UnitedHealth Group Insurance Coverage for Drug Rehab

Discover how UnitedHealthcare covers addiction treatment, including rehab options, outpatient services, and support for mental health.

UnitedHealth Group Insurance Coverage for Drug Rehab

Discover how UnitedHealthcare covers addiction treatment, including rehab options, outpatient services, and support for mental health.

UnitedHealth Group is a global business that provides a variety of health focused solutions. Their UnitedHealthcare company offers health insurance for over 29 million people in the United States. They also have 2.2 million people insured in South America. For folks who are older you can get a Medicare Advantage plan through UnitedHealth. They also have Medicaid plans for lower income folks in multiple states.

Does UnitedHealth Group Cover Addiction Treatment?

There are a lot of treatment options to help you leave addiction behind. Best of all, most UnitedHealthcare plans can help pay at least some of the costs of drug rehab. Back in 2010 there was a law passed called the Affordable Care Act (ACA). The law said that most long term health insurance plans have to offer coverage for specific types of care, and both mental healthcare and addiction treatment are on the list.

There are exceptions to the law, however, so be sure to verify your insurance coverage before you start rehab.

How the coverage works will depend on your specific plan. For specific details about your coverage you should talk to the insurance company. For example, they can help you choose a center that’s part of the network and maximize your insurance benefits.

What Insurance Plans Does UnitedHealth Group Offer?

You can find UnitedHealth plans in every state except New York. They have many different plans to help their members access healthcare.

In the United States individual and family plans are provided in three primary kinds of insurance plans. They are Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and Exclusive Provider Organizations (EPO).

A PPO gives you maximum flexibility which is important. It also has the most expensive premium. PPO plans often provide out of network benefits, which means you can go to any facility you want. However, the insurance will cover less of the cost and you will cover the rest. That’s why it’s a good idea to find a provider in the network if possible.

An HMO is the least expensive monthly, but you can only use network doctors and facilities. Overall, United Healthcare works with over 1.3 million doctors and 6,700 hospitals and facilities, but your specific plan will have a smaller network focused on your local area. You’ll need to have a designated primary doctor and have them give you referrals for specialized care, which includes drug rehab.

An EPO requires you to choose in network doctors and facilities, but what I like about these plans is that you don’t need a referral to see a specialist. That means you have more flexibility about where and when you get the help you need.

UnitedHealth has insurance policies in almost every state. Make sure you fully understand your coverage. That will allow you to get the help you need while maximizing your insurance benefits.

United HealthCare also provides certain Medicare plans. Medicare Advantage through UHC includes the same benefits as Original Medicare and usually has a prescription benefit. The plan may also offer vision and dental coverage along with free fitness memberships and more.

Both Original Medicare and Medicare Advantage plans have premiums and deductibles along with other out of pocket costs like copayments or coinsurance. One advantage of Medicare Advantage plans is that they often have set copayments instead of having you pay a percentage of the bill. This ensures you know what to expect and that there are no great surprises when you receive your healthcare bills.

With Original Medicare you can see any participating Medicare providers or facilities in the United States. With Medicare Advantage, you may be required to see providers or seek care with in network providers only. There are exceptions in cases of emergency or urgent care situations.

UnitedHealth also offers Medicare Supplement plans which are known as Medigap. Medigap is a supplemental insurance plan that helps you pay some out of pocket expenses such as your coinsurance. These plans are meant to help Medicare be more affordable.

For people with special needs UHC offers a Medicaid plan called Dual Eligible Special Needs plans (D SNP). This type of plan offers participants additional coverage because it allows for individuals to be covered under both Medicaid and Medicare if they meet eligibility requirements.

They also offer Medicare Part D which is a plan for prescription medication coverage.

United HealthCare offers Medicaid plans to lower income individuals and families in specific states. For qualifying children and adolescents, they offer a medicaid plan called Children’s Health Insurance Plan (CHIP).

Medicaid generally offers coverage for addiction treatment but you need to find a provider that accepts Medicaid coverage. Each state has its own state and county funded programs that may accept this insurance plan and often you can get care for $0 or a very low fee.

