated pool the nurse on duty the technician that run groups and the counselor/psychiatrist,and the other clients that were there at my stay... but what really got me was soon as walked in the door the energy that overcame my body and In my belief the other countless souls of the people who came and left before me left a part of themselves there. And I knew that I was safe from whatever my problems were that they were gonna be taken care of I want everyone too know that starbridge recovery has saved me and has shown my family a new man one that they deserved for 30 years ..... thank you for saving my life everyone at starbridge and beyond. I now have a life without drugs and fighting mental health issues because they gave me the tools I needed to prevail and strive in my new clean sober life thank you and if anyone needs help or has doubts let starbridge take your hand and show you the path to sober life I give a 5 star cause Google doesn't have 10 thank you so much I can't say it enough sor saving me. Please call starbridge for you or a loved one don't hesitate it's never to late love your client Tyson kempfer thanks again and again........
Tyson Kempfer
2 months ago
This was the best recovery experience! This was not my first time in treatment and I thought that I knew what to expect. The groups were small and intimate. The staff and other clients were caring, empathetic, open minded and friendly. I was introduced to Smart Recovery which is a great alternative to 12 step programs. We attended 12 Step meetings as well. All the techs and counselors were committed to my success. My therapist Stephanie is a great listener! She heard my concerns and was able to present other perspectives that I hadn t thought of. The chef, Dean is a fabulous cook! Dustin, Evan, Leslie, Sam, Brittany, America were all essential in this process. They are all proof that the opposite of addiction is not sobriety but connection!
L J
3 months ago
Starbridge Recovery Center didn t just save my life they taught me to be the best version of myself I could ever imagine. Walking into Starbridge, I was broken and lost, but from the very first moment, I felt surrounded by compassion, warmth, and genuine support. The staff here goes above and beyond; they are more than just professionals they re real people who care deeply about each and every person who walks through the doors.Through their guidance, I didn t just recover; I discovered a new sense of self-worth and confidence that I never thought possible. They taught me essential tools, grounded in empathy and understanding, that I now carry with me every day. I ve left Starbridge with not only a new outlook on life but also with a strong foundation for a bright future. I am forever grateful to Starbridge Recovery for helping me find myself and become someone I m proud of.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult Program
Private InsuranceSelf-Pay OptionsFinancial Aid
As the parents of a loved one that received treatment in this program, we cannot say enough about the Immersion Recovery program. From Residential to PHP through IOP, not only was our loved one provided with an incredible amount of support and guidance in the journey to recovery, but the amount of support we received as a family was amazing. From the very first week we received support from the therapists, family therapists and many others along the way. Weekly virtual family group is held by the family therapists Larae and Todd for families to log in and gather in a safe and welcoming space with each other and receive support. There is also a 3 day intensive family workshop for interested families to come together with their loved ones. The constant family support aspect provided for us cannot be emphasized enough and we cannot imagine going through these months without it. Thank you from the bottom of our hearts to Larae, Erin, Todd and Ashley for your constant support, meetings, calls, advice, guidance and genuine care. Thank you to Sarah for answering just about any questions we ever had. We are forever grateful to you all.
Melissa R
1 week ago
I went to Immersion in January, this is my second treatment center i went too in the past two years, unlike the first one i went too Immersion is 12 step focused! They have specific groups in residential where you read the big book as well. They guided me through the steps and profoundly changed my life.
Today I celebrated 4 months of sobriety thanks to immersion! I went through there detox—residential-PHP and iop program.
If you want to change your life go to immersion they actually care and guide you through the steps.
Thank you Immersion!
william wooster
2 weeks ago
I would like to give a shout out to Immersion Recovery Center. All of the Staff here takes Recovery seriously. Immersion is one of the few programs that help and guide you through a thorough and in-depth 4th Step. They have specific 4th step personnel that will sit down with you and help you open your mind to all of the resentments you have had since your childhood. This helps to build a foundation for the remaining steps and helps you get on the right track towards a successful recovery. Addiction is Life or Death! This program will help you begin a new life beyond your wildest dreams! If you are serious about recovery I recommend Immersion Recovery Center.
It was a great experience that was truest life changing for me. I thank all the staff from top to bottom, amazing.
Eugene Moses
2 months ago
Staff including Erica T, Haylee, Ms. Karen, Kiersten, Nadya, Tom, Justin, and Mark just to name a few there were truly amazing people who gave me tools of success to recover from my drug addiction and to go back into this world a changed man. This is a great place if you wanna recover from you addiction. I ll never forget the wonderful experience I had here and knowing that even I can recover!
Connor Lepere
2 months ago
My experience here was awesome, helpful and needed. I recommend this place to alot. I'll miss the people and staff dearly.
