UMR Health Insurance for Addiction Treatment

UMR is a third party benefits administrator that is part of United Healthcare Services. UMR works with employers who have self funded health plans to provide access to medical provider networks and other benefits strategies.

The company is the nation’s largest third party administrator with over 3,800 benefit plans as clients. Their networks and services help 6 million members access the care they need. Employers can get claims data and reports that help them understand and manage health care costs while also accessing UnitedHealthcare’s large national network.

Does UMR Cover Addiction Treatment?

UMR helps self funded employers build their own unique insurance plans to offer employees. These plans do not have to offer essential benefits as defined by the Affordable Care Act. However if they do offer mental health or addiction treatment coverage it must be at the same level as other medical coverage according to the Mental Health Parity Act.

In order to determine what coverage you have for substance use treatment you will need to talk to your company’s benefit specialist. To maintain your privacy you can ask how to find out what behavioral health providers are in the plan’s network. You can also ask if the plan has any coverage for out of network care.

When you verify insurance coverage before beginning treatment you can ensure you get any referrals or preauthorization that is required. This allows you to avoid any unpleasant surprises while you’re trying to focus on recovery.

What Products Does UMR Offer to Employers?

UMR offers a wide variety of products and services to employers including backend solutions for benefits coordination and payment integrity.

The most important product is the connection to a high quality medical provider network. Because they are a subsidiary of United Healthcare, clients have access to high quality and cost effective providers. They also have cost management solutions and reports that help employers fully understand the use of benefits.

For member service there are three options. The Customer First model allows employees who are insurance plan members to contact a designated customer care team that’s trained on the employer’s specific plan and benefits. The Plan Advisor model provides advocacy service so members can have help navigating benefits with personalized care. There’s a single contact for members to ask questions and get information about finding the best care for their needs as well as a nurse helpline.

The GenerationYouTM service model gives the highest level of support which includes advocacy and engagement to promote better health outcomes. If your employer has GenerationYouTM you will have digital access that gives you information about your benefits and providers along with highly personalized help accessing healthcare.

UMR also provides help for employers who want to offer financial accounts like FSAs or HSAs. They can also administer HRAs and lifestyle accounts (LSAs) along with Retiree reimbursement accounts (RRAs).

As an employee member you may also have access to case management for complex health conditions and programs that provide incentives for wellness and healthy lifestyle choices.

What Inpatient Addiction Treatment Does UMR Cover?

Self funded plans are not legally mandated to cover addiction treatment. However, many will offer these benefits. As the central focus of insurance is on providing medically necessary care you will always need get a treatment plan from your doctor before starting any intervention — like inpatient addiction treatment.

The American Society of Addiction Medicine (ASAM) Criteria is an assessment framework medical professionals use to determine appropriate care levels. With this tool—which evaluates criteria like severe withdrawal risk and underlying medical conditions—a medical professional will assess your need for residential care.

If inpatient treatment is the best route for you then medical detox is usually the first step. During this phase individuals are under round the clock supervision to manage withdrawal symptoms safely after stopping the substance of abuse.

Inpatient or residential care is typically the next stage in a person’s recovery journey. These settings provide a structured environment created with one primary purpose: assisting individuals to live a drug free life. Residential care benefits individuals in recovery by providing targeted treatment and reducing relapse risks while also offering continuous support.

Recovery promoting activities like individual and group therapy along with medication management and life skills workshops characterize a typical day in an inpatient program. The goal is to treat the whole person which means addressing the physical and psychological as well as social aspects of addiction and equipping individuals with the tools needed for long term recovery.

What Outpatient Rehab Does UMR Cover?

Your employer’s insurance plan may partner with UMR to cover three outpatient rehab approaches: Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) along with general outpatient care.

A PHP is the more involved alternative as it can include 20+ hours of weekly treatment. You attend during the day and return home at night. An IOP requires 3 to 5 days of weekly programming while general outpatient care—the most flexible mode—offers sessions that vary in frequency based on each person’s case.

Outpatient programs are structured to assist individuals in rejoining their social and professional lives in the most useful way. Individual and group counseling along with skills training are some methodologies employed to help you develop new habits and coping strategies while maintaining your daily responsibilities. Aftercare services follow outpatient treatment to strengthen a person’s support networks and sustain long-term recovery.

