Rehabs That Take Highmark Insurance: Our In-Network Campus and Your Coverage

A Highmark plan will usually pay for some addiction treatment. Marketplace plans must cover substance use disorder treatment as an essential health benefit [1], and federal parity law bars most plans from limiting that care more harshly than medical and surgical care [2]. How much your own plan pays, and for which level of care, is what a benefits check settles. The quickest way to get one is to verify your insurance with our family of treatment centers, and admissions will look up your exact plan.

This page is for someone holding a Highmark card who wants to start treatment soon. It shows which of our campuses is on our in-network list for Highmark, what the Highmark companies are, what a plan usually covers, what you may pay and how to check your benefits step by step. For the wider picture across carriers, see our guide to how insurance covers rehab.

Rehabs That Take Highmark: Our In-Network Campus

Our list for Highmark shows one campus, and it is in Pennsylvania. We would rather show you one accurate entry than a longer list we cannot stand behind. The entry names the plan it was checked against. If your card comes from a different Highmark company or state, give admissions the exact plan name and they will check it for you.

If you live in Pennsylvania and want to know more about how a Highmark plan works there, including Medicaid and the state exchange, our page on Highmark coverage for rehab in Pennsylvania goes deeper.

What Highmark is and which plan you may hold

Highmark is not one plan. It is a group of companies, and the name on your card tells you which one you have. State regulators publish some of this, and it is worth knowing before you call anyone.

In Pennsylvania, the state Insurance Department’s list of 2026 rate filings shows three Highmark companies selling individual plans on Pennie, the state marketplace: Highmark, Inc., Highmark Benefits Group and Highmark Coverage Advantage [3]. The same list shows Highmark companies filing small-group plans for employers, including Highmark, Inc., Highmark Benefits Group, Highmark Care Benefits, Highmark Coverage Advantage and Highmark Senior Health Company [3].

Highmark also sells outside Pennsylvania, and in some states the plans carry the Blue Cross Blue Shield name:

• Delaware. The state Department of Insurance lists “Highmark Blue Cross Blue Shield” as the company behind its approved 2026 individual Marketplace plans, effective January 1, 2026 [4].
• West Virginia. The state approved Highmark Health Options West Virginia as a managed care organization for Medicaid members, with Blue Cross and Blue Shield-branded plans and coverage starting July 1, 2024 [5].
• New York. The state Department of Financial Services lists Highmark Western and Northeastern New York Inc., based in Buffalo, in its directory of licensed companies [6].

So a Highmark card might be an employer plan, a plan you bought yourself, or a Medicaid plan. Each one has its own rules and its own network. Before you call, take three things off your card: the company name, the plan or product name, and your member ID. The answers in the rest of this page depend on those three details. For how the wider Blue Cross Blue Shield system handles rehab, see our page on Blue Cross Blue Shield rehab coverage.

What a Highmark plan usually covers for addiction treatment

Start with the floor. All Marketplace plans must cover behavioral health treatment, such as counseling, plus mental and behavioral health inpatient services and substance use disorder treatment [1]. Marketplace plans cannot refuse you or charge you more because of a pre-existing condition, including a substance use disorder, and they cannot put yearly or lifetime dollar limits on these services [1]. Your exact benefits still depend on your state and the plan you picked [1].

Parity adds a second layer. Under the Mental Health Parity and Addiction Equity Act, a plan that covers mental health and substance use care may not apply harsher limits to it than it applies to medical and surgical care, and that reaches prior authorization and step therapy as well as visit and day caps [2]. The scope is worth knowing: it applies to non-federal governmental plans with more than 50 employees, to group health plans of private employers with more than 50 employees, and to the individual market [2]. Plans from small employers are not covered directly; they get comparable protection through the Affordable Care Act’s essential health benefits requirement [2].

