Understanding your health insurance benefits is often the first step in deciding what kind of alcohol and drug rehab to seek and where to get it. In this article, we will discuss the addiction treatment coverage that is often offered by UnitedHealthcare as well as the different plans and treatment options you may have as a UnitedHealthcare policyholder. If you are covered by UnitedHealthcare and looking for a rehab that accepts it, we will discuss what type of programs and how much you should expect your policy to pay.
Does UnitedHealthcare Provide Coverage for Drug and Alcohol Rehabilitation?
While it’s true that drug and alcohol rehab centers can be costly, it’s important to know that there are several ways to offset this cost and make the treatment you need and deserve more affordable. One of the most common ways that individuals afford addiction treatment programs is through their private insurance policies. UnitedHealthcare is one of the most popular insurance companies in the nation and many of their insurance plans provide at least some level of coverage of drug and alcohol rehab centers.
Due to the implementation of the Mental Health Parity and Addiction Equity Act of 2008, insurance companies are now required to offer equal coverage for mental health treatment as what is offered for other medical services. This means that if your UnitedHealthcare plan provides coverage for medical treatment, it should also offer the same level of coverage for mental health services which include substance use disorders (drug and alcohol addiction).
While most UnitedHealthcare insurance plans offer some or full coverage for addiction treatment, the exact amount of coverage will vary depending on the plan and a person’s location. Let’s look at some of the most popular UnitedHealthcare insurance plans and the coverage levels these plans typically provide.
Different Health Plans Offered by UnitedHealthcare
The exact coverage and coverage tiers offered by UnitedHealthcare can vary significantly depending on the state a person lives in. However, the general levels of coverage of healthcare offered by UnitedHealthcare are as follows:
- UnitedHealthcare Choice: This UnitedHealthcare insurance plan provides in-network coverage for nearly one million medical providers throughout the nation. However, there is no coverage for out-of-network providers and seeing an out-of-network doctor will require you to pay for services 100 percent out of your own pocket. UnitedHealthcare Choice plans require policyholders to pay copayments for medical services as well as an annual deductible and coinsurance.
- UnitedHealthcare Choice Plus: This UnitedHealthcare plan provides all of the same features as the UnitedHealthcare Choice insurance plan as well as some coverage for out-of-network providers. Seeking out-of-network medical care will typically require a higher copay and/or deductible.
- UnitedHealthcare Options PPO: This plan is a Preferred Provider Organization (PPO) plan that allows members to seek treatment with any medical provider and receive moderate to full coverage. Seeking treatment within the UnitedHealthcare network will typically require lower out-of-pocket expenses. Referrals are not needed to see medical specialists. Members are required to submit claims for out-of-network services to receive coverage/reimbursements.
- UnitedHealthcare HMO: Another plan offered in some states by UnitedHealthcare is a Health Maintenance Organization (HMO) plan. This type of plan requires members to receive referrals for medical care from their primary care provider (PCP) and only provides coverage for in-network medical services. HMO plans typically have lower monthly premiums than other UnitedHealthcare insurance plans
Now that we have a basic understanding of the insurance plans offered by UnitedHealthcare, let’s take a look at how these plans translate into drug and alcohol addiction coverage.
In-network Versus Out-of-network UnitedHealthcare Coverage
Understanding the difference between in-network and out-of-network coverage is an important component to deciphering your insurance plan and deciding where you will seek treatment. In-network medical providers and facilities are those that work directly with UnitedHealthcare to agree on service rates that will be offered to UnitedHealthcare customers. As a result, seeking treatment from an in-network provider is often less expensive than out-of-network services because UnitedHealthcare has a say in the cost of treatment.
Out-of-network medical services are those offered by medical providers that do not work directly with UnitedHealthcare. This means that out-of-network treatment typically costs more money out-of-pocket than in-network treatment. However, it’s important to note that a few UnitedHealthcare insurance plans offer some level of coverage for out-of-network providers. As a result, even if a treatment facility is out of UnitedHealthcare’s network, your insurance plan may still provide compensation to offset the total cost of out-of-network medical services.
