Highmark Insurance Coverage for Mental Health Care
If you’re a Highmark member seeking support for anxiety, depression, bipolar disorder, PTSD, psychosis, or co-occurring substance use, it helps to know how your benefits work. Our team at Friendly Recovery in Tustin will verify your Highmark coverage, estimate your costs, and match you to the right level of care. Depending on your plan and medical necessity, care may include standard outpatient therapy and psychiatry, Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP), and virtual visits.
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What Highmark Offers for Behavioral Health
Highmark is an independent licensee of the Blue Cross Blue Shield Association offering health plans in Pennsylvania, Delaware, West Virginia, and Western & Northeastern New York (via Highmark Blue Cross Blue Shield/Blue Shield). Plan names and administering entities vary by region. Always check your member ID card for the specific Highmark company and product.
Highmark members typically have out-of-area access through the BlueCard program, which links Blue plans nationwide so you can obtain in-network benefits when traveling or living outside your plan’s service area. Coverage and cost-sharing depend on your specific product.
What We Treat
Friendly Recovery treats a broad range of mental health and co-occurring conditions commonly supported under Highmark plans (subject to medical necessity and your specific benefits):
- Anxiety (generalized, panic, social), OCD
- Major depressive disorder, persistent depressive disorder, bipolar spectrum
- PTSD and complex trauma
- Thought disorders, including schizophrenia and schizoaffective disorder
- Personality disorders
- Co-occurring substance use disorders (dual diagnosis)
Before starting care, we verify that your diagnosis and recommended level of care are covered under your Highmark plan.
Levels of Care We Can Help You Access
Coverage varies by product and medical necessity:
- Standard Outpatient (OP): Individual therapy, medication management
- Intensive Outpatient Program (IOP): Multiple sessions per week while you live at home
- Partial Hospitalization Program (PHP): Structured day treatment
- Telehealth / Virtual Care: Therapy and psychiatry visits online
- Referral to Higher Care: If needed, we coordinate referrals to in-network facilities
Many outpatient behavioral health services may require prior authorization depending on your plan; we confirm these requirements before scheduling.
Not Sure What Your Highmark Plan Covers? We Can Help
Verify Your Insurance Benefits
Using Highmark for Mental Health Treatment
In-network vs out-of-network
Seeing in-network providers generally lowers out-of-pocket costs due to negotiated rates. Use your member portal/app to find participating clinicians and facilities.
Out-of-area access
When you’re away from home, BlueCard can help you receive in-network-level benefits with participating providers in other Blue plan areas (product-specific).
Referrals and prior authorization
Many behavioral health services, especially structured levels like IOP/PHP, may require prior authorization under certain policies. We handle the verification and submit authorizations via the required Highmark channels (e.g., Availity/fax), so there are no surprises.
What Costs Should I Expect with Highmark?
Your costs depend on:
- Deductible status
- Copay/coinsurance for behavioral health under your plan
- In-network vs out-of-network use
- Telehealth cost sharing (if applicable)
- Any prior authorization requirements for higher levels of care
After verification, we provide a personalized estimate before you begin treatment. (Benefits and costs differ by plan; consult your plan materials or Member Services.
Verify Your Highmark Benefits
Have ready:
- Member ID and group number
- Full name, date of birth, and address on the policy
- Clear photos of the front and back of your Highmark ID card
We confirm eligibility, covered levels of care, required authorizations, and estimated costs, and we’ll schedule your first appointment.
Common Mental Health Conditions Covered by Highmark
Highmark provides resources and coverage pathways for behavioral health care, including therapy, psychiatry, medication management, and structured outpatient care when medically necessary and covered by your plan:
Depression
Plans often include outpatient treatment (therapy, medication management); coverage specifics vary by product.
Generalized Anxiety and Panic Disorder
Evidence-based therapy (e.g., CBT) and psychiatric services are commonly supported, subject to plan rules.
Bipolar Disorder
Benefits may include outpatient psychiatry, therapy, and structured care when medically necessary.
PTSD and Trauma-Related Disorders
Highmark provides education and access pathways to trauma-informed care; coverage depends on plan and necessity.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Behavioral therapy and medication management may be covered under your plan.
Obsessive-Compulsive Disorder (OCD)
Access to ERP-focused therapy and psychiatry may be available depending on your benefits.
Schizophrenia and Schizoaffective Disorder
Coverage pathways typically include psychiatric stabilization and medication management per plan terms.
Co-Occurring Mental Health & Substance Use Disorders
Highmark offers SUD resources and directs members to treatment locators and hotlines alongside mental health support. Coverage is plan-specific and based on medical necessity.
Note: Benefits vary by Highmark region and product (commercial, Medicare Advantage, Medicaid/Wholecare/Health Options). Verifying your benefits is the best way to determine what’s available under your plan.
Find Out if Your Highmark Plan Covers Treatment
Considering outpatient mental health care with Highmark? Start with a benefits check, we’ll handle it for you.
FAQs About Highmark & Mental Health Coverage
Do you treat co-occurring addiction
Yes. We address co-occurring substance use alongside mental health treatment and coordinate in-network referrals when a different setting is appropriate. Highmark also points members to additional SUD resources and hotlines.
Will Highmark cover IOP or PHP?
Many plans cover higher-intensity outpatient levels of care when medically necessary. We confirm coverage and check any prior authorization rules before scheduling.
What if my plan includes national or out-of-area access?
Some employer plans include partner networks for care outside the home service area. We review your ID card and confirm access under your specific product.
Are prior authorizations needed for counseling sessions?
Often no, but some services and higher levels of care may require review. We handle this process and keep you informed.
Do you accept Highmark for therapy and psychiatry?
Yes, if your specific Highmark product allows those services with us in-network. We verify eligibility before your first visit.
Related Mental Health Insurance Information
Looking for more details about insurance providers accepted for outpatient mental health treatment? Explore how different plans may support access to care:
Aetna
AmeriHealth
Blue Cross Blue Shield
Anthem Blue Cross
Premera Blue Cross
Anthem BCBS
Empire BCBS
Regence BCBS
Beacon Health Options
Blue Shield of CA
Carelon Behavioral Health
Cigna
ComPsych
Elevance Health
First Choice Health
First Health Network
GEHA
Halcyon
Health Net
HMC Networks
Humana
Kaiser
Magellan
Meritain Health
MHN Health Net
MultiPlan
NYSHIP
Optum
UMR
UHC
Value Options
Wondering How Your Coverage Works?
Medically Reviewed By: Shahana Ham, LCSW
Shahana Ham, LCSW, is a Licensed Clinical Social Worker with a Master’s in Social Work from the University of Southern California. She specializes in client-centered care for individuals facing mental health and substance use challenges, fostering a supportive environment for healing and growth.
