Explore UPMC Health Plan’s coverage for addiction treatment, including inpatient and outpatient options, plus mental health support.
UPMC Health Plan Coverage for Addiction Treatment
Explore UPMC Health Plan’s coverage for addiction treatment, including inpatient and outpatient options, plus mental health support.
UPMC Health Plan is the insurance arm of the UPMC (University of Pittsburgh Medical Center) health company that provides integrated health care and insurance coverage to residents of western and central Pennsylvania plus parts of Maryland and Ohio and West Virginia. They are headquartered in Pittsburgh Pennsylvania.
UPMC has their own network of hospitals and doctors and they also contract with other providers including the Cigna PPO network to serve members who live or travel outside of their main service locations. UPMC actively supports Pennsylvania community arts and education groups such as the Pittsburgh Promise, an educational scholarship fund to which they donated $10 million in 2023.
Does UPMC Health Plan Cover Addiction Treatment?
As required by the 2010 Affordable Care Act (ACA) most UPMC Health Plan insurance plans offer mental health and substance abuse treatment along with other medical care. However there are exceptions to the law and every insurance plan is different, so be sure to check with your insurance provider to find out which addiction treatments are covered by your specific plan.
Most UPMC in network substance abuse rehabs are in Pittsburgh, but there are some UPMC covered rehabs in Maryland and New York.
If you have a Cigna PPO plan or other out of network plan that has a partnership with UPMC Health Plan, you may have other rehabs available to you as well. Check with your insurance provider to find out which addiction treatments are covered by your specific plan.
Making the decision to go to Beachway was, by far, the most positive and impactful experience of my life. The entire staff was incredible, as was the community as a whole. I felt safe, seen, and supported throughout my stay, and even now, as I continue my healing journey at home. I was completely set up for success in my healing journey thanks to Beachway, and I will forever be grateful.
Beth Hagan
2 weeks ago
My experience at Beachway was a 100/10. The life skills I learned are priceless and that’s putting it lightly. Beachway was the third treatment center I had been to, following the sudden loss of a loved one. I had prior sobriety before beachway and was convinced that I was only there because of a death, and that that was why I was spiraling. The staff at Beachway saw I needed much more help than that. They all knew before I did that if that death didn’t happen, I probably wouldn’t have stayed sober anyway. There was still much more therapy to be done, and more to learn.
The staff took a genuine care in doing so, and looking back at their clinical process they are nothing short of a power house of a team. I never felt so cared for as a human being by people that just met me. The staff quickly became my family, cheering me on while also taking it extremely serious. They are unapologetically honest, which in my experience is the #1 thing needed in recovery. Many of the things they said to me during my time there still stick with me (a year later) and help me navigate life!
I tell anyone that has a loved one with Substance abuse or mental health issues about beachway.
There is no other place like it🤍
Patrick Kelly
3 weeks ago
I owe Beachway my life for sure. I won’t lie and say that I loved every minute of it because I didn’t. A lot of it was very painful, because confronting inner demons is painful. It was a lot of group therapy (especially given how afraid of people I was going in), but they truly helped me gain sobriety and face down my trauma. And they put up with a lot of my crazy behavior while I was going through withdrawals in detox. Like any rehab, you’ll get out of it what you put into it. Surrender to the process for best results. Rehab isn’t a magic wand that makes problems vanish. Rehab gave me the opportunity to accept the ways in which I cause my own suffering instead of blaming everyone around me, while surrounded by professionals who prevented me from hurting myself while my dried out, and helped me identify the underlying causes of my addiction. It will be tough. It will be scary. It will be worth it. I wish I’d gone sooner. The staff there are wonderful and don’t get enough credit. Thank you Beachway.
I have had the opportunity to refer folks to Wellbrook. The facility is first rate. It is clean and welcoming. the staff is extremely professional and knowledgeable. The facility is small so individuals get a lot of hands on encouragement. They stay with you after your discharge. First rate !!!
Mark Saffran
2 weeks ago
Very good environment, Great Staff, Proud to be a part of this program. Helped me alot to find myself and reconnect.
Aj Crisostomo
2 weeks ago
Tour the facility as an employee of another recovery facility and I must say I was thoroughly impressed with the clinical staff, Curriculum and amenities that is offered by Wellbrook tontheir clients! Their alumni support is above and beyond as well!