Will UnitedHealthcare Cover a Medically-Supervised Detox Program?
Some individuals may need to complete a medically-supervised detox program before entering into a drug and alcohol addiction treatment program. Most UnitedHealthcare insurance plans provide at least partial coverage for a medically-supervised detox program, especially when a detox program has been deemed medically necessary for the individual. Some UnitedHealthcare plans may require prior approval before covering a detox program while others will automatically cover a percentage or all of the detox treatment as long as the detox facility is within UnitedHealthcare’s network.
Additionally, when an emergency situation arises and medical detox is required to treat the patient and/or the detox is performed in a hospital setting, UnitedHealthcare will likely cover this at least partially.
If you are unsure if your UnitedHealthcare insurance plan offers coverage for a medically-supervised detox program and you believe that you should attend one, it’s best to speak with a UnitedHealthcare representative to confirm your coverage options.
Will UnitedHealthcare Cover Drug and Alcohol Inpatient Rehab?
Most if not all UnitedHealthcare insurance policies offer coverage for inpatient drug and alcohol rehab program. How much coverage you are eligible for through UnitedHealthcare will depend on your specific plan as well as the state you live in.
The following are the general coverage levels of the two different types of UnitedHealthcare plans:
- UnitedHealthcare PPO: Depending on the specific UnitedHealthcare PPO plan you have, you may receive as much as 50 percent coverage for all inpatient treatment costs. This coverage is typically offered when an inpatient drug rehab program has been pre-authorized with UnitedHealthcare before a patient attends the program. When inpatient treatment has not been pre-authorized, you may be expected to pay an out-of-pocket fee up front to be admitted as well as additional fees. Depending on the specific plan, you may be required to pay a 20 percent to 100 percent coinsurance for inpatient treatment.
- UnitedHealthcare HMO: This type of UnitedHealthcare insurance plan typically requires a more expensive coinsurance payment to participate in an inpatient drug rehab program. Additionally, policy holders are often expected to pay anywhere from a 10 percent to 30 percent physician fee. Most HMO plans will not provide any coverage for out-of-network inpatient treatment facilities.
Inpatient treatment may be the right choice for UnitedHealthcare policyholders who:
- Have been diagnosed with co-occurring disorders (a mental health illness and addiction)
- Live in an environment where drug and/or alcohol use is regularly present
- Do not have transportation or the ability to attend an outpatient program consistently
- Do not have a healthy and reliable system of support
- Cannot abstain from drug and/or alcohol use on their own
Will UnitedHealthcare Cover Drug and Alcohol Outpatient Rehabilitation?
Most UnitedHealthcare insurance plans provide partial to full coverage for outpatient drug and alcohol addiction treatment. Unlike inpatient rehab centers which often requires an upfront, lump sum payment, outpatient treatment typically asks that patients pay a copay for each treatment session attended.
- UnitedHealthcare PPO: With a PPO plan, policy holders may be asked to pay anywhere from a $10 to $45 copay for each outpatient rehab session. Some UnitedHealthcare PPO plans will not require any copay. Additionally, some PPO policies will provide up to 50 percent of coverage for outpatient rehab that is out-of-network. However, most plans require patients to receive pre-authorization before providing coverage or the patient will be subjected to a penalty.
- UnitedHealthcare HMO: An HMO plan with UnitedHealthcare may require a copay that ranges from $15 to $50 per outpatient treatment session. Some plans may ask for a coinsurance payment rather than a copay. Additionally, some UnitedHealthcare HMO plans may cover outpatient services completely. Most HMO plans offer no coverage for out-of-network addiction outpatient treatment.
Outpatient treatment may be the right choice for UnitedHealthcare policyholders who:
- Cannot get away from their work, school and/or family responsibilities long enough to attend an inpatient treatment program
- Have a safe and drug-free home environment
- Cannot afford to attend inpatient rehab
- Have other commitments that they cannot get out of
- Have a more mild drug or alcohol addiction
Will UnitedHealthcare Cover Other Addiction-Related Rehabilitation Services?
