HMC HealthWorks Mental Health Insurance Coverage
20% of American adults are living with a mental health condition, and close to eight percent of the population are dealing with substance use disorders.1 Yet, millions of these people never receive treatment, partly due to financial reasons.
The gaps in access to mental health care are a major issue for individuals and, equally, for employers and plan sponsors. In fact, mental health and substance use conditions affect more than 20% of the workforce and contribute to roughly 36% of productivity loss.2
HMC HealthWorks takes a broad, whole-person approach to healthcare. It coordinates a comprehensive continuum of care that surrounds participants with a multidisciplinary clinical team. If you’re curious to know more about how HMC Healthworks operates, the team at Mission Connection can help.
This page can also help explain HMC HealthWorks’ healthcare products and mental health coverage in detail, as it explores:
- What HMC HealthWorks is
- The different HMC HealthWorks programs
- How HMC HealthWorks operates
- The mental health conditions HMC covers
- The types of therapies and services included in coverage
- How to check your coverage
What Is HMC HealthWorks?
HMC HealthWorks is a holistic health and wellbeing organization that’s been around since 1976, long before conversations about mental health in the workplace became mainstream.3
It partners with employers, commercial brokers, third-party administrators (TPAs), and unions and offers flexible insurance plans. Their solutions work just as well for small organizations as they do for large, complex ones.
The company was founded by Dr. Janis S. DiMonaco, Ph.D., who spent years working as a clinical social worker in Massachusetts.4 She noticed, during her hands-on work, that people struggled to get help largely because meaningful mental health support simply wasn’t available where they spent most of their time. Therefore, Dr. DiMonaco began developing Employee Assistance Programs and early workplace wellness initiatives for employers to support their workforce.
HMC HealthWorks operates as part of Uprise Health and is built on more than 40 years of clinically grounded protocols. Its programs span both physical and mental health support across the full continuum of care.
HMC HealthWorks Insurance Programs
There are six core services under HMC HealthWorks. We discuss each of these in turn in the following paragraphs.
Behavioral Health Services
HMC HealthWorks’ behavioral health services help employers manage behavioral health costs responsibly, without losing sight of the person behind the diagnosis. Features include:
- Clinical utilization management for higher levels of behavioral health care
- 24/7 crisis assessment and triage
- Appointment assistance
- Guidance on benefits, eligibility, and referral pathways
- Access to a comprehensive provider network
- Appeals management to support continuity of care
- Claims processing support
These behavioral health services can be tailored through customized reporting, client-defined benefit designs, options to use HMC’s provider network or an external one, and flexible claims solutions.
HMC HealthWorks also supports clients with a dedicated account team, which includes an account executive and experienced clinical leaders.
Chronic Care Management
Living with a chronic condition is a common human experience with routines, setbacks, small victories, and moments in which people need support. Through its health management education program, HMC HealthWorks helps a large portion of the population who experience chronic pain with empathy.
The program stratifies people into low-, moderate-, and high-acuity risk levels so that outreach and education can be based on real clinical need.
Conditions addressed through chronic care management include:
- Diabetes
- Coronary artery disease (CAD)
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Back pain
- Heart failure (HF)
- High cholesterol
- High blood pressure
Chronic care management is delivered by trained nurses and wellness coaches. The program also lowers healthcare spending by improving condition management.
Wellness Plans
Wellness plans help to sustain a practical, measurable, and realistic culture of health for today’s workforce. They engage people and give them tools to make behavior changes that positively affect their lives. A mentally and physically healthy workforce contributes to higher productivity, and its organizations see reduced absenteeism.
Wellness programs include a dedicated nurse care manager or wellness coach, backed by a clinical team. The experience is intentionally simple so that participants remain motivated.
Modules in wellness plans include:
- Weight management
- Exercise and physical activity
- Healthy eating guidance
- Stress management
- Smoking cessation
- Heart disease and diabetes prevention
All programs are delivered via HIPAA-compliant technology that allows employees to participate anytime, anywhere, across multiple devices.