I went to rehab while facing drug charges. First was Hazelden/Betty Ford. After five weeks, they wrote a letter to the judge on my case that said, Sam has emotional issues that we are unequipped to deal with. I transferred to a second dual diagnosis treatment center that was, similarly, unable to help me. With very little hope, I tried a third time, at Tranquil Shores. I can t pretend that it was an easy/totally smooth experience, but they were the first team to not give up on me. They were the only facility that actually lived up to their promise of individualized treatment. I have a graduate degree from one of the top universities in the world but the most important education I ever received was from Tranquil Shores. It s one of the only places I ve ever really felt welcome. I can t say enough good things about their program. If you or a loved one are lost and struggling, ready to give up, go to Tranquil Shores.
Sammy thrashLife
5 months ago
Out of all the treatment programs I have participated in, Tranquil Shores goes above and beyond in all areas to help a client succeed on their recovery path. Clinically, the team does an excellent job at addressing each area of life where mental health and substance abuse are affected. The overall atmosphere is one of care and it is the type of care that challenges someone to grow. I would only suggest Tranquil Shores to a friend or loved one in need of treatment. Best team ever!
Sam Hill
7 months ago
What a AWESOME experience during my recovery!! GREAT staff, OUTSTANDING therapists and great place for your recovery!!! Unforgettable experience in my 90 days recovery treatment, feeling GREAT!! 100% recommend. All of the people that works @Tranquil Shores have a space in my heart by helping me life sober. THANK YOU Tranquil Shores you guys went beyond above everything.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse
Adult ProgramYoung Adult ProgramLGBTQ Program
Private InsuranceSelf-Pay Options
I m extremely thankful for NPR. You all have tuned my life around for the good. You guy s gave me the tools to motivate me towards my sober lifestyle now. I would highly recommend this place to anyone that is wanting to make a new life of sobriety. The staff, counselors nurses are awesome.
L.R. Laursen
2 months ago
Great techs. Supportive of early recovery patients. The food was plentiful and good. They listen to criticism and react to it.
William Schreiber
2 months ago
Northpoint is great. All the staff, nurses and environment are inviting. I bonded with a lot of other clients Which was extremely helpful for my recovery. And the food is great I would recommend Northpoint to anybody looking for help.
The counseling and people that work there were just amazing
Erica Ewing
2 months ago
Restore saved my life at first I wanted to leave the 24 hour hold on my things was helpful kept me from making a bad decision and the staff was extra helpful and caring to my needs. The food was awesome. This day was great. Went to the ocean and also learned a lot about sobriety and how to use the tools that they gave me to stay clean for 112 days as of right now never thought I could do it thank you restore
Courtney Niles
3 months ago
Restore Health and Wellness Center provides compassionate, professional addiction treatment in a supportive environment. The staff is knowledgeable and truly cares about each individual's recovery journey. Their comprehensive approach makes a real difference for those seeking lasting change.
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What Are Harvard Pilgrim Health Care Plans?
Harvard Pilgrim Health Care offers individual and family plans on the state insurance Marketplace in Maine and Massachusetts along with New Hampshire. These plans are generally either health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
An HMO allows you to coordinate your care through a primary care physician (PCP) who gives you referrals for specialists like addiction or mental health professionals. Your doctor will also help you get preauthorization if necessary. You will need to seek care within the provider network.
For a PPO you can see in network specialists without a referral. A PPO also gives you the opportunity to see out of network providers but you will pay significantly more out of pocket. You may still need preauthorization for certain types of care.
If you have Original Medicare and need help with your out of pocket expenses you can get a Medicare supplement plan from Harvard Pilgrim Health. Another option is replacing Original Medicare with a Medicare Advantage plan. Advantage plans cover everything Original Medicare does and often offer additional benefits such as vision or dental coverage. However you generally need to use providers in the plan’s network and you may need preauthorization for certain services.
What Perks Come With Harvard Pilgrim Health Care Plans?
Harvard Pilgrim plans come with some helpful perks. For example you may have access to wellness programs and discounts and the Harvard Pilgrim mindfulness program. They also have telehealth options and experts such as nurses and social workers who can help answer your questions.
Another helpful perk is the discount they offer on complementary and alternative therapies. Certain plans allow you to get up to a 30% discount on alternative medicine services if you select a provider from the network they have partnered with.
What Inpatient Addiction Treatment Does Harvard Pilgrim Health Care Cover?
The first step to getting addiction care is for a provider or clinician to assess what level of care you need. If inpatient addiction treatment is the right level of care, they will recommend it to you. The assessing clinician will likely be the one who asks your insurance company for prior approval, but sometimes it’s your primary care provider who does that part. Either way, inpatient addiction treatment is very resource intensive, so most insurance companies want to make sure it’s the right place for you, thus the requirement for prior approval.
There are a couple of different types of inpatient addiction treatment that Harvard Pilgrim may cover for you. One inpatient treatment type is medical detox. The goal of detox is to get you safely through opioid or alcohol withdrawal. Treatment center staff medically monitor your progress and manage your symptoms. The length of time you’re there depends on how quickly you are able to detox, usually somewhere between three and ten days.
