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.
I had a wonderful experience at Beachway. Highly recommend. They helped me in so many ways and I am forever grateful for the experience
Chloe Davis
1 week ago
Beachway Therapy Center supported someone dear to me as they navigated personal challenges with genuine care and patience. The staff made them feel safe and supported from the start. I’m deeply grateful for the kindness and professionalism at Beachway.
Caroline Harper
1 week ago
Beachway Therapy Center was a blessing for our family. My loved one went in during a really difficult time, and the care they received made all the difference. The therapists were attentive, patient, and genuinely invested in helping them heal. Communication with our family was consistent and compassionate, which helped us feel supported throughout the process. We’re incredibly grateful for the progress they’ve made and for the people at Beachway who treated them with dignity and respect. I would recommend Beachway to any family looking for real help and real change.
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
1 month 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 months 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
2 months 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
2 months 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
2 months 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 month 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
1 month ago
Staff are caring and highly professional, and the facility is always clean and well maintained.
Exceptional care..I could not recommend this place any higher than I am. Narrative based interviewing transformed my daily routine and changed my life for the better..
Mike Krevinas
1 month ago
I implore you to find a more intimate and personalized treatment facility! Especially with the additions of Narrative Based Interviewing and Celebrate Recovery to the curriculum, one can expect a much higher sucess percentage upon discharge. Every single staf member at Silver pines legitimately cares about the experience each and every client has with the facility. It certainly shows.
I strongly suggest rocking with Eddy in the narrative based interviewing as research is indictating a 100% success rate if practiced every day. This practice is not only changing how we treat substamce use disorder and mental illeness , but also will be instrumental in creating a global shift to bring people back to the power of the moment and realize the endless possibilities with being the most active participant within the unfoldment of their lives. I assure you this will change the world.
God is great and Silver pines treatment facility is almost heaven on earth.
If you or a family member are struggling. Call them. They care. And it shows .
If you're anything like me , you probably dont have much else to lose, so go and fix you. Give yourself another chance .
David Boniscavage
1 month ago
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
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
7 months ago
Treatment here was a great experience, the staff really cares about the clients!
AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid Addiction
Adult ProgramYoung Adult ProgramLGBTQ Program
Private insuranceSelf-Pay Options
Caron provided me the environment/people that I needed, in order to feel comfortable enough to accept the reality that my drinking had gotten the best of me physically, mentally and emotionally and that a path exists, which leads to less suffering. I am grateful every day that I suffer less and smile more as a result of my time at Caron.
K B
1 week ago
My friend went through Caron in 2023 and has found sustained recovery since. We’ve seen him flourish since— an active father, accountable employee, and a present friend. We are grateful for all he learned at Caron and excited for what is in store for him. Since then he’s gone back to speak to the Caron patients to share his story.
Julie Flannery
2 weeks ago
I owe so much of my health, happiness and family to Caron Treatment Center. I was a patient at Caron PA in August of 2020 and choosing Caron over so many other treatment facilities was the best decision my family and I made for my sobriety.
I will forever be grateful for Caron and their staff each and every day!
First I would like to thank the staff who are wonderful people. Even when you leave you get support. I would recommend this place to anyone, and whoever is deciding if they wanna go to a rehab. Please go and go to this rehab you will not regret it.
Sean Bates
1 week ago
I just wanted to thank Mt laurel for saving my life. I am 47 days and counting sober. As they helped give me the skills and tools I needed to become so er and stay sober. Like all rehab facilities there is a good side and a bad side. I am one more success story. So ty Mt. Laurel for giving me my life back. I am forever grateful.
Nicole Ethridge (Nikki)
2 weeks ago
Mountain Laurel has an amazing staff and the facility has a peaceful, comforting environment.
The combination of filters you have selected has no results. Please refine your selections and try again.
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.
Sponsored Helpline
800-784-1361
Alcoholism
Drug Addiction
Dual Diagnosis
Mental Health and Substance Abuse
Opioid Addiction
Substance Abuse
Adult Program
Young Adult Program
Private Insurance
Self-Pay Options
Military Insurance
Military Program
Sliding Scale Payment Assistance
Medicaid
Medicare
Financing
LGBTQ Program
Program For Men
Financial Aid
