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Harvard Pilgrim Healthcare Insurance Coverage for Drug & Alcohol Rehab 

NOTICE: Step One Rehab works hard to make sure our information is accurate. Due to constant changes in insurance company policies, we suggest you contact your insurance company with your member ID for any policy questions. This FAQ is only intended as a guide to point you in the right direction.

Harvard Pilgrim Drug and Alcohol Rehab Coverage – FAQ

Where does Harvard Pilgrim Operate?

Harvard Pilgrim operates mainly in Connecticut, Maine, Massachusetts, and New Hampshire. They are one of the nation’s top-rated insurance providers.

Does Harvard Pilgrim Cover Rehab?

Harvard Pilgrim usually will cover drug rehab as part of their Behavioral Health Program. They base coverage on a number of factors which vary based on your plan. Harvard Pilgrim offers a host of individual medical plans for health insurance. They have HMO plans, PPO plans, and offer student insurance.

Harvard Pilgrim coverage ranges from partial to full. You are responsible for whatever they do not cover. If your plan has a deductible, you have to pay the deductible amount before your insurance coverage takes over.

Most Harvard Pilgrim plans have coverage for the following:

  • Detoxification
  • Inpatient/residential treatment
  • Partial hospitalization
  • Intensive outpatient programs (IOP)
  • After-care programs
  • Various mental health and behavioral health programs

To manage your United Healthcare plan, or learn more about it, you can visit Harvard Pilgrim’s HPHConnect Website. They also have a mobile app


How Long will Harvard Pilgrim Cover Addiction Treatment?

Harvard Pilgrim coverage length varies. It is typical for them to cover up to 28 days and as long as 90 days.

Are out of network providers allowed with Harvard Pilgrim?

Out-of-Network providers are allowed with their PPO plans. They are not allowed with an HMO plan, or will incur additional costs. If you have an HMO or POS plan, you must choose a Primary Care Physician (PCP) to ensure coverage. PPO plans do not require a PCP or referrals for specialty care.

Contact Harvard Pilgrim to confirm your level of coverage, if any, for out-of-network providers.

Does Harvard Pilgrim Allow for Treatment at Luxury Rehab Facilities?

They may allow you to go to a luxury or private rehab. It depends upon your plan. Luxury (private) drug rehabs are often where wealthy people and celebrities will go for addiction help. They are often as nice as any hotel or resort you may use for a vacation spot. They usually have massages, acupuncture, hot-tubs, pools, and quality dining, in addition to other exclusive privileges.

Inpatient Addiction Treatment vs. Outpatient Treatment

This is one of the biggest and most important choices that a patient or their family will make when looking for addiction help. Where you go, and what you do from here on matters and can determine your level of success.

Both options are better than not seeking treatment and could save your life. They each have their own strengths and weaknesses.

An outpatient facility is usually a local option. They give you the chance to meet with medical professionals like doctors, alcohol and drug counselors, or therapists, attend group sessions, and go to recovery meetings while being able to head home afterwards. Co-pays may be required for each visit.

Inpatient facilities, also called residential programs, are most often 28 day programs. They provide structure and are typically remote destinations where you stay in the facility for the duration of the program.

Do I need Insurance to go to Rehab?

You are not required to have insurance to get addiction treatment. However, without insurance, the cost of drug rehab facilities is usually very expensive and impractical for most people. You would need to pay out of pocket. You can certainly pay with a credit or debit card, work out a payment plan, or use other methods that each facility accepts.

Typical inpatient rehabs may cost anywhere from $6,000-$20,000 for a 28 day program.

Outpatient Rehab can range from $4,000-$10,000 for 90 days. The cost of outpatient rehab will vary and is mostly based on how many visits are made.

How does Harvard Pilgrim Decide my Claim?

The majority of Harvard Pilgrim’s health plans have been awarded NCQA Health Plan Accreditation.

Harvard Pilgrim makes decisions about their coverage based on your health plan. Each claim decision is reviewed on a case by case basis and varies by state. In general, Harvard Pilgrim will look at services you use. They then follow national guidelines and other policies to determine if you’re covered. Services that may be covered can include drug addiction rehab, blood-tests, surgeries, or hospital stays.

For drug treatment, you will need a doctor’s evaluation and recommendation, and you may need prior approval from Harvard Pilgrim.

If your claim is denied, Harvard Pilgrim will notify you. You DO have the right to appeal.  To start an appeal with Harvard Pilgrim, call their Member Services number on your Harvard Pilgrim ID card. They typically allow 180 days from the date of the initial payment or denial notice to file. If Member Services doesn’t resolve your issue, ask for an appeal.

All Harvard Pilgrim appeals are responded to compliance with state, federal and NCQA guidelines. It is possible to get appeals expedited.

Follow this link to see more about Harvard Pilgrim’s Appeal Process.

What Else does Harvard Pilgrim Provide?

Harvard Pilgrim has a host of health, wellness options, and discounts

A network of over 179 hospitals and 53,000 doctors/clinicians.

Eldercare, eye-care, and new parenting options.

A variety of plans and the ability to manage and adjust your plan.

Per HIPAA laws, anything that you say is kept confidential. You don’t have to worry about anyone knowing you may have trouble with alcohol or drugs.

Get an Approved Harvard Pilgrim Drug and Alcohol Rehab 

Verifying what insurance will cover can be a time-consuming process. This hassle usually involves lots of waiting and multi phone calls back and forth. Our knowledgeable staff can verify your coverage for you and take the stress and annoyance out of this already difficult time. You have enough to worry about already. Verifying insurance coverage for rehab shouldn’t be an additional burden.

Instead, give us a call now and let us handle this step, at no cost to you! We are totally confidential. Our number is 877-348-7494