Once you’ve completed detox, you can start to focus on changing your behaviors to keep from relapsing. You may be referred to residential rehab to work on developing these skills. The structured environment of residential rehab is designed to help break behavioral patterns that lead to using or drinking. The groups teach you about addiction and how to prevent relapse. A stay most commonly lasts for three to four weeks but can go longer.
What Outpatient Rehab Does Harvard Pilgrim Health Care Cover?
You can find a number of outpatient addiction treatment centers with Harvard Pilgrim’s network. Below are some of the treatment types you might be able to find.
The most intensive type of outpatient treatment is partial hospitalization. This type of treatment looks very much like residential rehab. You’re usually there all morning and all afternoon. The one big difference is you go home in the evening and on weekends. Since you have large chunks of time when you’re not in a supervised setting, this is a good option for people who can go a few hours or days outside a structured program without relapsing.
The next level down is intensive outpatient. This level usually requires a two or three time a week commitment for a couple of hours each day. The programming usually consists of groups and individual sessions where you learn and practice relapse prevention strategies.
Standard outpatient treatment is the level of care that most people are familiar with. This usually involves enrolling in a program where you see a therapist and a psychiatric provider. They may offer some groups you can choose to attend. You and your providers will determine how frequently you’ll meet.
Does Harvard Pilgrim Health Care Cover Methadone & Suboxone (MAT)?
Methadone and Suboxone are two FDA approved medications that treat opioid addiction. They can be used to help you stop opioids or as a maintenance treatment to help prevent you from relapsing during treatment.
These medications and others are sometimes used within a detox program. When they’re used this way your insurance plan will have the same coverage as it has for detox.
Suboxone and methadone are also used for maintenance treatment. This is when you receive these medications to keep you from going into withdrawal. Suboxone can be prescribed by your primary care or psychiatric provider. If this treatment is appropriate for you, your insurance plan may cover it as an outpatient treatment.
Another way to get Suboxone and the only way to get methadone is to go to a specialized opioid treatment clinic. Harvard Pilgrim has several of these clinic types within their network, and may cover this service if you’re eligible. Be sure to check your insurance plan for details before starting treatment.
Does Harvard Pilgrim Health Care Cover Other Mental Healthcare?
Harvard Pilgrim may cover a variety of different mental health services. Some of the acute services you may find in their network include inpatient psychiatric hospitalization for people of all ages from children to older adults. Some emergency departments have specialized crisis services that Harvard Pilgrim may also cover.
Certain plans may cover in home behavioral interventions for children and adolescents where the service is available. They also have providers who work with people who have autism including providers who use applied behavioral analysis.
People who find it difficult to travel to appointments may appreciate Harvard Pilgrim’s telehealth services benefit. This benefit allows you to see a provider online instead of going in person. Harvard Pilgrim partners with a telehealth only service provider but many brick and mortar offices offer telehealth too.
If you’re having trouble finding a provider Harvard Pilgrim can help connect you to someone through their case management service. If you just want some reliable information about a health condition their website includes a library of information you can access.
How Long Will Harvard Pilgrim Health Cover Rehab?
The length of treatment in most levels of care can be very individual. There is often some level of reassessment happening every few days. It’s common for residential treatment to last for three to four weeks for most people but some may stay up to 90 days.
Other programs like partial hospitalization and intensive outpatient also have highly variable lengths of stay. These programs can continue from weeks to months. Together with your treatment team you’ll be involved in setting the treatment goals that will inform your length of stay. You’ll get the best results if you participate fully in the goal setting stage and the totality of your treatment.
Can I Travel Out of State For Treatment With Harvard Pilgrim Health?
Your individual plan will determine whether you can travel out of state for treatment. Harvard Pilgrim’s network tends to be more concentrated in the states they operate in which are Massachusetts and Maine and New Hampshire. They do have one plan that is specific for families with dependents living out of state such as those who have a child in college. That plan has out of state options.
Some of Harvard Pilgrim’s plans will not allow you to seek care out of network at all even within your state. Plans that do allow you to go out of network will usually have higher copays and deductibles if you go that route. Those fees are generally much more than what they would have been had you received care from inside their network. If you are able to stay within their network for care you will be able to avoid these additional fees. If you do decide to get care from out of network pay special attention to your plan details to avoid surprises.
How to Verify Coverage With Harvard Pilgrim Health
You have a few options to verify what services your Harvard Pilgrim plan covers. One option is to call their customer service line and ask about the service you’re interested in. You can also log in to your account online and check if a service provider is part of your plan network.
One more way you can check is to speak directly to the service provider you would like to see and ask them to verify that they’re covered under your plan. Whichever of these options you choose to use it’s important to check using the name of your specific plan since different plans within Harvard Pilgrim have different provider networks.
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By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
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