Parity does not force a plan to pay for every stay. Coverage runs on medical necessity, meaning care needed to diagnose or treat a condition that meets accepted standards of medicine [7]. Many plans also ask for preauthorization, also called prior authorization, before some services [8]. That is the plan’s decision that a service is medically necessary, and it is not a promise that the plan will pay [8].

In practice, a plan decides one level of care at a time. You may hear about medical detox, residential or inpatient rehab, partial hospitalization or an intensive outpatient program. Detox is often the first step, not the whole plan. MedlinePlus notes, in its guide to opioid withdrawal, that most people need long-term treatment after detox [9]. So expect a second request when detox ends.

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.

What you will pay with a Highmark plan

Three numbers shape your bill. Ask for all three, for your plan, before a start date.

• Deductible. This is what you pay for covered services before your plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered care yourself [10].
• Coinsurance. This is your share of each covered service after the deductible, such as 20% [11]. HealthCare.gov gives a worked example. With $12,000 in allowed costs, a $3,000 deductible and 20% coinsurance, you would pay $4,800 in total [11].
• Out-of-pocket maximum. This is the most you pay for covered, in-network care in a plan year. After that, the plan pays 100% of covered benefits [12]. For a 2026 Marketplace plan, the limit is no more than $10,600 for one person or $21,200 for a family [12].

The out-of-pocket limit does not include your monthly premiums, services your plan does not cover or out-of-network care [12]. Parity helps here too. A plan’s deductibles and out-of-pocket limits must combine medical and surgical care with mental health and substance use care in the same classification [2]. Your rehab costs count toward the same totals as the rest of your care.

What does treatment cost before insurance? Our own cost page puts detox at $250 to $800 a day and 30 days of basic residential care at $2,000 to $20,000. Those are our own published ranges, not official figures. See what rehab costs for the rest, including partial hospitalization and outpatient programs.

How to check your Highmark benefits, step by step

A benefits check takes one call and a page of notes. Here is the order that works.

1. Read your card. Write down the company name, the plan name and your member ID. As the section above shows, several Highmark companies sell plans, so the exact name matters.
2. Get your Summary of Benefits and Coverage. This is a short, standard summary of a plan’s costs and coverage. You get one when you shop for coverage, renew or change it, and you can also ask your insurance company for one [13]. Look for the mental health and substance use lines.
3. Ask about the network by name. A network is the facilities and providers your plan has contracted with [14]. Name the facility and the level of care, not just “rehab.” A plan can treat detox, residential care and an intensive outpatient program differently.
4. Ask about preauthorization. Ask which levels need it, who files the request and how long a first approval usually lasts. Remember that an approval is not a promise to pay [8].
5. Ask for your numbers. Where your deductible stands today, your coinsurance for each level and your out-of-pocket maximum [10][11][12].
6. Write it all down. Note the date, the name of the person you spoke to and each answer.

You do not have to do this alone. You can verify your insurance online, and admissions will check the details with your plan. Our page on how admission works walks through what happens after that.

If your Highmark plan is out of network

Sometimes the place you want is not in your plan’s network. That does not always mean you pay everything. It does usually mean you pay more.

A provider that has no contract with your plan is sometimes called a non-preferred provider. You will pay more to see one, and some plans use tiered networks where certain providers cost extra [15]. Out-of-network coinsurance is the share you pay for those providers, such as 40%, and it usually costs more than in-network coinsurance [16]. There is also balance billing. That is when a provider bills you for the gap between its charge and the amount your plan allows. A preferred provider may not balance bill you for covered services [17]. Remember, too, that out-of-network care does not count toward your out-of-pocket limit [12].

Parity still applies when care is out of network. The parity rules sort benefits into six classifications, and inpatient out-of-network and outpatient out-of-network are two of them [2]. If a plan covers mental health and substance use care, it must provide those benefits in every classification where it provides medical and surgical benefits [2]. So if your plan pays anything for out-of-network medical stays, ask how it pays for out-of-network treatment stays.

