Optum Health Insurance For Addiction Treatment

Optum Health is a health services company. They are part of the UnitedHealth Group, one of the largest healthcare companies in the U.S. They do not provide insurance plans but rather partner with employers and insurance companies to provide various services to consumers.

These services can include behavioral health services and primary care clinics along with urgent care, specialty care, and care for chronic conditions. The goal is to improve the healthcare system by integrating care and improving your access to services.

Their key focus areas are care delivery and pharmacy services along with technology and data analytics. They also offer behavioral health services and health management. They help health plans save money by using digital strategies to reduce the cost of care. Other solutions include consulting services and payment delivery solutions along with risk management and quality performance to drive better outcomes.

Does Optum Health Cover Addiction Treatment?

Optum Health partners with various insurance plans to provide behavioral health services and addiction treatment for members and employees. They facilitate substance use disorder solutions to help individuals achieve stabilization and long term sustainable recovery.

These solutions include applying analytics to data that identify appropriate and effective early interventions. Optum Health helps connect members to evidence based care in their local area including treatment centers that offer inpatient and outpatient options. After your customized treatment program Optum will continue to promote your recovery offering ongoing support and guidance.

Not every insurance company or employer that uses Optum Health services will have the same benefits and levels of coverage. Before committing to a treatment program discuss your insurance details with your provider. This helps prevent unexpected bills from appearing after treatment.

What Kinds of Insurance Plans Does Optum Health Partner With?

Optum Health does not offer plans but instead, they partner with insurance companies to provide benefits for individual and family plans in the Health Insurance Marketplace and employer plans along with Medicare Advantage plans and some state Medicaid plans.

Depending on your state, Optum Health may partner with Aetna, Anthem Blue Cross Blue Shield, Cigna, UnitedHealthcare, and other health insurance providers. The insurance provider is responsible for defining the healthcare professionals and facilities that are in and out of the network.

Insurance plans have a variety of different formats. A health maintenance organization (HMO) plan requires you to use a network of designated providers. You can choose a primary care physician and get referrals from them for specialist care. An HMO gives you lower premiums and out-of-pocket costs but also limits your choices of providers.

A preferred provider organization (PPO) is a health plan that has the most flexibility in choosing healthcare providers. You can see any doctor or specialist without a referral and these professionals can be in network and out of network. A PPO generally has a higher premium and higher out of pocket costs but has fewer restrictions on care.

A point of service (POS) plan is a hybrid option that combines the features of HMOs and PPOs. You select your primary care doctor and need to get a referral to see a specialist. However under a POS plan you can see out of network providers at a higher cost. This offers you some flexibility.

An exclusive provider organization (EPO) combines some aspects of an HMO and PPO. It offers coverage only for services that are provided by in network providers except in an emergency. EPOs typically do not require a referral to see a specialist but do not cover out of network care. They often have lower premiums and moderate out of pocket costs.

Where Does Optum Operate?

Optum partners with insurance companies across the U.S. In each state, Optum partners with different medical providers and may offer different services to insurance plan clients.

For example in Connecticut Optum connects insurance plans with a medical network that includes primary and specialty care along with urgent and virtual care. They also have provider networks for Medicare Advantage plans in Connecticut and have developed effective and cost effective care for complex or serious medical problems.

Within Minnesota Optum has partnered with MedExpress to provide insurance plans with urgent care clinics both in person and virtually to treat various conditions.

In Ohio Optum partners with Unity Health Network and American Health Network so insurance plan members can choose from over 70 medical offices and 200 primary care physicians. Their partnership with American Health Network provides insurance plans with network options for video visits and primary care along with health management programs.

What Inpatient Addiction Treatment Does Optum Health Provide?

Optum works with partnered insurance companies to provide medically necessary inpatient addiction treatment. Several steps can support your need for care. The first is to work with your doctor to develop a treatment plan. This helps provide documentation of medical necessity to the insurance company.

The next is the American Society of Addiction Medicine (ASAM) assessment. This comprehensive tool evaluates several criteria and guides healthcare providers in determining the most appropriate level of care. They use a multi dimensional approach that includes the level of intoxication or withdrawal symptoms along with physical conditions and emotional, behavioral, or cognitive conditions. It also considers your readiness to change and the risk of relapse along with your current living situation.

