Rehab Centers That Accept UnitedHealthcare Insurance

If you’re searching for an alcohol and drug rehab center, you may be concerned about the cost. However, many substance abuse treatment programs are covered by UnitedHealthcare insurance. Each policy is different, but knowing what addiction treatment services are generally covered and what factors affect coverage can help you plan for your care.

UnitedHealthcare insurance covers drug rehab because substance use disorders are part of the protected mental health care category in the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.

MHPAEA requires insurance companies to provide the same level of coverage for mental health treatment as they do for any other medical treatment. The Affordable Care Act (ACA) also mandates that health insurance companies, such as UnitedHealthcare, must cover certain services, including substance abuse screenings and treatment. However, the amount of coverage depends on the type of plan you’re enrolled in.

Many services related to substance use disorders and addiction treatment fall under behavioral health care. Some UnitedHealthcare policies provide at least partial coverage for medical, behavioral and mental health care, such as medically supervised detox in a hospital. However, most of these services are handled by its sister organization, United Behavioral Health, also called Optum.

There are several evidence-based treatment programs available for substance use disorder, including inpatient and outpatient care. The following addiction treatment services are at least partially covered by UnitedHealthcare insurance.

The first step in most treatment programs is medical detoxification. This is the period when your body gets rid of the substance and withdrawal symptoms tend to peak.

UnitedHealthcare insurance plans cover at least part of the treatment cost for medically necessary detox services. Some plans may offer more extensive detox coverage, especially if you can find an in-network provider.

Medication-assisted treatment (MAT) is a common part of addiction treatment plans that involves the use of medications to reduce withdrawal symptoms and cravings.

The following medications are approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder and/or alcohol use disorder:

• Acamprosate
• Buprenorphine
• Disulfiram (Antabuse)
• Methadone
• Naltrexone (Vivitrol)

Most UnitedHealthcare insurance plans cover at least a portion of MAT treatment. However, coverage varies by policy, and some require prior authorization.

Inpatient rehab, also known as residential treatment, is for people who need round-the-clock support and a higher level of care than they would get in an outpatient program. Inpatient programs can range from a few days to several months and usually include individual and group therapy, as well as other evidence-based treatments.

UnitedHealthcare policies must cover medically necessary inpatient or residential substance use treatment under MHPAEA. However, there may be limits on how long you can stay in rehab, which services are covered while you’re there, and whether the facility must be in-network.

Below are examples of how general plan coverage may work for two different UHC policies:

• UnitedHealthcare PPO: With this type of insurance plan, you may receive partial coverage of inpatient treatment services. In some cases, you might need prior authorization for inpatient substance use treatment. Without it, you may be required to pay a co-pay, which could range from 20% to 100% of treatment costs.
• UnitedHealthcare HMO: This insurance plan usually requires a higher co-pay for inpatient treatment. You also won’t receive coverage for out-of-network inpatient care unless it’s a medical emergency.

Many people who have a substance abuse problem also have an underlying mental health condition, which is known as co-occurring disorders or a dual diagnosis. This can occur when a person uses substances to deal with the symptoms of a mental health condition or when substance abuse causes mental health symptoms. Treating co-occurring mental health disorders can promote long-term recovery from addiction.

UnitedHealthcare plans generally cover medical care, including medications prescribed during addiction treatment. Mental health care services, including behavioral health therapy, are usually covered under United Behavioral Health/Optum.

For those who’ve graduated from inpatient rehab or don’t require a higher level of care, outpatient treatment programs are an ideal option. Outpatient treatment uses a step-down approach, with the level of care decreasing as the client progresses. These include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs) and general outpatient care.

Most UnitedHealthcare plans offer partial to full coverage for outpatient programs, but coverage may be provided through United Behavioral Health, depending on the specific services. Outpatient services usually require co-payments each time you go rather than a total lump sum at the beginning of treatment.

Here’s a breakdown of what outpatient coverage could look like with common UHC plans:

• UnitedHealthcare PPO: Insurance plans may require a $15 to $50 co-pay for outpatient treatment. Out-of-network providers may be covered up to a certain percentage without prior authorization, and you may have higher co-pays.
• UnitedHealthcare HMO: Some of these insurance plans may cover the cost of outpatient treatment entirely. However, most plans will require a co-pay of $15 to $50 per treatment session. Out-of-network treatment providers aren’t covered by most UnitedHealth HMO plans unless there are extenuating circumstances.