Very friendly, both peer ran and counselors, in beautiful nature area, trails are gorgeous so is the chapel!! I give thanks to the staff here! All the RAs and counselors oh and don’t forget the nurses! They are all super friendly and supportive
Jade Viglione
1 month ago
St. Joes is an absolute paradise! Such a beautiful place to go and work on yourself. The staff are amazing and the treatment is so productive. They're pulling strings you may not realize to help you!! Thanks to St. Joes I've found me again. He was lost for a long time in the fog of a deep depression, masking that with substance use, I thought he was gone forever. Thank you guys so much for an opportunity to live again, not just exist. If you are struggling and need help, give them a call. They will pick you up and mark will call you everyday until they do to ask how you are doing! I've never been to a more beautiful place that helps you as a whole being, mind, body, and soul!
Chuck Rose
damon rose
1 month ago
Absolutely amazing place if you are in jeed of recovery from substance abuse. Amazing staff. Great place to go to get yourself back on the right track. I would recommend this to anyone who is in need of help. They also offer an iop for those that could benefit from it as well
This place is amazing! From the community to the staff and the nurses! If anyone needs help with addiction Swift River is the place to be ! Thank you !
Much love
Thomas McMaster
Thomas McMaster
1 month ago
Great place great community, great staff, all around great experience
The staff is incredibly accommodating and a great group of people. All my needs were met and I felt very comfortable.
John Ryan
1 week ago
Silvermist is in a league of it's own! The staff is amazing, the grounds are beautiful, the food is incredible, and the facility itself is so clean and well kept. 10/10!!!
MK Fullerton
2 weeks ago
Staff are caring and highly professional, and the facility is always clean and well maintained.
I attended twice, Great facility, however I’m on my wife’s UHC plan through her employer,not Medicare. No problem with insurance the first time I went, however (going the 2nd time) they are trying to say I’m on Medicare. I called UHC and nothing has changed in my coverage. Trying to charge me 15,000. What’s going on? Also once there ,they) Siver Pines) wanted out of pocket money(cash,Cc card) they never asked for that upfront either time. They even checked recorded call. I’m very dissapointed with billing. Put a “sour taste”on my experience
Drew Henderson
1 week ago
I'm truly happy and grateful that I got to come to Silver Pines. I had my reservations seeing as I don't suffer from substance use addictions but I chose to come here for my mental health. For the downsides: there's a 14 day blackout on personal electronic use unless you get approved for important things like calls, bills etc, but I needed that time to disconnect. You'll also be woken up in the middle of the night by the behavioral health techs doing their checks , and if you're unlucky you might get a roommate that's messy or snores. The BHTs truly do care about you and want to help you on your recovery journey, they've all been truly stellar to me, especially Will. The therapists are very compassionate and helpful in processing your issues, my thanks go to Alisha my personal therapist, Deidre, Zack and Jesus especially for helping me so much. The kitchen staff is full of hard workers who make great food and they're so kind, especially miss Dre, who cares a lot about your nutrition and if you have any dietary restrictions or eating disorders. Angie the janitorial worker is always working her butt off and I appreciate her so much. The nurses are bubbly and delightful and cared a lot for me, especially both Karens, when I was struggling to settle in. There's meaningful and helpful resources for helping yourself or those who struggle with SUDs, there's great aftercare as well with the alumni coordinator Jenn, and they're always willing to accept feedback and address any concerns you may have. My only complaint is that there's probably only 2-3 LGBTQ+ groups a week, which is a HUGE boon but may make it harder for those who aren't openly out to process their struggles with identity and their SUD/Mental health. Other than that, I'm hoping that if you or someone you love and care about needs help with any sort of addiction, you can come here. There's a truly loving community here who'll support you and share their hearts with you. Thank you Silver Pines for helping me on my recovery journey.
Des (ぴよこデス)
1 week ago
This is the best rehab I attended and has been my last. First time I even felt sad after leaving because I made so many great connections with staff, nursing, and the community. Cooks are extremely skilled and provide the greatest food you will get in rehabs. There is a desert and savory treat made every single night and theres always numerous snacks to pick from. The nursing staff is the greatest staff of all time they should honestly be awarded somehow. Everyone in the staff there is just amazing and they always foster a connected community. Counselors are super chill and knowledgeable about addiction and thoroughly aid you through the process. After the rough detox beds you are moved to the residential side. The Beds and Pillows on this side are super comfortable. They allow you to use your phones quite often and take care of emergencies through your phone typically without a problem. I could honestly go on forever talking about my amazing experience. If you need help please come here you won’t regret it for real.