When necessary medical detoxification is the first step in addiction treatment. Inpatient medical detox provides 24/7 support and medical management. You can be prescribed FDA cleared prescriptions that help reduce the withdrawal symptoms and reduce the risk of life threatening conditions that may happen during detoxification from certain drugs.

Once the addictive drugs are out of your system you typically transition into an evidence based treatment program that addresses your addiction triggers and helps you develop healthier coping strategies. If necessary this can be an inpatient or residential treatment program which uses this combination of treatments to promote long term sobriety and sustainable recovery while providing you with 24 hour supportive care.

What Outpatient Rehab Does Optum Health Provide?

Outpatient care provides unique benefits and many insurance plans that Optum supports help cover outpatient treatment. However your outpatient treatment must be medically necessary and most must be prior authorized before treatment can begin. You’ll want to work with your insurance provider before the program starts so you are not surprised by bills during treatment.

There are several levels of outpatient treatment and not all treatment centers provide all levels. A partial hospitalization program (PHP) provides the most intensive level of outpatient care. Most people receive the same level of care they would as an inpatient but they’re able to go home each evening.

An intensive outpatient program (IOP) provides a few hours of therapy each day for several days each week. The intensity of your program is based on a comprehensive evaluation of your substance use disorder and any co occurring mental health conditions.

A general outpatient treatment program typically offers therapy once a week and sometimes twice per week. IOPs and general outpatient treatment are typically more flexible and allow you to meet your work and school obligations.

After completing an outpatient program you may transition into aftercare. The intensity of your aftercare depends on your customized program and what the treatment center and community offer. It may include weekly or biweekly therapy and community support groups along with vocational support and community resources.

Does Optum Health Provide Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) can be used during medical detoxification and for ongoing treatment of opioid and alcohol use disorders. During medical detoxification medications are prescribed to help reduce the symptoms of withdrawal and the potentially life threatening side effects of withdrawing from some medications.

In ongoing treatment medication assisted treatment can help reduce cravings and the risk of relapse. It is typically included in a medication management program that evaluates the prescribed medications and their expected effects along with side effects to help support your recovery journey.

Typical medications include methadone and buprenorphine as well as naltrexone and Suboxone. Methadone and buprenorphine are opioid agonists and used strictly in opioid use disorders. Naltrexone is used in opioid use and alcohol use disorders. Suboxone is a combination medication of buprenorphine and naltrexone.

Does Optum Health Provide Other Mental Healthcare?

It is not uncommon to have a co occurring mental health condition with a substance use disorder. Insurance companies that partner with Optum Health often provide care for mental health conditions whether those are independent or co occurring mental health conditions.

If you have a co occurring mental health condition with a substance use disorder, it’s called dual diagnosis. Treatment for dual diagnosis requires integrated care delivered to address both conditions at the same time. This helps improve the rate of success to reach sobriety and maintain long term recovery.

Mental health conditions require evidence based treatments and also respond well to holistic approaches such as exercise, good nutrition, and being outdoors. Most plans cover mental health treatment — including dual diagnosis — because of the 2010 Affordable Care Act. However there are exceptions to this rule. It’s essential to check with your insurance provider about coverage benefits and limitations. This helps prevent unexpected bills.

Can I Travel Out of State For Treatment With Optum?

Some insurance policies allow you to travel out of state for treatment. However most plans require you to work with a provider and facility that are in network unless you need emergency help. You can maximize your insurance coverage for treatment when you work with in network providers. You’ll also typically pay far less in deductibles and copayments.

Some treatment centers will help you verify your insurance details before committing to a program. Treatment centers will generally know if they are in network with your insurance plan.

How to Verify Coverage With Optum

There are several ways to verify your insurance coverage. When you enrolled, you were likely told whether to contact the insurance company directly or verify your benefits through Optum. If you don’t have that information most insurance companies and Optum have customer service numbers you can call to verify your benefits.

You also have access to an online account through Optum by going to the Optum state page. Finally you can work with the treatment center you’re interested in. They can let you know if they accept your specific insurance plan and Optum. They can also help you verify your benefits with your insurance company.

It’s important to give them the exact plan name and any significant numbers and not just the name of the insurance company. There are a wide variety of plans and treatment centers do not always accept all plans from an insurance company.