Since 1994, Harvard Pilgrim Health Care, Inc. has operated as a full-service health insurance company headquartered in Wellesley, Massachusetts. The mission of the Harvard Pilgrim Health Care Institute (HPHCI) is to improve health care through teaching and research.
As a medical school and a health plan, the HPHCI conducts research to identify systems to improve healthcare and quality of life for members and the overall population. In addition to these goals, the core mission of HPHCI is education and teaching. Research within the institute spans many areas, including primary care clinics, preventative services, hospitals, chronic illness management, prenatal and palliative care.
Harvard Pilgrim Health Care Plans are known for providing a range of services including behavioral health services that support emotional and mental well-being, including addiction treatment.
Who Accepts Harvard Pilgrim Health Care?
80,000 doctors and other clinicians in the region participate in the Harvard Pilgrim network. This includes 183 hospitals. Harvard Pilgrim Health Care doctors practice in a range of settings including group and hospital based practices, as well as private practices and small offices. There are more than 3 million members and customers in the Harvard Pilgrim Health Care network.
With a large, expansive network and thousands of care providers, members with Harvard Pilgrim Health Care have access to some of the best healthcare in the region, and also have a range of choices, so they can pick the health care providers that are best for them.
Harvard Pilgrim Health Care Plans
Harvard Pilgrim Health Care provides a variety of health care plans for members. Choose the type of plan that works for your health care needs.
Harvard Pilgrim PPO Plans
Officially known as Preferred Provider Organization (PPO) plans, these plans come with high premiums. PPO plans are preferred by many members because they provide flexible coverage, allowing patients to see providers or specialists whether they’re in-network or not, without a referral.
As an added benefit, members of PPO plans pay low co-pays and low fees for doctors visits and services, as long as they stay with providers that are in-network.
Harvard Pilgrim HMO Plans
An HMO plan, also known as a Health Maintenance Organization plan, is a plan with low deductibles and premiums and low fixed co-pays. HMOs require patients to see doctors in-network.
Out-of-network care may require pre-authorization, a referral and may also come with high co-pays. HMOs are very popular because they’re relatively affordable, but they can be restrictive to patients seeking out-of-network care.
Harvard Pilgrim POS
A point of service plan, more often referred to as a POS plan, is similar to an HMO. However, flexibility for out-of-network provider coverage is better with POS plans. For anyone who is hoping to seek addiction treatment with an out-of-network provider, a POS plan is often a good choice.
Harvard Pilgrim CDHP
Harvard Pilgrim’s Consumer Driven Health Plan is a high deductible health plan (HDHP) combined with a health care account. These plans have low premiums, but the copays and coinsurance are much higher. These plans have a health savings account that can cover part of the deductible.
Can Harvard Pilgrim Pay for Substance Abuse Treatment?
Yes, Harvard Pilgrim will pay for substance use disorder treatment, but estimating your costs can be very difficult. Out-of-pocket costs depend on a number of factors including your plan type, whether your deductible has been met, where you’re seeking services, whether the services you’re seeking are in-network or not, the cost of your program, and other factors.
Estimating out-of-pocket costs can only be done after you’ve met with representatives from the rehab program of your choice. During your meeting, you’ll determine how your insurance plan with Harvard Pilgrim Health Care will provide coverage for the services you require.
Some people who enter these rehabilitation programs must pay hundreds or thousands of dollars, while others pay little or nothing. Be prepared to pay for some of your care out of pocket, but work with your insurance company to minimize costs.
Does Harvard Pilgrim Require Preauthorization for Addiction Treatment?
Depending on the type of plan you have with Harvard Pilgrim Health Care, you may need to get preauthorization for some types of addiction treatment. To seek preauthorization, your health care provider must fill out a form and turn it into Harvard Pilgrim Health Care in order to certify that the treatment you need is medically necessary.
To find out whether preauthorization is necessary, contact Harvard Pilgrim either before looking for a substance abuse treatment service provider, or once you’ve found a provider that works for you. If you don’t have a substance abuse service provider when you contact Harvard Pilgrim, you may end your conversation with more questions than answers.
Preauthorization usually requires a specific form to be filled out, so ask Harvard Pilgrim for the form. Whether you’re seeking residential treatment, partial hospitalization, inpatient treatment, intensive outpatient treatment, outpatient detox services, neuropsychological testing or other services, contact Harvard Pilgrim to find out whether pre-authorization will be required under your plan. You may also be able to tell if preauthorization is required by reading the plan document for your particular insurance plan. This form can be found on the Harvard Pilgrim website.
Find Your Addiction Treatment Coverage and Cost
Getting addiction treatment for a substance abuse problem is one of the best decisions you’ll ever make, for your health and future happiness. Following through with your addiction treatment can help you regain quality of life. If you or someone on your health insurance plan suffers from addiction, work with representatives from Harvard Pilgrim Health Care to get information about treatment.
For your convenience, use our addiction treatment insurance coverage tool to get more information about the final cost of addiction treatment.