Keep in mind that these numbers are typical ranges, and you should check your Summary of Benefits to find your expected out-of-pocket costs.

Both inpatient and outpatient treatment programs use some form of behavioral therapy and counseling as a way to help clients achieve long-lasting sobriety.

Some of the most common forms of therapy include:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Motivational Interviewing (MI)
• Group therapy
• Family therapy
• Individual therapy

UnitedHealthcare provides coverage for behavioral therapy and counseling through United Behavioral Health/Optum.

Even after completing a treatment program, it’s normal to feel unsure about going back to the same environment you were in before you went to treatment. Continuing care, also called aftercare, is a way to continue receiving support through peer groups, sober living and ongoing therapy.

United Behavioral Health covers ongoing therapy necessary for continued substance abuse treatment, but housing costs for sober living are considered out-of-pocket expenses.

UnitedHealthcare offers a wide variety of insurance benefit plans, and each policy provides a different level of coverage with its own co-pays, coinsurance and deductibles.

Factors that can affect your UnitedHealthcare insurance coverage for drug and alcohol rehab include:

• Your diagnosis
• The type of medical treatment you’ll need
• Your plan’s specific co-pays and deductibles
• Specialist referral or prior authorization requirements
• The treatment provider’s network status

You can verify insurance coverage for substance abuse treatment by contacting a UnitedHealthcare member representative and talking to the prospective rehab facility.

Some UnitedHealthcare insurance policies cover out-of-network rehab programs when there isn’t an in-network option that makes sense for your location and needs. However, you may need prior authorization for the policy to cover treatment.

In-network providers work directly with UnitedHealthcare and have agreed to specific rates for UHC clients. If you choose an out-of-network provider, you’ll likely pay more out of pocket for treatment.

If you or someone you love is interested in UnitedHealthcare Insurance plans, you have multiple options. Each plan offers different coverage amounts and specifications for out-of-network care.

UnitedHealthcare offers:

• Individual insurance plans in 30 states
• Employer-based coverage
• Medicare
• Medicaid
• Short-term health insurance
• Supplemental insurance, including vision, dental and critical illness insurance

There are two distinct types of UnitedHealthcare plans available on the health insurance marketplace:

• Health Maintenance Organization (HMO): Patients with an HMO plan are typically only covered for in-network care, and you may need a referral for a specialist.
• Exclusive Provider Organization (EPO): Patients with an EPO plan are only covered if they use physicians, specialists and hospitals within the plan’s network. No out-of-network coverage is provided, but you don’t need a referral to see a specialist.

Different states have different laws regarding insurance coverage and policies. If you have questions about your state’s specific insurance laws, contact UnitedHealthcare directly.

If you’re searching for treatment options for a drug or alcohol addiction, understanding how UnitedHealthcare handles substance abuse and behavioral health can give you a better idea of what your health insurance plan may cover. UnitedHealthcare generally considers substance use disorders as part of its coverage through United Behavioral Health.

Common addictions that are typically covered include:

• Alcohol
• Opioids
• Marijuana
• Methamphetamines
• Cocaine
• Prescription drugs
• Heroin
• Benzodiazepines

Some plans may also cover rehab or therapy related to behavioral addictions, such as gambling or compulsive shopping.

The first step in seeking help for alcohol or drug addiction is finding a center that accepts UnitedHealthcare insurance. You can get a list of in-network providers near you by calling the member services number on the back of your insurance card. This number connects you with a representative who can help you find a treatment facility that fits your needs.

The second option is to log in to your member account online through the UnitedHealthcare Member Hub. Once you’re signed in, there’s an option to locate in-network providers, and you can search by specialty to find an alcohol and drug abuse treatment center.

Because some of UnitedHealthcare’s plans require prior authorization and referrals to see a specialist and attend a drug and alcohol treatment facility, you may want to contact your insurance representative before looking for a treatment program.

If you’re struggling with substance use, your UnitedHealthcare insurance policy can make treatment more affordable. Call our helpline number to speak with our addiction treatment experts, who can explain your coverage and help you find an in-network treatment center today.