Rehab Centers That Accept POMCO Insurance

Getting help for a substance use disorder (SUD) is a courageous step, but for many, the cost of treatment can feel like a major barrier. Fortunately, insurance providers and third-party administrators, such as Private Occupational Medical Corporation (POMCO), offer coverage for various drug and alcohol rehabilitation programs to help ease the financial burden. POMCO (now a division of UnitedHealthcare/UMR) can help ease that financial burden by covering a wide range of addiction treatment services.

If you have a POMCO-backed insurance plan, you may be eligible for coverage that includes inpatient and outpatient rehab, detox services, therapy, and more. Understanding your insurance options and how to navigate coverage can make a significant difference in accessing the care you need.

In this article, you’ll learn:

• What types of addiction treatment are typically covered by POMCO insurance
• How POMCO works with major providers like UnitedHealthcare
• Whether your plan includes in-network and out-of-network coverage for rehab
• How to use tools like RehabNet to find treatment centers that accept your insurance
• Tips for verifying your coverage and getting help from trusted resources

Whether you’re seeking treatment for opioid addiction, alcohol use, or another substance-related disorder, this guide can help you take the first step toward recovery with confidence and clarity.

Many individuals rely on insurance to help ease the financial burden of treatment services costs. POMCO, which was acquired by UMR in 2017, can help policyholders with the cost of treatment. UMR is a third-party administrator (TPA) and is the nation’s largest TPA to date. UMR supports businesses with self-funded insurance plans by providing access to customized employee policies through well-known insurance providers like UnitedHealthcare. TPAs like POMCO or UMR also provide various administrative services such as expediting and overseeing claims, issuing insurance cards, and maintaining policyholder records.

If your insurance plan is backed by POMCO or UMR, your plan most likely abides by the Affordable Care Act (ACA), which dictates that policies must provide coverage for substance addiction and mental health treatment. This means that if you choose a healthcare provider or facility within your plan’s network, you will likely receive coverage for rehab and other addiction services. Some plans may offer coverage for out-of-network treatment as well.

Because every plan is different, it’s important to understand your insurance options and network when seeking treatment. A POMCO or UMR representative can help with this, as can the trusted experts at RehabNet.

A third-party administrator is not a direct insurance company but rather subsidizes claims on behalf of an insurance provider like UnitedHealthcare. They primarily work with medium to large employers who prefer self-funded insurance plans for their employees. The TPA oversees various details of the plan, including administrative duties and claim payouts. For example, POMCO or UMR may assist in employee insurance enrollment, eligibility, compliance, and processing claims for the business on behalf of the insurance provider.

The primary difference between a health insurance provider and a TPA is that a TPA does not offer actual insurance or benefits, therefore avoiding taking on any risk. Rather, a TPA acts as a bridge between an insurance company and a business to support its self-funded plan and ensure communication and claims are as smooth as possible for policyholders.

Claims are first sent to a TPA, such as POMCO or UMR, for adjudication as to whether the claim is eligible for processing and funding from the insurance company. The TPA can also process claims on behalf of the primary insurance provider for a business and its employees. This eases the burden on the company’s administrative or financial team and streamlines the claims process for employees.

POMCO, now UMR, offers several employer-sponsored plans through its TPA services. Some of these plans include:

• UnitedHealthcare Choice Plus Network
• UnitedHealthcare Choice Plus with Premium Tiered Benefits
• UnitedHealthcare Freedom PPO Network
• Aetna Signature
• Alliance – Premier Network
• American Healthcare Alliance
• Community Health Alliance
• Health One Alliance
• HealthEOS

Each plan varies in its benefits and tiers. For example, the UnitedHealthcare Choice Plus Network offers PPO plans that provide coverage for both in-network and out-of-network providers.

POMCO works with several popular insurance carriers, some of which include:

• Blue Cross Blue Shield
• Cigna
• Alliance
• Health One Alliance
• MagnaCare
• Anthem
• Humana

Common POMCO health plans include:

• Preferred Provider Organizations (PPO): PPO plans provide coverage for both in-network and out-of-network providers, but offer a lower rate for in-network treatment providers.
• Health Maintenance Organizations (HMO): HMO plans require policyholders to obtain primary care and other treatment services within a set network to receive coverage.
• POS (Point of Service): POS plans provide lower overall out-of-pocket costs but with more limited options for in-network providers. This type of plan is typically a combination of HMO and PPO plans.
• HDHP (High-Deductible Health Plan): A high-deductible health plan incorporates a health reimbursement arrangement or health savings account with regular medical insurance coverage to help policyholders save for future healthcare needs without the risk of high out-of-pocket costs.

