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.
In 2020, I went to the Aloha house in West Palm, after treatment. I was a chronic relapser and out of hope. The structure and support at the house set my feet on a path of victory and recovery. I'm almost 5 years sober today, reunited with my husband and 3 children, and helping others out of addiction. I'm not sure where I would be if I had not found Aloha. There was just enough structure and freedom to allow me to safely start rebuilding my life. I highly recommend. There is HOPE.
Jessica Wilging
1 week ago
LEONARDO ADRIAN IS THE BEST MAN IN THIS PLACE !! Thank you LEO YOU REALLY CHANGED MY LIFE THANK YOU !! 🙏🏽
Michael Cortez
3 weeks ago
My experience at Beachway was not perfect, as nothing truly is. However, I would not change a single thing. I learned so much and was embraced and understood for what feels like the first time in my life. Words can not express how thankful I am for the staff, the therapist, and the facility as a whole. I want to specifically thank Tripp, my primary therapist, and Brandon, my trauma therapist. Without these two gentleman I would not be living the life I am today. As I write this I have almost 7 months sober, moving into my own place, have a great job, and so many connections within the recovery community. I go to sleep often without worry, I breathe more calmly, and I am at peace almost daily. I love my life today, and that is in part thanks to Beachway! They will forever have a place in my heart. Thank you Beachway.
I can't say enough positive things about my experience at Wellbrook. The house and the setting were absolutely beautiful. From the moment I arrived, I felt genuinely welcomed, understood and supported. The staff here are more than just professionals-they're compassionate, knowledgeable and truly dedicated to helping on your path to recovery. The program is well structured. What really sets this place apart is the community. The clients I met, the staff and the alumni all made me feel like I was part of their family only wanting to see me succeed. That sense of belonging made all the difference. Today I feel like a new person-stronger, healthier, and more hopeful than I've been in years. If you or a loved one is struggling with alcohol dependency, I wholeheartedly recomend Wellbrook.
Bryan “Bryan L” L
1 month ago
Wellbrook Recovery was an amazing place for me to truly understand my substance abuse behaviors and how they were connected to my mental health. Their dual diagnosis therapy helped me work through issues I didn’t even realize were fueling my addiction. The home itself is beautiful and comfortable, which made it feel a lot different from traditional recovery centers. I would highly recommend Wellbrook to anyone looking for a place that focuses on both mental health and addiction in a supportive, welcoming environment
Mitch Ryder
2 months ago
Wellbrook is the most incredible place you could ever imagine. I was in the absolute darkest time of my life. I didn’t want to live and thought that I was destined to die from my disease. Wellbrook and their incredible staff helped me learn to love myself again. That I am worth it and that I am seen. I learned so much about myself and how my past traumas weren’t going to dictate my life and my chance at recovery any longer. They help you in all facets of your recovery and help heal you from the inside out. I never thought life could be this beautiful and this good. That I could ever have this kind of peace. If you are someone or know someone who is struggling, please please please pick up the phone and call here. I will forever be amazed and honored to get to say that I am a WellBrook Alumni. This house is special.
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
Paul Hastings
1 month ago
SJI was by far THE best experience for me and my recovery. I wish I had known about them years ago. Top notch facility with compassionate, educated and all around amazing staff. From the kitchen to housekeeping & maintenance to nursing, RAs and counselors/clinical staff...they were ALL so supportive and kind. I never felt like I was treated "less than" like some other places do. The facility is absolutely beautiful even in the winter lol highly recommend SJI to anyone looking to start their recovery journey!!! They also offer an alumni app & weekly Zoom meeting, which I don't think I've missed since being home🤗Melissa who runs this group goes above and beyond to be there for any and every one she meets. Probably juggles thousands of recovering clients and does it with grace & love🥰Crazy to say but I kinda miss SJI. They'll always have a special place in my heart🫶🏼
❤️Reisa
*Forever an SJI family member*
RJ
2 months ago
So Blessed to have found St. Joseph’s! Saved my Life! As a mature 50 something grandma, I would never have believed that I would get so sucked into addiction that I could give up everything for one thing! But Nothing Shy of a Miracle would make me quit.God heard my plea for Help and St Joseph’s delivered! 3 weeks into my rehab I had a heart attack, I would probably be dead had I been outside of St Joseph’s using like I was, and after a quick procedure I was back to finish my rehab 48 hours later. My stay extended beyond 60 days, and sure there were days I felt trapped inside this village, but I needed precisely there to be rules, stability, structure. Quitting One thing for Every Thing would not be my New Reality had it not been for St. Joseph’s!
Great place great community, great staff, all around great experience
jeff favreau
1 week ago
Swift River is amazing! It is truly and amazing experience. Its definitely one of a kind. From the very minute you arrive til the time you leave you you are under the best care imaginable. The staff are incredible and you no right away it's all about healing and recovering with all of them. Nursing, counselors, therapists, case management, kitchen, House keeping, BHT's are all on the very top of what they do. The campus is beautiful, clean, comfortable, and up to date. Its college campus like and never feel locked in at all. They offer many different types of recovery classes and do not single out any one way. They offer many different options recreational wise as well. 9 hole disc golf course is my favorite. They provide multiple avenues of further treatment all done with your own case manager. Also, an amazing Alumni group with all kinds of stuff going on to keep you connected to people in recovery. Thanks Swift for all that you do.
Robert perryman
3 weeks ago
Best residential rehab -and hopefully the last- I've attended so far. Patients are giving more personal autonomy and respect and they have much better programming. The outside campus is amazing. Art room and Music room are open during the afternoon. The ropes course was closed sadly but everything else was great including the food.
