Highmark PPO members · Encino, Los Angeles

Highmark Coverage for Drug and Alcohol Rehab in Los Angeles

Commercial Highmark plans cover medically necessary detox and residential addiction treatment. The complication is the card itself: Highmark holds the Blue Cross licence in part of its territory and the Blue Shield licence alone in the rest. New Spirit Recovery treats Highmark members at its residential facility in Encino, Los Angeles, using their out-of-network benefit.

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Out of network on every plan · detox and residential on site · adults 18+

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One name, two licences

Is Highmark the same as Blue Cross Blue Shield?

Highmark is an independent Blue Cross Blue Shield licensee, but it does not hold both licences everywhere it operates. Across 42 Pennsylvania counties it is Highmark Blue Cross Blue Shield. Elsewhere in the state it is Highmark Blue Shield, and a different company entirely holds Blue Cross.

Which licence a Highmark member holds, by where the plan was written.
Where the plan is written	What the card says	Who holds Blue Cross there
Western Pennsylvania, 29 countiesBoth licences	Highmark Blue Cross Blue Shield	Highmark
Northeastern Pennsylvania, 13 countiesBoth licences	Highmark Blue Cross Blue Shield	Highmark
Central Pennsylvania and the Lehigh Valley, 21 counties	Highmark Blue Shield	Capital Blue Cross
Southeastern Pennsylvania: Philadelphia, Bucks, Chester, Delaware, Montgomery	Highmark Blue Shield	Independence Blue Cross
Delaware, West Virginia, and eight counties of western New York	Highmark, as the licensee for those areas	Highmark

Three different products carry the Highmark name, and two are public programmes.

Alongside its commercial plans, Highmark runs Highmark Wholecare for Medicaid and Medicare members in Pennsylvania, and Highmark Health Options as the Delaware Medicaid plan. Both publish their own Highmark addiction treatment pages, and both rank in the same search results as the commercial ones.

A member who lands on a Wholecare page reads accurate information about a product they may not hold. The distinction matters here because New Spirit Recovery admits adults on commercial plans and does not accept public programme coverage, so establishing which Highmark product a member carries is the first thing the admissions team does.

New Spirit Recovery reads the licence and the product family off the card before quoting anything, since a Pittsburgh member and a Philadelphia member can both say they have Highmark and hold different coverage.

Highmark’s licence areas are published by Highmark at highmark.com. The central and southeastern Pennsylvania Blue Cross areas are published by Capital Blue Cross and Independence Blue Cross.

Levels of care

What levels of addiction treatment does a commercial Highmark plan cover?

A commercial Highmark plan covers the full continuum where care is medically necessary, from withdrawal management through residential treatment to outpatient programmes. What differs between members is the cost share and whether the plan reaches a facility outside Highmark's four states at all.

What a commercial Highmark plan reaches at each level, and where New Spirit Recovery delivers it.
Level of care	On a commercial Highmark plan	At New Spirit Recovery
Withdrawal managementOn site	Authorized before admission, on withdrawal risk and medical stability.	Delivered in Encino with nursing cover around the clock and physician oversight.
Residential treatmentOn site	The level most closely reviewed, and the one an out-of-state plan is most often asked about.	Continuing from withdrawal management in the same building, without a second intake.
Partial hospitalization	A step down, and commonly offered when residential is not authorized.	Arranged near the member’s home rather than in California.
Intensive outpatient	The least contested level, and the one Highmark’s own materials point members toward first.	Named in the discharge plan before the member flies home.
Medication treatment for opioid use disorder	Highmark states that members reach medication treatment and therapy in network, including virtually.	Started on site where clinically indicated, then handed to a prescriber at home.
Sober living	Housing rather than treatment, so no medical benefit reaches it.	Arranged in discharge planning and quoted separately.

Four steps, in order

How does a Highmark plan reach a facility outside its four states?