HMC HealthWorks covers assessments, biometric screenings, health campaigns, self-directed behavior change courses, and access to an extensive health education library.
Employee Assistance Programs
HMC HealthWorks offers an Employee Assistance Program (EAP) as a credentialed provider network of more than 50,000 affiliates. It includes behavioral health clinicians and specialty networks covering legal and financial services, substance use treatment, professional SAP support, and Critical Incident Stress Debriefing (CISD).5
HMC provides a broad-brush model EAP, which simply means participants are encouraged to reach out for help at the first sign of concern. The program is available 24 hours a day, seven days a week.
The services available to employees include support for:
- Addiction, alcohol use, and substance use concerns
- Anxiety, panic attacks, stress, depression, and phobias
- Anger management and conflict resolution
- Grief, loss, and life transitions
- Marital, divorce, parenting, and family relationship issues
- Eating disorders
- Domestic violence and abuse
- Legal and financial guidance
Opiate and Pain Management
The opioid and pain management program is a clinically driven initiative designed to reduce the impact of opioid misuse.
HMC’s Medical Director is board-certified in pain management with more than 25 years of experience. Plus, the nursing team has a combined 40-plus years of clinical practice in pain management and education.
The program covers a thorough clinical assessment to understand someone’s pain condition, current opioid use, and potential risk factors. They work collaboratively with pharmacy benefit managers (PBMs) for tighter prescribing controls.
Participants also receive clear, focused information about the risks associated with long-term opioid therapy and the availability of alternative pain management options.
Value Added Services
No two employees have the same needs. Therefore, HMC HealthWorks’ value-added services fill the gaps that traditional healthcare plans don’t cover. They supplement existing healthcare programs with added, targeted clinical support where it’s needed most, without disrupting an existing plan.
These plans can be selected individually or integrated into a broader healthcare ecosystem.
Some of the key services are:
- Early intervention for participants with multiple chronic conditions and/or psychosocial needs through medical and behavioral complex care management.
- Health risk assessments and biometric screenings that raise awareness for potential issues.
- Comprehensive reviews of pharmacy benefit manager services and identification of cost-saving opportunities.
- A diabetic supply program that promotes appropriate use of drugs, disease prevention, and better disease control.
- Personalized assistance helping participants with questions about their health benefits, health bills, and provider selection.
- Additional services such as telemedicine options, targeted programs addressing back and neck pain in workers’ compensation cases, etc.
How Does HMC HealthWorks Work?
HMC HealthWorks operates on a clinically integrated model. All programs take into account a global, holistic view of a participant’s health and physical, behavioral, and environmental needs. Prevention and positive behavior change are built into the foundation.
Each participant receives personalized attention based on their readiness to change. HMC HealthWorks individualizes care plans using all available data, including medical and pharmacy claims, health risk assessments, biometric screenings, and clinical conversations.
HMC’s approach is carried through three core pillars:
- Timely, relevant educational resources combined with the support of a health coach who answers all your questions.
- Condition management through regular follow-ups.
- Care support, which includes delivering education and outreach in cost-effective, appropriate ways.
What Mental Health Conditions Does HMC HealthWorks Cater To?
HMC HealthWorks caters to the following mental health issues:
- Anxiety disorders
- Major depressive disorder
- Bipolar disorder
- Stress and burnout
- Anger management
- Emotional regulation challenges
- Phobias
- Grief, loss, and life transition-related distress
- Trauma-related concerns
- Substance use and co-occurring mental health conditions
- Eating disorders
- Family and interpersonal conflict issues
The plans also cover both short-term and more persistent conditions.
What Kind of Therapy Does HMC HealthWorks Cover?
HMC covers both outpatient and inpatient therapy. We discuss the details of these approaches in the following sections.
Outpatient Therapy
Outpatient therapy is the most common point of care. HMC HealthWorks supports outpatient treatment for people with mild to moderate mental health concerns that do not require 24-hour supervision.
