A company focused on the wellbeing of the whole person, UnitedHealth Group is one of the largest healthcare companies in the United States. Offering healthcare coverage and benefits through its subsidiaries UnitedHealthcare and Optum, UnitedHealth Group is able to provide medical benefits to people in 130 countries around the world and in all 50 states.

Providing the largest behavioral health network in America, Optum uses a person-centered care approach. They have over 166,000 network providers currently active.

Through UnitedHealthcare, the following types of insurance plans are offered:

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  • Individual and family plans: private insurance options for families and individuals
  • Medicare plans: for individuals aged 65 and older (or eligible individuals who suffer from a disability)
  • Medicaid plans: for low-income families and individuals
  • Small business plans: for employers and their employees for businesses with 99 employees or fewer
  • Short-term health insurance plans: transitional healthcare coverage

Within these health insurance plans types, levels of coverage can vary. A representative for UnitedHealth Group can offer policyholders more information on exactly what types of benefits a specific plan has, what the coverage includes, and how to use it to pay for substance abuse treatment services. Professionals at a substance abuse treatment facility are also well versed in insurance coverage and can help families and individuals maximize coverage benefits as well.

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Understanding UnitedHealth Group Insurance Coverage

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In order to use insurance coverage when enrolling in a drug addiction treatment program, individuals will often need to go through their insurance company or primary care provider (PCP) first. UnitedHealthcare plans may stipulate that in order for services to be covered, a preauthorization, or verification, must be done prior to enrollment. Plans may also require that services be deemed “medically necessary” by an approved PCP, mental health, or substance abuse treatment provider before services are rendered.

UnitedHealthcare policyholders can use the member site, myuhc.com, to find a provider, obtain a verification form, or get more information on coverage and referral requirements. Often, outpatient services are covered first, potentially requiring a copay at the time of the visit, which is a set amount paid initially for services. Covered services may include group and individual therapy sessions, detox, medication management, educational services, recovery support, and diagnostic assessments. Inpatient programs, partial hospitalization programs (PHPs), and intensive outpatient programs (IOPs) may require additional verification and authorization from an approved physician prior to enrollment in order for coverage to be used. These services may only be covered after outpatient treatment is attempted first.

Insurance generally covers services after an annual deductible amount is reached. This means that a person must pay out of pocket for all services in full until the set amount is met. After this, coverage kicks in.

Insurance plans typically have a coinsurance amount as well, meaning that individuals are required to pay a percentage. Coinsurance amounts vary, depending on the plan. There is also an out-of-pocket maximum amount; once reached each year, approved and eligible services will then be covered in full.

Services are generally more affordable when policyholders choose providers that are considered in-network, as they contract with UnitedHealth Group to provide discounted rates on these services. Depending on their plan, members may still be able to use out-of-network providers; it will just be at a higher cost to them.

UnitedHealth Group representatives and substance abuse treatment providers can both help individuals and families determine how to best use UnitedHealthcare insurance to cover the costs of addiction treatment services.