Highmark stays the plan that reads the benefit and decides the claim, even when the treatment happens two thousand miles away. Which means the work happens before anyone travels, and it starts with reading the card properly.

Step 1Read the card

Establish which Highmark licence the plan was written under

A card reading Highmark Blue Cross Blue Shield and a card reading Highmark Blue Shield were written in different parts of Pennsylvania under different licences. Delaware, West Virginia and western New York members hold something different again.

New Spirit Recovery records this first, because published guidance written for one Blues territory routinely describes rules that do not apply in another.

Step 2The product

Rule out the Medicaid and Medicare products before going further

Highmark Wholecare and Highmark Health Options are public programme plans, and they publish addiction resources that surface in the same searches as the commercial ones. A member reading either is reading about a different product.

New Spirit Recovery admits adults on commercial coverage, so this step decides whether the rest of the process applies at all rather than merely shaping it.

Step 3The benefit

Find the out-of-network behavioral benefit, not the provider directory

A directory search returns facilities inside Highmark’s own territory, which is the wrong question for a member travelling to California. The question is whether the policy carries an out-of-network behavioral health benefit and at what share.

That answer lives in the plan document rather than in any directory, and New Spirit Recovery reads it from the policy on the first call. Blues plans reach out-of-area providers through an arrangement explained on the Blue Cross Blue Shield page.

Step 4Who files it

Authorization opens before admission, not after arrival

Residential treatment is authorized in advance, and a member who travels first and asks afterwards has the weaker position. The request turns on clinical documentation: the diagnosis, the level of care sought, and why a less intensive setting would not be safe.

New Spirit Recovery prepares and files that record, tracks each continued-stay review, and reports the outcome the same day.

Related coverage

Blue Cross Blue ShieldCoverage detail NYSHIPCoverage detail Insurance coverage for drug rehabCoverage detail AetnaCoverage detail

If you or someone else is in immediate danger, call or text 988 for the Suicide and Crisis Lifeline, available 24 hours a day in English and Spanish. SAMHSA's free treatment referral helpline is 1-800-662-4357. For a medical emergency, call 911.

Two thousand miles

Can a Highmark member from Pennsylvania travel to New Spirit Recovery?

Yes, where the plan carries an out-of-network behavioral health benefit. That benefit belongs to the member rather than to a state, so a policy written in Pittsburgh, Wilmington, Charleston or Buffalo reaches a residential bed in Encino on the same terms it would reach one at home.

Highmark’s members live in Pennsylvania, Delaware, West Virginia and western New York, so every search in this cluster comes from outside California. Distance cuts both ways: it helps a member whose own environment is the problem, and costs a member who needs family close.

What the plan pays comes from the policy rather than from Highmark as a company. Two commercial members can hold different out-of-network shares for identical treatment. New Spirit Recovery reads the figure and the cash quote together, and publishes no reimbursement percentage, because its records document none.

New Spirit Recovery holds no contract with Highmark or any Blues licensee. Members admit on the out-of-network benefit their own plan carries, and that benefit puts a drug and alcohol rehab in Los Angeles in reach of somebody whose nearest bed is a month away.

What to ask Highmark

Is my plan commercial, or is it Wholecare or Health Options?
Does my card carry Blue Cross Blue Shield or Blue Shield alone?
Does the plan include an out-of-network behavioral health benefit?
What does it pay toward out-of-network residential treatment?
What is my out-of-network deductible, and how much is met?
Has authorization been opened, and what does it still need?

Available on site: medical detox, residential treatment and dual diagnosis care. More on how coverage works.

Check your Highmark benefits with New Spirit Recovery

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(855) 932-2725 If your card says another Blues plan

Questions Highmark members ask

Highmark and rehab, answered

Does Highmark cover drug and alcohol rehab?

Yes. Commercial Highmark plans cover medically necessary withdrawal management and residential addiction treatment, with authorization opened before admission. What varies is the plan behind the card and whether it carries an out-of-network benefit. New Spirit Recovery reads both from the policy.