Successfully completed IOP treatment with Ethan Green as my therapist. He was an amazing source of empowerment and strength in my recovery journey, his down to earth and human approach shatters any hesitation anyone may have to get treatment. I truly recommend this treatment center.
Luis Gonzalez
5 months ago
Treatment here was a great experience, the staff really cares about the clients!
just finished their PHP program, spent a month of my life here, great and supportive staff especially Mac and Griffin
lukas hernandez
1 year ago
This experience was a pivot point of my life. rebuilding my relationship with god and having a better understanding of maself was humbling. If anyone wants to recover and build their lives back together and serious about their recovery, Asheville is it!!!! The network, the staff, the treatment was better than anything I expected. Saved my life!!! Thank you real recovery!!!!
Perfecto Sambula
1 year ago
I was so nervous about the decision to attend a treatment center but drugs and alcohol had kicked my butt. Real Recovery saved my life. I will always be indebted to them for everything they done for me. They allowed me to be and never judged me when I was vulnerable. If you're a person like me who struggled with drugs and alcohol REAL RECOVERY is the best.
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult ProgramLGBTQ Program
Private insuranceSelf-Pay Options
In May of 2010, I arrived at Wernersville, PA, via intervention. I would later realize, all of the seeds were planted during my time at Caron and I finally learned about my disease and about the chemical makeup of my brain when using. I wasn't ready after my 30 days. However, on June 25th, 2017, the miracle happened. Caron laid the foundation at my feet. Magic mountain is real and very a spiritual place. The facilities are very clean, good therapists and doctors, and a great overall team. I will be forever grateful of the gift I was given to attend Caron's 30 day inpatient stay. FYI..This included 3 days in their detox facility on site. The detox staff were truly compassionate and loving. Exactly what I needed after years of using and untreated mental health. Sincerely,
Paul B, CT
Paul Bochicchio
2 weeks ago
Caron saved me and was the first place to actually put hope in my recovery. Was in the teen male program and everyone is amazing. Kinda pissed they recommended me for sober living and then sent me to a place that wasn't sober living but its OK I love em anyway
Adan de Andrade
2 weeks ago
"I recently completed the detox program, and I am genuinely impressed by the experience. From the moment I started, I felt supported by knowledgeable staff who truly cared about my well-being. The program was well-structured, incorporating a variety of healthy meals, engaging activities, and informative workshops that made the process enjoyable and enlightening.
One of the highlights for me was the personalized approach. The team took the time to understand my specific needs and goals, which made the detox feel tailored to me. I appreciated the blend of physical detoxification with mental wellness practices, such as yoga and meditation, which helped me feel rejuvenated both inside and out.
I noticed significant improvements in my energy levels, mood, and overall clarity after completing the program. It’s amazing how a focused detox can reset your body and mind. I would highly recommend this program to anyone looking to cleanse their system and embark on a journey toward better health. I left feeling empowered and equipped with the tools to maintain a healthier lifestyle moving forward.
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Frequently Asked Questions
What UPMC Health Plans Are Available?
UPMC offers individual and family plans through the state Insurance Marketplace and through employers. If you qualify you can also get Medicare or Medicaid plans through UMPC.
The individual and family plans have several different options. They have Exclusive Provider Organization (EPO) plans, which require you to get care in the provider network but you don’t need a referral to see a specialist such as an addiction counselor.
They also have Health Maintenance Organization (HMO) plans, which require you to stay in network and to get a referral for specialist care. However, HMOs are often the least expensive on a monthly basis. Finally, a Preferred Provider Organization (PPO) gives you the most flexibility with some out of network coverage and no referrals required. However these plans tend to cost the most each month.
UPMC Health Plan offers Medicare Advantage (“Medicare part C”) HMO and PPO plans. Medicare plans by UPMC healthcare are called UPMC for Life. These plans provide the same services as regular Medicare, including coverage for addiction care, but they generally offer extra benefits like prescription coverage and vision and dental care.
Your Medicare Advantage plan will have its own coverage limits and requirements to get addiction treatment, so be sure to work with your doctor and get the referrals and preauthorization you need before you commit to treatment.
Medicaid plans by UPMC healthcare are called UPMC for You. Like regular Medicaid, these plans cover medical treatment and substance abuse treatment. However, they also cover prescriptions and dental and vision care.
If you qualify for both Medicare and Medicaid, UPMC for Life Complete Care offers $0 premium fees and $0 copays on medical care and $0 copays for prescriptions. It also offers dental and vision and hearing benefits. Members can get free transportation to healthcare providers and grocery stores along with fitness centers and adult day care centers. There’s also an allowance you can use to buy over the counter products.
