Harvard Pilgrim Insurance Coverage for Behavioral Health Care
Table of Contents
What Harvard Pilgrim Offers for Behavioral Health
Using Harvard Pilgrim for Mental Health Treatment
In-network vs out-of-network
Seeing behavioral health providers who participate in the Harvard Pilgrim network typically lowers your out-of-pocket costs because contracted clinicians agree to negotiated rates. Members can use the Harvard Pilgrim member portal or the Find a Provider tool to locate participating therapists, psychiatrists, and behavioral health specialists who offer in-person or virtual care.
Referrals and prior authorization
For most Harvard Pilgrim plans, you do not need a referral from your primary care provider to see a behavioral health clinician. However, prior authorization may be required for certain behavioral health services, depending on your plan and the type of care you receive. Members or providers should contact Harvard Pilgrim’s Behavioral Health Access Center to confirm authorization requirements before starting treatment.
Virtual and Regional Access
Harvard Pilgrim offers access to behavioral health services through its regional network of in-person providers and telehealth partners such as Grow Therapy, Doctor On Demand, AbleTo, and Valera Health. These options allow members to receive therapy, psychiatry, and care management support conveniently across Harvard Pilgrim’s New England service areas.
What Costs Should I Expect?
What We Treat
Friendly Recovery would treat many of the same behavioral health and co-occurring conditions that Harvard Pilgrim supports (subject to medical necessity and plan coverage), including:
- Anxiety disorders (generalized anxiety, panic, social anxiety)
- Major depression, persistent depression, bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Thought disorders (schizophrenia, schizoaffective, etc.)
- Co-occurring substance use disorders
Before beginning care, we will verify whether your specific diagnosis and recommended level of care are covered under your Harvard Pilgrim plan.
Levels of Care We Can Help You Access
Coverage and available services depend on your specific plan and medical necessity.
- Individual Therapy
- Group Therapy
- Medication Management
- Psychiatric Evaluations
- Partial Hospitalization Programs (PHP)
- Intensive Outpatient Programs (IOP)
- Standard Outpatient Programs (OP)
- Telehealth and Virtual Mental Health Care
If your plan requires prior authorization for specific behavioral health services, we will manage that authorization process on your behalf.
Not Sure What Your Highmark Plan Covers? We Can Help
Insurance can be complex. If you’re considering outpatient mental health care and want to understand how your Harvard Pilgrim benefits apply, a quick verification gives you clear answers about eligibility, costs, and any pre-approval needs.
Verify Your Insurance Benefits
What Costs Should I Expect with Havard Pilgrim?
Your costs and the authorization process depend on:
- Whether the provider is in-network
- Whether your plan requires prior authorization
- Your deductible, copayment, and coinsurance structure
- The tier or network level of the provider (for plans using provider tiers)
- Whether services are in person or virtual
After verification, we will provide an estimate of your out-of-pocket costs before starting treatment.
Verify Your Harvard Pilgrim Benefits
To verify coverage, we’ll ask you to provide:
- Your Harvard Pilgrim Member ID (and group number)
- Member’s full name, date of birth, and address
- Front and back photos or scans of your Harvard Pilgrim ID card
We will use this information to check eligibility, covered services, the need for prior authorization, and estimated costs, then schedule your first session.
Common Behavioral Health Conditions & Harvard Pilgrim Coverage
Depression
Therapy and psychiatric treatment are generally covered under in-network benefits.
Generalized Anxiety and Panic Disorder
Evidence-based therapy and psychiatric care available through participating providers.
Bipolar Disorder
Covered treatment may include outpatient psychiatry, therapy, and structured care when medically necessary.
PTSD and Trauma-Related Disorders
Harvard Pilgrim offers resources and coverage for trauma-informed care via its behavioral health network
Schizophrenia and Schizoaffective Disorder
Psychiatric stabilization and ongoing care are supported through behavioral health benefits.
Co-Occurring Mental Health and Substance Use
Harvard Pilgrim provides coverage pathways and support for integrated treatment of mental health and substance use disorders.
Find Out if Your Harvard Pilgrim Plan Covers Treatment
FAQs About Harvard Pilgrim & Behavioral Health Coverage
Do you treat co-occurring substance use?
We treat substance use disorders alongside mental health conditions and coordinate referrals when higher care is needed. Harvard Pilgrim covers SUD treatment through in-network providers and supports continued care after discharge.
Does Harvard Pilgrim cover IOP / PHP?
Many plans will cover structured levels of care when medically necessary, with prior authorization. We will determine your plan’s policy and submit authorizations.
What if I need care while traveling or outside my plan’s service area?
Harvard Pilgrim members may have access to in-network or partner clinicians through virtual care or through network agreements, depending on the plan.
Do you accept Harvard Pilgrim for therapy and psychiatry?
Yes, if your specific plan allows access to behavioral health services from in-network providers. We verify enrollment before your first session.
Is prior authorization required?
Often yes, especially for higher-intensity behavioral health care (e.g., IOP, PHP). We’ll handle the authorization process through Harvard Pilgrim’s required channels.
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.