What Inpatient Rehab Does UnitedHealth Group Offer?

Inpatient rehab is a covered service for many with United Healthcare but you should verify your mental health benefits before obtaining services. You might have to have documentation of medical necessity and it’s important to know which providers and facilities are in network for your plan.

Inpatient rehab may include medically supervised detox and residential rehab services.

Medically supervised detox can be done in an inpatient hospital setting or residential rehab facilities. During medical detox individuals with alcohol and substance use disorder receive close medical supervision from qualified professionals and may receive FDA approved medications to ease withdrawal symptoms and prevent potentially serious health complications.

This type of treatment is especially beneficial for those with serious addictions especially when the addiction is to alcohol, barbiturates and/or opiates. Detox can last anywhere from a few days to several weeks with the average completion time of 5 to 14 days. After completion of medical detox individuals typically enter inpatient rehab or outpatient treatment.

Inpatient or residential rehab centers include individual and group therapy in a structured setting with 24/7 support. In some programs you can continue with a longer term medication assisted treatment (MAT) depending on your unique needs. Many inpatient programs also use other therapy methods such as music and art therapy along with holistic treatment options such as massage and yoga.

What Outpatient Addiction Treatment Does UnitedHealth Group Offer?

Most UnitedHealth plans cover outpatient alcohol and substance abuse treatment for members. Coverage and plans differ so it is important to check the benefits summary for information on what is covered and determine if in network providers must be used or if prior authorization is required.

Outpatient treatment options such as a partial hospitalization program (PHP) and intensive outpatient along with medication assisted treatment are options that can help you on your recovery journey.

Some outpatient care is more intensive and other programs are less so. A PHP is a full day program that’s similar to residential care except you don’t live at the facility — you go home at night. A PHP is not the right approach for everyone so it is important to discuss options with your healthcare providers to understand what is right for your treatment plan.

The goal of a PHP is to help with sustained recovery and prevent relapse by helping individuals improve coping skills, develop a relapse prevention plan and put together a community support system.

An Intensive Outpatient Program (IOP) is often the next step in recovery once residential or PHP treatment is completed. Understanding that early recovery can be difficult an IOP offers individuals intensive treatment including nine or more hours of treatment per week and a structured plan for recovery. You might also be able to receive MAT during treatment.

The goal of IOP is to help individuals prevent relapse and to develop coping strategies and behavioral change. They also help you establish or re establish support systems. Individuals participate in individual counseling and group therapy sessions and may include vocational training and case management services.

Medication-assisted treatment (MAT) is a form of treatment available for alcohol and opioid addictions. With this form of treatment FDA approved medications are combined with other therapies to treat substance use disorders. United HealthCare plans may cover expenses for any prescription medications that are required for your addiction treatment such as Suboxone or methadone. The specific plan determines how much you’ll have to pay out of pocket.

Keep in mind you may need a referral to a MAT program to get insurance coverage, and your doctor might need to preauthorize the care with the insurance company before you begin.

Can I Travel Out of State for Treatment With UnitedHealth Group?

The type of UnitedHealthcare policy you are enrolled in will determine whether or not out of state care is covered.

Some insurance plans require that members only see providers or use facilities and healthcare systems that are in their network. For those plans, you would not be able to travel out of state unless the other state had in network providers for your specific plan. For example most UHC Medicare Advantage plans are HMOs and will not cover out of network services.

Again, it is important to know your policy. Utilizing the UnitedHealthcare website or calling and speaking with a representative can help clarify any questions about covered benefits.

How to Verify Coverage With UnitedHealth

There are multiple ways to verify UnitedHealthcare coverage. You can call the number on the back of your member card and speak with a representative about coverage and also ask any questions you have about providers or required documentation. Members can go to the UnitedHealthcare website to verify coverage and find providers.

For many, a treatment center you’re interested in can offer assistance in verifying active insurance. They can let you know if your doctor needs to send a referral or ask for preauthorization. Because UnitedHealthcare offers so many different types of health insurance programs in many states it is important that you have the specific name of your plan available when verifying coverage.

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