What Inpatient Addiction Treatment Does UPMC Health Cover?
All insurance plans will focus on covering medically necessary care which is often defined by the treatment plan your doctor creates. It’s also important to verify your insurance and make sure you get a referral or preauthorization if necessary.
Some of the inpatient drug rehab treatment options that may be included in UPMC Health Plan’s behavioral health insurance policies are medical detox and residential treatment.
Detoxification is the process of letting substances leave your body. Many times you’ll get medical support to help you move through withdrawal symptoms. This may include medication assisted treatment (MAT). Commonly used MAT medications for treating alcohol or opioid addiction are methadone and buprenorphine along with naltrexone.
Inpatient treatment takes place in a clinic or hospital and residential care takes place in a non hospital facility and offers a more home like setting. Both options provide around the clock support and care.
Residential treatment often lasts 28 to 30 days or more. You’ll get a variety of therapy options which often includes holistic approaches like art or music therapy. Inpatient or residential treatment allows you to fully focus on your recovery without any distractions.
What Outpatient Rehab Does UMPC Health Plan Cover?
Outpatient programs, including intensive outpatient programs and regular outpatient programs, are available through UPMC Health Plan’s mental health benefits. Intensive outpatient programs typically involve up to nine hours of treatment each week, for between three to six weeks.
In a general outpatient program, counseling and education sessions may take place at a clinic or rehab facility. Addiction and relapse prevention education are provided, with individual sessions offered as needed.
There are multiple types of outpatient care. The most intensive outpatient treatment is a partial hospitalization program (PHP). This is a full day program that offers more than 20 hours of treatment per week. The treatment options are similar to inpatient or residential care.
At the next level are intensive outpatient programs (IOPs) which typically involve nine to 20 hours of treatment each week, with the hours spread over three to five days. Often 90 days of IOP treatment are recommended. The lowest intensity is general outpatient treatment, where counseling and education sessions may take place at a clinic or rehab facility once or twice a week. Addiction and relapse prevention education are provided, with individual sessions offered as needed.
Do UPMC Health Plans Have Additional Benefits?
Part of what makes UPMC Health stand out is the extra benefits members receive. For example preventive services may be free of charge and members can access virtual (telehealth or video) urgent care services to diagnose illness or prescribe medication.
They also have the MyHealth program that provides free health coaching for weight loss and smoking cessation along with tips on stress management and more. Finally, members can get six sessions of free counseling with a trained counselor through the Life Solutions program.
Does UMPC Health Plan Cover Methadone & Suboxone (MAT)?
MAT is covered by most UMPC plans. This treatment uses FDA approved medications to help those with alcohol and substance use disorder during the early recovery period. These medications such as naltrexone and buprenorphine along with methadone and acamprosate ease withdrawal symptoms and help to normalize brain chemistry. This is especially important during medical detox.
Some individuals only need MAT during the detox process while others need it throughout treatment to help manage cravings to reduce the risk of relapse and decrease the risk of overdose. Longer term MAT is combined with inpatient or outpatient treatment to help you establish long term recovery. Once treatment ends you can taper off the medication support and live a fully substance free life.
Does UMPC Cover Other Mental Healthcare?
In 2010 the Affordable Care Act was enacted into law. The ACA requires insurance plans to cover 10 essential health benefits which include mental health and substance use care. As a result most UMPC plans cover mental healthcare such as counseling and crisis intervention. You may get individual or group counseling along with mental health medication.
The extent of coverage differs from plan to plan. It is important to understand the details of your specific plan before starting treatment so you know whether you need a referral or preauthorization. You’ll also learn what out of pocket costs to expect.
Individuals with alcohol and substance use disorder often have co occurring mental health conditions. What’s most important in these cases is that you get treatment that addresses both mental health and addiction. That’s the only way to ensure you get the help you need to reach long term recovery.
Does Addiction Treatment Need to Be In Network?
Many UMPC plans require you to use an in network provider to get coverage. However some allow you to use an out of network provider although you’ll pay a lot more in out of pocket costs. For example your copayment and deductible may both be higher. Or you might have to pay a percentage of the cost instead of a flat copayment.
To maximize your insurance coverage it’s best to use high quality in network providers or facilities. To find out whether your plan allows non network care contact UMPC directly. This can be done by calling the phone number on the back of your ID card or by going online to their webpage at UPMC.com
Calls to any general helpline will be answered or returned by a paid advertiser.
By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.