Understanding Your Insurance Made Easy in West Virginia

Getting help for addiction or mental health can feel like a big step. At Pyramid Healthcare West Virginia, we want to make that step easier. One of the most common questions we hear is, “How do I use my insurance?” 

This blog will explain what your insurance might cover, what pre-authorization means, and how to use your plan — whether you have Medicaid, Aetna, Highmark or another provider. 

What Does “Pre-Authorization” Mean? 

Pre-authorization (sometimes called pre-approval) means your insurance company wants to make sure a treatment is medically necessary before they agree to pay for it. 

Here’s how it works: 

• Before starting certain services (like detox or residential care), Pyramid Healthcare sends information about your treatment needs to your insurance company. 

• The insurance company reviews it and gives a “yes” or “no.” 

• Once it’s approved, your treatment can begin, and your insurance will help cover the costs. 

Our admissions team takes care of this for you — we contact your insurance provider, gather paperwork and confirm everything before you start. 

How to Use Your Insurance Step-by-Step 

1. Call Pyramid Healthcare West Virginia. Tell us you’d like to use your insurance. 

2. Have your insurance card ready. We’ll need your name, date of birth and policy number. 

3. We verify your benefits for free. Our team calls your insurance company to find out what your plan covers. 

4. We explain everything clearly. You’ll know exactly what’s paid for and if there are any out-of-pocket costs. 

How to Use Your Insurance Plan 

Below are some of the most common insurance plans we work with in West Virginia and how to make the most of your benefits. 

Aetna Better Health 

• Covers detox, therapy and residential programs 

• Some programs need pre-authorization first. 

• Bring your insurance card—we’ll call Aetna and confirm your coverage. 

Highmark Blue Cross Blue Shield of West Virginia 

• Covers both mental health and addiction treatment 

• Check if we’re in-network for lower out-of-pocket costs. 

• You might need a doctor’s referral; our team can help with that. 

Cigna and Aetna (Commercial Plans) 

• Covers therapy, group sessions and residential care 

• Some plans cover telehealth sessions. 

• Ask our team about deductibles and copays so you know what to expect. 

Optum 

• Often covers detox, therapy and medication-assisted treatment (MAT) 

• Some programs need pre-authorization—we’ll handle it for you. 

• We stay in touch with your provider during treatment to keep coverage active. 

Highmark Health Options 

• Covers mental health and addiction programs 

• May need approval before residential care. 

• We contact Highmark directly to confirm what’s included. 

Medicaid (West Virginia) 

• Covers most treatment programs 

• Outpatient therapy doesn’t need pre-authorization. 

• Some residential programs do, and we’ll help with that paperwork. 

• Make sure your Medicaid coverage is active before you start. 

PEAK Health 

• Covers detox and therapy services 

• Ask our team if you’re eligible for aftercare or relapse prevention. 

• If your plan has a case manager, we’ll coordinate with them to keep your care on track. 

The Health Plan 

• Covers therapy, detox and outpatient programs 

• Some services may require pre-authorization. 

• We’ll check coverage before you start treatment. 

Unicare 

• Covers therapy and substance use treatment 

• Some services need approval first, which we’ll take care of. 

• We’ll also communicate with Unicare case managers to keep your care organized. 

WV Public Employees Insurance Agency (PEIA) 

• Covers mental health and addiction treatment 

• May require a referral for inpatient programs 

• We file all PEIA claims for you to make billing stress-free. 

Veterans Affairs Community Care Network (VA-CCN) 

• Allows veterans to use their VA benefits for care outside of the VA system 

• You’ll need a referral or authorization from your VA provider. 

• We handle all communication and billing with VA-CCN so your care is uninterrupted. 

What If You Don’t Understand Your Plan? 

That’s okay—most people don’t! Insurance languages can be confusing. The best way to know your benefits is to let us check for you. Our team will: 

1. Verify your insurance benefits for free 

2. Explain what your plan covers in simple terms 

3. Handle all pre-authorization and paperwork 

You’ll know exactly what’s covered and what your options are before you begin treatment. 

Start Your Recovery Without the Stress 

You deserve to focus on healing—not on paperwork. Whether you have Aetna, Medicaid, Highmark or another provider, Pyramid Healthcare West Virginia can help you use your insurance and start treatment quickly. 

Call our admissions team today to verify your benefits and take the first step toward recovery with confidence.