Many plans are also broken down into tiers that dictate factors like deductibles and premiums. Some common health insurance plan tiers that POMCO-supported insurance providers offer include:

• Bronze: This tier typically offers the lowest premium with the highest out-of-pocket costs for policyholders.
• Platinum: A platinum-tier plan provides a combination of affordable premiums and out-of-pocket expenses.
• Silver: This type of plan often has a higher premium with lower out-of-pocket costs.
• Gold: A gold-tier plan offers the lowest out-of-pocket expenses but often has the most expensive monthly premium.

For more information on specific tiers and plans offered, reach out to a POMCO or UMR representative today. You can also receive additional guidance through our confidential helpline.

Most POMCO-administered plans cover evidence-based mental health and addiction services as mandated by the Mental Health Parity and Addiction Equity Act. This Act requires many health insurance plans to provide the same level of coverage for mental health condition treatment and substance use disorders as the plans would for medical and surgical services. This Act also prevents discrimination and ensures policyholders receive equal access to these services as they would to other medical treatments.

If you’re unsure if your plan covers substance abuse treatment, such as inpatient or outpatient rehab, reach out to a representative with your insurance provider.

While addiction treatment coverage will vary based on your specific POMCO plan, the following are commonly covered services for SUDs:

Residential rehab programs require an extended stay at a substance use disorder facility that typically lasts between 30 and 60 days. Individuals reside at the facility during this time and partake in various therapies, such as group therapy and cognitive behavioral therapy. Many Inpatient rehab centers offer various levels of care based on each individual’s unique needs.

The two primary types of outpatient addiction treatment programs include partial hospitalization programs (PHP) and intensive outpatient programs (IOP). PHPs are more intensive and often require individuals to attend treatment services for several hours a day throughout the week. IOPs are considered a step-down from inpatient and partial hospitalization programs and may include attending therapy and other treatment services a few times a week.

Outpatient behavioral health and addiction programs are a good option for those who don’t require the intensive level of care offered at an inpatient facility. They are also a good option for those who are graduating from a residential rehab program and require further support on their recovery journey.

A detoxification program is often completed before an individual moves into an inpatient rehab facility. This program requires individuals to stay at a facility throughout their detoxification from drugs or alcohol. During their time at the detox facility, patients receive round-the-clock medical care that may include the administration of medications, monitoring of vitals, and ensuring safety and comfort.

Therapy is often an intricate part of a substance use disorder treatment plan. During therapy, an individual meets one-on-one or in a group with a licensed and experienced addiction clinician to learn more about their addiction and various ways to cope with it.

Common types of therapy used to treat SUDs include:

• Assertive community treatment
• Dialectical behavior therapy
• Cognitive behavioral therapy
• Motivational enhancement therapy
• Group therapy
• Family therapy

Medication-assisted treatment is an addiction service that encompasses various aspects of recovery, including FDA-approved medications for certain substance use disorders, behavioral therapy, and peer interaction. Opioid use disorders are the most common addiction treated with MAT.

The experienced professionals at RehabNet can help you better understand the type of treatment you may need for your unique situation, as well as provide more information on your options and coverage.

Several factors can affect your POMCO plan’s coverage for rehab. Understanding these factors can help you make a more informed decision on the type of treatment you seek and where you obtain it.

Here are a few important aspects that may affect POMCO rehab coverage limits and POMCO insurance requirements for addiction treatment:

• In-network vs. out-of-network providers: In most cases, seeking services from an in-network provider will offer the lowest out-of-pocket costs for policyholders.
• Pre-authorization requirements: Some plans may require prior authorization for addiction treatment and services, including rehab coverage, prescription drugs provided during your treatment, and medication-assisted treatment. If pre-authorization is required, your healthcare provider can submit the necessary information to your insurance company for review and approval.
• Annual or lifetime limits on mental health benefits: The ACA dictated that most insurance plans cannot set limits on mental health or substance use disorder benefits. However, it’s important to check with your insurance company to make sure there are no limits, especially if you’ve received previous addiction or mental health services.