There are several additional drug and alcohol rehab centers services that a person may be recommended for or may seek on their own. Each UnitedHealthcare insurance plan will vary as to if coverage will be offered for additional substance abuse rehabilitation as well as how much coverage will be provided. The following are the most common addiction services that may be covered under your UnitedHealthcare plan:
- Medication-assisted treatment (MAT): Many UnitedHealthcare plans will provide coverage for medication-assisted treatment if it is deemed medically necessary. This type of treatment typically requires pre-authorization before UnitedHealthcare will pay for it. Common medications covered by UnitedHealthcare when used as part of a MAT program include Suboxone (buprenorphine), Bunavail/Zubsolv (buprenorphine/naloxone), methadone, Vivitrol (naltrexone), Disulfiram and Acamprosate. The type of medication that is best for each patient will be determined by a medically trained health professional.
- Therapy/counseling: Both inpatient and outpatient drug rehab programs typically incorporate one or various forms of therapy. Common types of therapy used to treat substance use disorders include group, individual and family therapy as well as cognitive-behavioral therapy, motivational interviewing and other cognitive-behavioral types of counseling. Most UnitedHealthcare insurance plans provide partial or full coverage for therapy provided during an addiction treatment program.
- Drug testing: Many drug and alcohol addiction programs require patients to take regular drug tests as part of their recovery plan. This helps ensure that individuals remain sober throughout the course of their treatment and allows medical professionals to take proper action when patients do not remain sober. Most UnitedHealthcare plans cover drug tests.
- Medications: In addition to medication-assisted therapy, many treatment programs incorporate medications into a person’s recovery plan for other reasons. For example, someone attending an inpatient program may experience extreme anxiety as a result of getting sober and being in a new environment. Medical professionals may choose to prescribe the individual anti-anxiety medicine to allow the patient to better cope with their condition. Medications may also be used to treat co-occurring mental health disorders. UnitedHealthcare plans typically cover medications prescribed during an addiction treatment program.
- Sober living: Many people who complete an inpatient program will be recommended to transition into a sober living home following treatment before returning to their previous living situations. Some UnitedHealthcare plans may offer partial or full coverage for sober living as long as it is in-network.
Questions to Ask When Inquiring about Your UnitedHealthcare Addiction Services Coverage
The best way to find out what type of addiction services your UnitedHealthcare plan will cover as well as the level of coverage you are eligible for is to speak with a UnitedHealthcare representative. You can often find the contact information for your insurance company on the back of your insurance card. When speaking with a UnitedHealthcare representative, be sure to ask the following questions in relation to addiction treatment:
- Does my UnitedHealthcare plan provide any coverage for a medically-supervised detox program?
- Will my insurance plan cover any portion of drug and alcohol addiction outpatient rehab? If so, what copay and other out-of-pocket expenses will I have?
- Will my UnitedHealthcare plan cover some or all of an inpatient addiction treatment program? If so, what copay and other out-of-pocket expenses will I have?
- What length of stay will my UnitedHealthcare plan cover for inpatient treatment?
- Does my insurance plan cover medication prescribed during an addiction treatment program?
- Does my plan cover medication-assisted therapy?
- Do any addiction treatment services require prior authorization before I am eligible for coverage through UnitedHealthcare?
- Are there any drug rehab services that my plan will not cover that I should be aware of?
How to Find a Drug and Alcohol Addiction Treatment Facility that Accepts UnitedHealthcare
There are several inpatient and outpatient drug rehab programs throughout the United States that accept UnitedHealthcare insurance plans. If you are unsure if a facility accepts your plan, you should call ahead before attending the program to have a representative verify your benefits. To learn more about using your UnitedHealthcare plan to receive drug and alcohol rehab, contact one of our dedicated addiction specialists today.