If you are comparing carriers or holding more than one plan, our pages on Aetna rehab coverage and Cigna rehab coverage show how other carriers handle the same questions.

If Highmark denies coverage

A denial is not always the end. Federal rules give you a way to ask your plan to look again. HealthCare.gov describes three steps: a claim is filed, the plan denies it, and you file an internal appeal [18].

The plan must tell you in writing why it said no, and there are time limits [18]:

• within 15 days if you are seeking prior authorization for a treatment
• within 30 days for medical services already received
• within 72 hours for urgent care cases

You then have 180 days, or six months, from the denial notice to file your internal appeal [18]. Fill out your insurer’s forms, or write to it with your name, claim number and member ID, and add anything you want it to consider, such as a letter from your doctor [18]. The Consumer Assistance Program in your state can file an appeal for you [18]. If your situation is urgent, you can ask for an external review at the same time as your internal appeal. If the plan still says no, you can file for an external review [18].

Keep copies of everything, including notes from each phone call. This page explains the process. It is not legal advice. If your Highmark plan is Pennsylvania Medicaid rather than a commercial plan, the route is different, and our page on Pennsylvania Medicaid and rehab explains it. For programs across the state, see drug and alcohol rehab in Pennsylvania.

Frequently Asked Questions

Sources

1. HealthCare.gov. (2026). Mental health and substance abuse health coverage options. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
2. Centers for Medicare and Medicaid Services. (2026). The Mental Health Parity and Addiction Equity Act (MHPAEA). CMS. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
3. Pennsylvania Insurance Department. (2026). Archived 2026 Affordable Care Act Health Rate Filings: Individual Market Plans and Small Group Market Plans. Commonwealth of Pennsylvania. https://www.pa.gov/agencies/insurance/posted-filings-reports-company-orders/posted-product-and-rate-filings/aca-health-rate-filings/archived-health-insurance-rate-filings/2026-health-rate-filings
4. Delaware Department of Insurance. (2026). 2026 Highmark Blue Cross Blue Shield: Individual (Marketplace) Plans. State of Delaware. https://insurance.delaware.gov/divisions/ratesforms/ratefilings/highmark-2026/
5. West Virginia Department of Human Services, Bureau for Medical Services. (2024). DoHS Approves Highmark Health Options West Virginia as MCO for State Medicaid Beneficiaries. State of West Virginia. https://bms.wv.gov/article/dohs-approves-highmark-health-options-west-virginia-mco-state-medicaid-beneficiaries
6. New York State Department of Financial Services. (2026). Company Directory: Highmark Western and Northeastern New York Inc.. State of New York. https://myportal.dfs.ny.gov/companydirectory/dir_det.jsp?search_value=1214&search_type=CPAT_NUM&naic=55204&frst=dir_srch_optiono&filekey=dir&c=c
7. HealthCare.gov. (2026). Medically necessary: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/medically-necessary/
8. HealthCare.gov. (2026). Preauthorization: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/preauthorization/
9. MedlinePlus, National Library of Medicine. (2026). Opiate and opioid withdrawal. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000949.htm
10. HealthCare.gov. (2026). Deductible: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/deductible/
11. HealthCare.gov. (2026). Coinsurance: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/co-insurance/
12. HealthCare.gov. (2026). Out-of-pocket maximum/limit: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
13. HealthCare.gov. (2026). Summary of Benefits and Coverage (SBC): Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/summary-of-benefits-and-coverage/
14. HealthCare.gov. (2026). Network: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/network/
15. HealthCare.gov. (2026). Non-preferred provider: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/non-preferred-provider/
16. HealthCare.gov. (2026). Out-of-network coinsurance: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/out-of-network-coinsurance/
17. HealthCare.gov. (2026). Balance billing: Glossary. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/glossary/balance-billing/
18. HealthCare.gov. (2026). Internal appeals. U.S. Centers for Medicare and Medicaid Services. https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village