Always verify your insurance coverage before committing to a treatment plan as self funded plans can differ widely in terms of coverage and limits along with requirements for outpatient rehab services.

Does UMR Cover Methadone & Suboxone (MAT)?

If your insurance plan covers MAT this approach can be a helpful tool for treating opioid and alcohol abuse disorders.

In the initial stage of treating opioid addiction medications like methadone or buprenorphine are critical during the medical detox step—when the drug gets out of a person’s body—to manage withdrawal symptoms.

For a long term opioid free life MAT can help by incorporating medication such as naltrexone and Suboxone which help normalize brain chemistry—disrupted by substance abuse—and control cravings that can persist for months. This allows you to stay stable in treatment and lowers the chance of treatment.

MAT can be a valuable option for treating alcohol addiction. Medical professionals employ medications in the initial detox phase to cope with the withdrawal symptoms of stopping alcohol consumption. In the later stages of the recovery journey medications like naltrexone and acamprosate can reduce alcohol cravings and support long term sobriety.

MAT interventions are most effective when combined with counseling to empower individuals with life skills to establish long term recovery and sustain treatment outcomes. Over time you can taper off the medication support and live fully substance free.

Remember to verify coverage before committing to a plan. You may need a referral or preauthorization as plans can differ regarding individual medications and coverage requirements.

Does UMR Cover Other Mental Healthcare?

Self funded insurance plans are not legally ordered to cover mental health but many do. Always check your insurance coverage before initiating care to prevent unanticipated costs.

Mental healthcare demands an individualized approach. Some individuals struggle with mental health issues without other disorders. In these circumstances treatment will generally start with therapy sessions with qualified professionals. These are used to identify the appropriate care you need which might include counseling along with group sessions and potentially medication.

Individuals who struggle with addiction commonly have co-occurring mental health disorders as well. About 21.5 million adults in the United States battle addiction while facing mental health challenges like depression and anxiety along with mood disorders.

In these cases treatment must address substance abuse and co occurring conditions simultaneously to increase the chances of success on both fronts. Why? Because mental health issues make individuals more vulnerable to drug abuse. Also medications for mental health disorders like anxiety can interact with substance use so a holistic approach that considers every aspect of a person’s mental health and circumstances along with underlying medical conditions and crisis support is vital to obtain long term favorable outcomes.

Does Addiction Treatment Need to Be In Network?

Self funded plan coverages vary much more than other insurance plans. However, always keep in mind that self funded plans are focused on cost effective care. It’s possible that some of these plans may cover out of network care but not all plans will. If out of network care is covered it will be at a higher cost for you. For example you’ll usually have much higher deductibles and copayments.

Before initiating treatment double check network status and coverage details with your insurance plan and UMR. In network providers are your best choice to keep out of pocket costs low and maximize your insurance’s benefits. Out of network care can significantly increase your expenses so it’s best to utilize the network to your advantage.

What to Do if UMR Won’t Cover the Cost of Rehab

Self funded plans may cover addiction treatment options. However they may be more limited than traditional plans and you may encounter less comprehensive benefits. Don’t let this fact discourage you from seeking the care you need.

Consider contacting treatment centers and ask if they have sliding scales of fees based on income or offer scholarships or payment plans to facilitate payment.

Get resourceful and seek free and low cost rehabs such as the Salvation Army—which permits you to work instead of paying—or a county or state run program.

Addiction affects every aspect of your life so make treatment a priority. Borrow money or rely on your savings to advance on your path to recovery; the effort may change your life.

How to Verify Coverage With UMR

The best way to verify coverage with your insurance plan and UMR is to reach out to your organization’s benefits manager or contact person. If you have been provided a customer service number take advantage of it to access reliable coverage information.

If your employer suggests you contact UMR directly you can rely on their excellent customer service to help you determine what treatment is best and where to get it based on your plan.

Refrain from contacting treatment centers directly for insurance verification because each self funded insurance plan is unique. Treatment centers may accidentally provide you with wrong information that doesn’t relate to your real benefits.