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.
By Rita Milios
Rita Milios, The Mind Mentor, is a recently retired psychotherapist, freelance author (recovery, mental health, spiritual growth), seminar leader, and podcaster from Kissimmee, FL. She provided counseling in rehab facilities in Ohio and Florida, as well as in her private practice. Rita also served as a DOT Substance Abuse Professional (SAP) consultant.
Medically Reviewed by Danielle Letenyei
Danielle Letenyei is a freelance writer living in Madison, Wisconsin. She specializes in personal finance and insurance topics, including medical insurance and Medicare. Her work has appeared in FinanceBuzz, Market Realist, U.S. News & World Report, and more.
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Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramProgram For MenProgram For WomenYoung Adult Program
Private InsuranceSelf-Pay Options
My experience at All In Solutions exceeded my expectations. I was treated with respect, honor and dignity. I was kept comfortable while detoxing.
Timothy Snow
4 weeks ago
My wife completed residential treatment here for alcohol addiction and the change has been remarkable. Family therapy sessions helped all of us understand how to support her moving forward.
Rosalind Actongale
1 month ago
Attentive medical staff during detox, comfortable rooms, board-certified providers who explain everything clearly.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis
Adult ProgramProgram For MenProgram For WomenYoung Adult Program
Self-Pay OptionsPrivate insurance
I absolutely love All in Solutions. They've played a large role in developing me into the person I am today. The staff is great! Especially the counselor, Mrs. Hepzibeth!! She's been the sweetest, and I've created an unbreakable bond with her. She will always hold a special place in my heart. l love y'all and am forever grateful for everything!!
Fleniecia Caldwell
1 month ago
For anyone dealing with opioid or fentanyl dependency specifically, the medical detox with 24-hour clinical supervision is the detail that matters most early on. Withdrawal management done properly makes everything that comes after it more possible.
A Google User
1 month ago
The alumni support program is something I don't see mentioned enough when people talk about what makes a rehab worth considering. Getting through treatment is one thing. Having some kind of structured support afterward is a completely different conversation, and it matters.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
ICFR was just what I needed to learn about my addiction and learn about ways to recover successfully. The clinical staff and support staff are outstanding in every way. The accommodations are comfortable and they do everything they can to address your needs.
Michael Pritchard
3 weeks ago
Great place would recommend to anyone in need.
Joseph Hickman
1 month ago
Really changed my life. Feel like a completely different person leaving than when I first got here. The group facilities are fantastic and really are able to help you on a deep level. The community overall is phenomenal and recommend it to anybody who is struggling
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Silver Pines changed & saved my life!! I've never been to a rehab where all the staff truly cares about the clients and proves it everyday. They have so many different pathways to recovery and are accepting of any & everyone. They also help a ton with mental health comorbidities. Even people behind the scenes in admissions or administration are so helpful. I can't recommend this place enough. Thank you SP!!
Khalilah Lawal
4 weeks ago
This place saved my life.
Patrick Campbell
4 weeks ago
STR Silver Pines helped me when I was at my lowest. The calm atmosphere, caring staff and educational (and fun!) Groups and lessons helped me form new coping mechanisms and life skills i desperately needed. I now live a life I am proud of, and continue to make big strides in my recovery.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
My experience at Silvermist was truly transformational and one of the best things I’ve ever done for myself. The staff created an environment where I felt supported, challenged, and genuinely cared for throughout my stay. I’m leaving with a much better understanding of myself, practical tools for moving forward, and real confidence about the life I’m returning to. I’m incredibly grateful for the people I met here and the care I received. Five stars without hesitation.
John Phebus
1 month ago
Fantastic staff. Definitely cares about quality of service and its clients
Nicholas Clemens
1 month ago
The Staff Was Great, The Clients Great! A Life Changing Experience!
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Staff is amazing!!! Please come here if you looking into rehabs it’s a great place and all the staff is amazing especially the client care will take care of you or any concerns but please come to the haven if you are seeking help they treat you like family!
Tance 870
2 months ago
This is my first time in a treatment facility. I was nervous about what it would be like but was ready to beat my addiction to alcohol. I picked the most perfect place. I love it here! I’m learning so much not only about myself but others in here and their lives, struggles and addictions. I’m happy here. Smiling and laughing as my true sober self. Thank you, Haven, for providing my such good care and support.
Patricia Bettis
2 months ago
The staff was excellent and took care of my every need. I met life long friends here and I couldn’t speak more highly of the staff. I highly recommend the Haven.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
Staff is very friendly and accommodating. Definitely received the help I’ve been needing. Good community
Poopy Dickbutt
3 weeks ago
I've had an excellent experience here. The staff has met all of my needs. The accommodations are very comfortable. The nursing staff has been very understanding and kind. I have had several one on one sessions with therapists and the group sessions have been very productive. There will probably be negative reviews about this rehab but this isn't my first and there are always people who complain. In my opinion this treatment center will meet your needs if you are truly ready for sobriety. You just have to realize that these centers aren't here to hold your hand but are here for guidance. You have to do the work. If you're truly ready than The Haven is a great place to start.
Brandon Reid
3 weeks ago
This facility has given me the time I needed to get my mind and body back into a place of health and peace. The staff was friendly, amenities caring and food good. Grateful for the opportunity to complete treatment there.
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center's quality right now.
I was struggling severely with my mental health before coming to Beachside. The Therapists and group facilitators are amazing. Fran took a special interest in me and always made sure I was ok daily. She could tell when I was struggling and would spend time after groups talking to me and helping me through my problems, as well as motivating me. All the techs genuinely care about you and make your stay easier. Special shoutout to Terrell and Billy. My therapist Sarah is amazing and gives great insight. I would recommend Beachside to anyone struggling with mental health or addiction. It can be scary checking into a facility, but beachside is welcoming and does whatever it takes to make you feel safe and cared for. I will be forever grateful for the care I received there as well as the aftercare. Cali, the alumni coordinator is awesome and always a text or phone call away for continued support. Thank you Beachside!
Cyndi
4 weeks ago
I had a great experience at Beachside. The therapists, providers, nursing staff, and techs were all incredible. I enjoyed the holistic offerings and group therapies as well. I would highly suggest it to anyone struggling with their mental health!
Alexa S
1 month ago
Beachside was a wonderful experience. I'd recommend Beachside to anyone.
Kathy Johnson
1 month ago
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Frequently Asked Questions
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.
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.Â
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
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.
Calls to numbers on a specific treatment center listing will be routed to that treatment center. Calls to any general helpline could be forwarded to SAMHSA or a verified treatment provider.
If you wish to connect with non-sponsor centers, you can browse top-rated listings, visit our homepage and browse by state, or visit SAMHSA.
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