Detox was rough ngl but the medical team knew exactly what to do kept me safe the whole time
Kyra Glover
1 week ago
Restore Health and Wellness Center sangat bagus. Saya berada dalam situasi yang sangat buruk beberapa tahun yang lalu. Saya mengambil kesempatan itu dan terbang ke LA. Saya sangat senang melakukannya. Bahkan hingga hari ini, saya mengenang kembali sebulan yang saya habiskan di sana. Pengalaman itu benar-benar membekas di ingatan saya. Stafnya, Chef Paul, komunitasnya; semuanya membantu saya pulih dan belajar lebih banyak tentang diri saya sendiri. Kita mendapatkan apa yang kita usahakan, seperti apa pun, tetapi dukungan itu ada selama kita memercayai prosesnya
Deja Freeman
1 week ago
Insurance covered my entire stay removing financial stress so I could focus solely on getting better
Silvermist changed my life not only for the better, but has truly given me the opportunity to heal from past traumas. I am beyond exceptionally impressed by the care of the staff and the fostered sense of comradery the community had to offer me. From working with the staff, I was able to heal from a generational hurt that other treatment centers failed to provide me the tools and foundation that Silvermist has to offer. On the other hand, the comradery instilled was healing as well in the sense of that even though it may not be the same struggle that we all deal with, the community gave me a sense of brotherhood. It showed me that I am not alone in my struggles and that I could get through this storm and that it will pass. I am proud to have completed this program and have the newly founded connections that Silvermist gave me the opportunity to seek.
Nolan Kratz
1 month ago
Silvermist has changed my life. I am a 2 time graduate now. The first time around I didn’t take it that serious but the 2nd time in working with my therapist and really paying attention in groups I can confidently say I am ready for the path life has ahead of me taking it on clean and sober. My first time I was here for mental health and my 2nd for alcohol abuse. I have a dual diagnosis and this is one of the only treatment facility’s for that. This facility is the best around though, the staff care very much and the brotherhood around you is 2nd to none. Huge shoutout to My therapist Billy for helping me get my life together. Also Miss Heather for eveything she did for me. Big Shout out aswell to Andre, Scott, Mrs. Amanda The case manager not the tech, Ryan, Miss Burn Burn, Rey, and Randy. And most of all a huggggge Shoutout to Laura, and Michelle for keeping me feed with amazing food!
- Max
Maxed Protege
1 month ago
Beautiful campus, wonderful staff. Truly great people.
Brian Sabo, Regional Director of Clinical Partnerships, is truly a gem! Even after working as a social worker for over 25 years, I know how challenging it can be at times to help clients navigate the referral process for rehab. Collaborating with Brian this afternoon was such a seamless experience. He was compassionate, kind, and empathetic while walking me through each step of the referral process. Thank you, Brian, for all of your help! You're amazing at what you do!
Julie Lebouitz
2 weeks ago
I had a great experience at Silver Pines. This was my first time experiencing residential treatment and my only regret was not doing it sooner. The staff was wonderful, I met a lot of great people and it has dramatically improved my life so far since being back home. I was hesitant to commit because it involved leaving home but knowing what I know now it was absolutely the correct decision. They present many different programs and tools to help, encourage you to explore the root causes and show care/compassion throughout. The food was great, days went quickly with a variety of activities and the other folks there made it a pleasant experience and allowed us to learn from each other in addition to the formal sessions. I highly recommend Silver Pines!
Adam K
3 weeks ago
My experience at Silver Pines was top tier, the entire staff from the drivers,cleaning crew cook staff, & yes the NURSES, Councelers & Therapists were very compassionate & knowledgeable… Loved the hole environment.👍👍👍
Akua is where I got clean.
The staff is very patient and kind. Because of this, I eventually came around to opening my mind more. I didn’t want to participate in meetings and put minimal effort in facilitated group on the beginning. Over time, I felt more comfortable and staff shared their struggles and how they overcame it. I felt like I was able to face the destruction of my past and eventually did. The different groups that they provide help build a well rounded foundation and I thank them for the time clean I have today.
Thank you Akua
Vanessa Myrick
11 months ago
Life-Changing Experience at AKUA
My time at AKUA's residential treatment program was truly transformative, and I can say with confidence that it has helped me become the man I am today. From the moment I arrived, the staff was nothing short of amazing. They were not only professional but also compassionate, understanding, and genuinely invested in my recovery and healing.
The AKUA team was instrumental in guiding me through one of the most challenging times in my life. Their dedication, support, and holistic approach helped me find a sense of peace and purpose. The environment fostered my growth and allowed me to confront and overcome the issues that had been holding me back.
I'm forever grateful and thankful for AKUA and the incredible staff who played such a key role in my journey. They are more than just a treatment center; they are a lifeline for those looking to rebuild their lives. My deepest thanks and love to everyone at AKUA for helping me reclaim my future.
If you or a loved one are looking for a place that truly cares and can help facilitate real change, I wholeheartedly recommend AKUA.
Lester J
11 months ago
The staff was very knowledgeable, caring and accommodating through my early recovery efforts! Plenty of time is made to provide access to the gym, AA/NA meetings, healthy and delicious food, therapy, group sessions, down time and yoga to name a few of the highlights. I had my reservations before enrolling with Akua but by the end of my month-long time there I was sad to have to leave, knowing that I would miss all the staff and clients, as well as the tools they provided me to succeed within my next chapters of the recovery process. I plan to attend their Wednesday AA alumni meetings!
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
4 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.
Christopher Allen
1 year ago
No results Found.
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