Therapy is delivered through licensed mental health professionals coordinated under HMC’s provider network. It includes:
- Individual counseling with licensed clinicians.
- Regular cognitive behavioral therapy sessions for chronic conditions such as anxiety and depression.
- Eye movement desensitization and reprocessing for trauma-related conditions.
- Dialectical behavior therapy for mood disorders.
- Outpatient substance use counseling.
- Medication management coordination, when combined with psychiatric care.
Inpatient/Residential Programs
Some people need more structured monitoring because their symptoms are too severe to be managed at home.
Inpatient programs provide 24-hour care in supervised settings and are intended for immediate stabilization until the person is ready for step-down care.
HMC HealthWorks authorizes inpatient or residential services based on evidence-based criteria. Covered services can include:
- Acute psychiatric inpatient hospitalization.
- Residential mental health treatment programs.
- Residential substance use treatment and dual-diagnosis programs.
- Partial hospitalization programs.
- Intensive outpatient program as step-down care.
Additionally, a care manager follows the patient from admission through discharge to coordinate with treating providers.
Does HMC HealthWorks Cover Rehab?
Yes, HMC HealthWorks does cover all or part of rehabilitation services when they are clinically appropriate.
Rehab is delivered through HMC’s behavioral health services and utilization management model. It ensures that every person receives the right level of care, in the right, safe setting, for the right amount of time.
Coverage decisions require a clinical assessment conducted by licensed clinicians. Based on medical necessity, HMC authorizes rehab services across inpatient and outpatient care. Rehab includes:
- Medically supervised detoxification services
- FDA-approved medication-assisted treatment
- Dual-diagnosis treatment
- Relapse prevention support
Are Mental Health Assessments Covered Under HMC HealthWorks?
Yes, mental health assessments are also covered under HMC HealthWorks’ behavioral health services.
Assessments are the clinical tools through which clinicians understand what someone is dealing with. They are used to classify the severity, risks, history, and context of a person’s symptoms.
HMC covers clinical assessments that determine mental health diagnoses, substance use concerns, level-of-care needs, and immediate safety considerations. These assessments establish medical necessity on which access to therapy depends.
How to Check Your HMC HealthWorks Insurance Coverage?
You can learn about your coverage with HMC HealthWorks by contacting them and asking them to review your benefits.
A representative will explain to you what services are covered under your plan, what levels of care are included, whether prior authorization is required, and what you are responsible for paying out of pocket.
HMC HealthWorks Is Accepted at Mission Connection
Mission Connection works with insurance policies administered through HMC HealthWorks to deliver high-quality, compassionate care.
We offer a full range of evidence-based mental health services to create an individualized plan for each client. All services are available both in person and through telehealth so that you stay consistent with care despite the challenges life throws at you.
If your HMC HealthWorks insurance includes behavioral health benefits, Mission Connection may be able to help you access care with reduced out-of-pocket costs. We can also verify your coverage before beginning treatment.
If you’re interested in treatment or would like assistance with navigating your coverage, reach out to us today.
References
- National Institute of Mental Health. (2024, September). Mental Illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness
- HMC HealthWorks. (n.d.). Health Behavioral: Quality, integrated care improves lives and delivers healthcare savings. Retrieved December 27, 2025, from https://hmchealthworks.com/wp-content/uploads/2023/05/Behavioral_Health_2020.pdf
- HMC Healthworks. (2023, September 15). About Us. HMC Healthworks. https://hmchealthworks.com/
- President and CEO, HMC HealthWorks, Dr. Janis DiMonaco. (2018). CVU. America’s Agenda. https://www.americasagenda.org/Newsupdates/president-and-ceo%2C-hmc-healthworks/dr.-janis-dimonaco
- Mitchell, J. (2024). Critical Incident Stress Debriefing (CISD) Introduction and Definition of CISD. U.S Army Corps of Engineers. https://corpslakes.erdc.dren.mil/employees/cism/pdfs/Debriefing.pdf