Other important aspects to understand about your insurance plan include deductibles, coinsurance, and copays. A deductible is how much your plan requires you to pay out-of-pocket before it will begin covering certain services.

A co-pay is a cost-sharing modality that dictates how much an individual will pay for a specific service. For example, you may have a $50 copay for primary care visits. Until your out-of-pocket maximum is met, you will be required to pay the copay for each visit.

Coinsurance refers to how much a policyholder is responsible for paying out-of-pocket once their deductible is met. For example, if your plan covers 80% of services after reaching your deductible, you’ll be responsible for the remaining 20% of service costs.

If you have questions about any of these factors related to POMCO insurance requirements for rehab, reach out to your insurance provider today.

Some insurance plans may offer coverage for out-of-network treatment. However, in most cases, you will pay a higher out-of-pocket cost for out-of-network addiction services. One particular issue that may arise is balance billing. This is when a patient is sent a bill for the difference between what their plan covers and what the services cost after services are rendered. Balance billing comes with the risk of unforeseen expenses that can result in high debt.

If you have a POMCO insurance plan and want to seek treatment out of your plan’s network, be sure to speak with an insurance representative first. The representative can help you better understand your out-of-pocket costs and what to expect in terms of expenses later down the road.

Some UMR or POMCO-supported plans may offer out-of-network and exception benefits. This means that you can seek treatment from a rehab without in-network coverage through POMCO and still receive the in-network rate. You’ll first need to find out if this is an option offered through your plan and then submit a formal exception request to your insurance provider.

To verify whether a treatment facility is in-network with your plan, use the RehabNet drug rehab locator tool today.

Substance use disorders covered by POMCO-supported plans are those diagnosable by the DSM-5. These include:

• Alcohol Use Disorder
• Cannabis Use Disorder
• Opioid Use Disorder
• Stimulant Use Disorder
• Phencyclidine (PCP) Use Disorder
• Sedative, Hypnotic, and Anxiolytic Use Disorder
• Other Hallucinogen Use Disorder
• Inhalant Use Disorder

Additionally, some behavioral addictions may be covered by your UMR or POMCO-supported plan. Common behavioral addictions covered on a case-by-case basis include:

• Gambling
• Sex addiction
• Pornography addiction
• Food addiction
• Shopping addiction
• Internet addiction

Dual diagnosis and co-occurring disorders are also typically eligible for coverage through POMCO-supported plans. A dual diagnosis is when a person suffers from both addiction as well as a mental health disorder, such as depression.

There are a few ways to find an addiction treatment facility that accepts your POMCO insurance plan. One way is to utilize the POMCO insurer portal. You can also go directly to your specific insurance provider’s website, log in, and perform a provider search.

Additionally, you can call POMCO customer service for help finding a drug or alcohol rehab near you that’s in-network. The customer service representative you speak with can also answer questions related to out-of-pocket costs and eligibility.

RehabNet is another trusted resource that helps users verify their insurance coverage and locate the best treatment facility options for their needs. To take advantage of RehabNet’s locator services to find a POMCO-approved rehab, visit our website or give us a call today.

There are several factors to consider when selecting a treatment center to ensure you receive the best care possible. Things to keep in mind and look into when searching for rehab facilities include:

• The addiction facility’s accreditation status
• The treatment specialties offered at the rehab center
• Reviews from individuals who have attended the rehab facility
• Licensure and accreditation of the facility’s staff

The following are frequently asked questions related to POMCO insurance coverage for substance use disorder rehab:

RehabNet’s mission is to connect individuals and families with affordable, insurance-covered addiction treatment options that best meet their unique needs and situations. We thoroughly vet each treatment facility we recommend to ensure the highest quality of care possible.

RehabNet helps ease the process of finding a reputable treatment program by offering assistance with verifying POMCO insurance benefits, matching users with quality treatment centers, and assisting with pre-approval paperwork. Our services are always confidential and free, and we provide nationwide assistance. Contact us today to find the best treatment options with your POMCO-supported insurance plan.