Is Highmark and Blue Cross Blue Shield the same thing?

Partly. Highmark is an independent licensee of the Blue Cross Blue Shield Association, so a Highmark plan is a Blues plan. It is not the whole brand, and not even the whole Blues presence in Pennsylvania, where two other companies hold the Blue Cross licence.

Is Highmark BCBS rehab coverage different from other BCBS plans?

Yes. Highmark BCBS addiction treatment rules are set by Highmark for its own territory rather than nationally, so another Blues company's published criteria describe a different plan. Highmark is one of dozens of independent licensees.

Which states does Highmark cover?

Highmark operates in Pennsylvania, all of Delaware, all of West Virginia, and eight counties of western New York. Within Pennsylvania the licence is split: 42 counties of western, north central and northeastern Pennsylvania carry Highmark Blue Cross Blue Shield.

Why does my card say Highmark Blue Shield rather than Blue Cross Blue Shield?

Because Highmark holds only the Blue Shield licence in central and southeastern Pennsylvania. Capital Blue Cross holds Blue Cross across 21 central Pennsylvania and Lehigh Valley counties, and Independence Blue Cross holds it in the five southeastern counties around Philadelphia.

What is Highmark Wholecare, and is it the same as my Highmark plan?

Highmark Wholecare is a separate Medicaid and Medicare product, and Highmark Health Options is the Delaware Medicaid plan. Both rank in search results alongside commercial Highmark pages. New Spirit Recovery admits adults on commercial plans and does not accept public programme coverage.

How much does Highmark cover for therapy?

That comes from the individual plan rather than from Highmark as a company, and it differs between an in-network session and an out-of-network one. No published figure describes a specific policy, which is why the benefit is read from the document itself.

Does Highmark cover residential treatment outside its own states?

Where the plan carries an out-of-network behavioral health benefit, yes. Highmark remains the plan that reads the benefit and decides the claim even when treatment happens in California, so the member's own plan rather than the treating state governs the outcome.

How do I find a rehab that accepts Highmark?

Ask whether the plan carries an out-of-network behavioral benefit, since Highmark drug rehab coverage reaches beyond the directory and a Highmark insurance drug rehab claim is read on the behavioral side. Highmark rehab coverage also differs by product.

Does Highmark cover alcohol rehab and detox?

Highmark alcohol rehab and withdrawal management are covered on a commercial plan where the clinical record supports it, with authorization opened before admission rather than afterwards. Both are assessed on withdrawal risk and medical stability.

Is New Spirit Recovery in Highmark's network?

No. New Spirit Recovery holds no contract with Highmark or any other Blues licensee. Members admit at the out-of-network rate, on whatever out-of-network behavioral health benefit their own commercial plan carries.

Can a Highmark member travel to Los Angeles for treatment?

Yes, where the plan carries an out-of-network behavioral health benefit, because that benefit follows the member rather than the state. New Spirit Recovery is in Encino, Los Angeles and coordinates travel from Pennsylvania, Delaware, West Virginia and New York, including flights and airport transportation.

Who wrote and reviewed this page

Written by Dr. Patrick Lockwood

Clinical Psychologist at New Spirit Recovery. Dr. Lockwood works with clients through detox and residential treatment.

Reviewed by Sean O'Neill, MS, LMFT

Clinical Director at New Spirit Recovery. Sean oversees the clinical documentation that supports every authorization request.

Highmark's licence areas are published by Highmark, and the central and southeastern Pennsylvania Blue Cross areas by Capital Blue Cross and Independence Blue Cross respectively. Highmark Wholecare and Highmark Health Options are named as Medicaid and Medicare products on Highmark's own member pages. Benefit amounts on any individual policy are verified by the New Spirit Recovery admissions team. This page explains how authorization works and does not state what any specific plan will pay.

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