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Harvard Pilgrim Insurance Coverage for Drug and Alcohol Rehab Treatment

Does Harvard Pilgrim Insurance Cover Drug or Alcohol Rehab?

If you are a Harvard Pilgrim Insurance member in need of drug or alcohol rehab, it helps to know that mental health and substance abuse treatment are generally covered under the insurance plans offered by this company.

Harvard Pilgrim Insurance is based in Massachusetts and has been providing medical coverage for nearly 50 years.1 The company has more than 3 million customers in New England and elsewhere. Harvard Pilgrim offers a variety of HMO, PPO, and POS plans for members.

Confirm your benefits and determine what substance abuse coverage you have available for drug rehab with American Addiction Centers.

How Does Harvard Pilgrim Insurance Coverage Work?

Many insurance plans, including Harvard Pilgrim Insurance, cover some form of substance abuse treatment. However, treatment of this type often needs to be pre-authorized by the insurance company. Pre-authorization means that the insurance company makes a determination about whether the treatment is medically necessary.

As with any insurance company, coverage varies from one plan to another. Plans usually include a deductible, which is an amount of money that you must pay out-of-pocket before your insurance provider starts to pay for treatment. After you meet your deductible, you may still be responsible for a fixed percentage of the cost of your treatment. This is known a coinsurance. Before or after your deductible is met, you may also be responsible for a co-pay, which is a fixed amount you pay for a covered service.

What if My Provider Is Out of Network?

Many insurance plans will provide you with a group of in-network providers that have agreed to provide services to the members of a plan at a set price. Your plan may recommend that you get treatment from an in-network provider or pay higher out-of-pocket costs.

If you want to get drug rehab through an out-of-network provider, the provider may be able to work out a payment plan with you or reach an agreement with Harvard Pilgrim to provide care to you at the in-network provider rate.

Which Substance Addictions Do Harvard Pilgrim Cover?

Harvard Pilgrim insurance plans will typically cover treatment for many forms of drug addiction, including:

  • Marijuana.
  • Prescription pills.
  • Cocaine.
  • Methamphetamine.
  • Opioids, such as fentanyl and OxyContin.
  • Heroin.
  • Benzodiazepines, including Xanax and Valium.
  • Alcohol.

Most rehabs can treat these addictions, though some programs may specialize in certain types of addiction.

Harvard Pilgrim Insurance Substance Abuse Coverage

There are many different types of drug rehab. They are covered by insurance, but your plan may have different co-pays or coinsurance depending on the type of care. Your plan may also limit the number of outpatient visits or days you can spend in inpatient per year.

Below are the most common types of drug rehab care.


Meeting Of Support GroupDetox is the process of allowing your body to process any remaining substances in your system before you begin treatment. It can include medical care and supervision, as well as medication.

Stopping the use of drugs or alcohol can result in withdrawal symptoms that can be uncomfortable and even be life-threatening. Some people experience intense cravings and relapse without professional help. Detox helps you or your loved one safely complete withdrawal.

However, detox is only the first step of addiction treatment. There is ongoing work to be done after detox to help you learn the skills needed to recover from addiction and avoid relapse.

Detox can be inpatient or outpatient, depending on the drugs involved, as well as other individual factors, including your physical and emotional health and the severity of your addiction.

Inpatient/Residential Rehab

Inpatient care provides around-the-clock supervision, and residents live at the facility. Treatment consists of group and individual therapy, 12-step meetings, and other therapeutic activities such as art therapy or group outings. Many facilities provide some level of medical care.

In some cases, a detox program may be in the same facility as an inpatient program. In that case, you would go through detox and then attend the inpatient program.

Partial Hospitalization

Partial hospitalization is a form of rehabilitation that offers treatment similar to that received in an inpatient facility. However, in a partial hospitalization program, you go home at night. Partial hospitalization programs typically run from 4 to 6 hours per day, 5 days per week, although some programs offer more days of treatment, including weekends. Partial hospitalization may be your initial course of treatment for drug rehab, but it can also be a step down from inpatient treatment.

Intensive Outpatient

In intensive outpatient treatment, you attend group or individual sessions 2 to 3 hours per day, a few days per week. Intensive outpatient treatment may be your initial course of treatment, or you may attend a program after completing an inpatient or partial hospitalization program.

Standard Outpatient

Standard outpatient treatment usually involves individual or group sessions with a counselor, which may occur 1 to 2 times a week, typically for an hour at a time.

Outpatient treatment can be part of an aftercare program, following other more intensive forms of treatment. Those who enter standard outpatient treatment as their initial form of treatment generally have less severe drug addictions.

Does Harvard Pilgrim Mental Health & Substance Abuse?

Like all health insurance companies, Harvard Pilgrim is subject to the requirements set forth in the Affordable Care Act (ACT). The ACA requires that all health insurance plans provide coverage for the treatment of mental health disorders. Treatment for substance abuse and substance use disorder is consider treatment for mental health disorders, and hence is covered under health insurance plans. To determine the extent of coverage that Harvard Pilgrim provides for mental health and substance abuse, you should reach out to a representative at Harvard Pilgrim.

Does Harvard Pilgrim Cover Inpatient Rehab?

Inpatient rehab is a common substance abuse treatment track. Considered a mainstay of treatment in medical circles, inpatient rehab is often covered to some degree by health insurance plans. To determine the extent of coverage that your Harvard Pilgrim plan provides, visit Harvard Pilgrim’s website.

Does Harvard Pilgrim Intensive Outpatient Rehab?

Intensive outpatient rehab, sometimes known as an intensive outpatient program (IOP), is considered a treatment for mental health disorders. As such, most health insurance plans offer some type of coverage. To find out if Harvard Pilgrim covers your intensive outpatient rehab, consider reaching out to a Harvard Pilgrim representative.

Does Harvard Pilgrim Cover Suboxone Treatment

Suboxone is a medication prescribed during medication-assisted treatment (MAT) during treatment for opioid use disorder. Some doctors who prescribe Suboxone work with Harvard Pilgrim. The best way to determine if a doctor works with Harvard Pilgrim is to reach out to them.

Does Harvard Pilgrim Insurance Cover Rehab Services?

Harvard Pilgrim will cover the standard elements of drug rehab treatment, whether it is inpatient or outpatient. Services typically include:

  • Physical exams.
  • Assessments, including those done by nurses, physicians, and substance abuse counselors.
  • Medications, including methadone maintenance and other medications prescribed in the course of treatment.
  • Therapy, both group and individual.
  • The cost of lodging and food during inpatient or residential rehab.

How to Check Harvard Pilgrim Insurance Rehab Coverage

If you are thinking about going to drug rehab, verify your benefits with us. Once we know your coverage, we can help determine the best treatment for your individual needs.

To get your benefits verified, you can either call us at 888-966-8152 and speak to an admissions navigator, use our chat feature, or fill out the online benefits verification form. Regardless of how you contact us, please know that everything is confidential.


[1]. Harvard Pilgrim Health Care. About Us.

Last Updated on March 10, 2022
Leah K. Walker, Ph.D., L.M.F.T.
Leah K. Walker, Ph.D., L.M.F.T.
Leah K. Walker is a licensed marriage and family therapist with a Ph.D. in family relations.

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