Using UnitedHealthcare/Optum for Drug & Alcohol Rehab

UnitedHealth Group is the largest healthcare company in the United States.¹ Offering healthcare coverage and benefits through its subsidiaries UnitedHealthcare and Optum, UnitedHealth Group provides medical benefits to people in 130 countries around the world and in all 50 states, including California.²

United Healthcare provides insurance coverage, while Optum provides clinical and pharmacy services to members.³

Does United Healthcare Cover Substance Abuse Treatment?

Most United Healthcare plans provide coverage for addiction treatment (possible exceptions include short-term or supplemental plans). ⁴

Due to laws like the Affordable Care Act (ACA), and the Mental Health Parity and Addiction Equity Act (MHPAEA), government-funded plans (like Medicare and Medicaid), Health Insurance Marketplace plans, and most employer-based group plans are required to cover substance use and mental health treatment in a manner equivalent to how they cover medical care.^4-7

The amount of insurance coverage provided may vary greatly depending on your specific policy and whether you choose a rehab facility that is within your United Healthcare plan’s network.

Which Types of United Healthcare Plans Cover Detox & Treatment?

United Healthcare plans that usually provide coverage for mental health and addiction treatment include:^6,7

• Individual and family plans: private insurance options for families and individuals, obtained through an employer or purchased on the Health Insurance Marketplace.
• Medicare plans: for individuals aged 65 and older (or eligible individuals who suffer from a disability)
• Medicaid plans: for low-income families and individuals.

Levels of coverage can vary based on the specific policy. A representative for United Healthcare can offer policyholders more information on a plan’s specific benefits, what the coverage includes, and how to use an insurance plan to pay for rehab.

Professionals at a substance abuse treatment facility—like the admissions navigators at Laguna Treatment Hospital—can help families and individuals maximize coverage benefits as well. Call to speak to an admissions navigator or use the to verify your benefits now.

What Types of Addiction Treatment Are Covered by United Healthcare and Optum?

Coverage will vary depending on the specific insurance policy. A UnitedHealthcare plan might cover one or more of the following:

• Medical detox: A medically supervised program in which withdrawal symptoms are managed with medications and supportive care.
• Inpatient rehab: An intensive treatment environment where the patient lives at the facility to give recovery 100% focus.
• Outpatient rehab: Ranging from very intensive to minimally intensive, outpatient programs offer the flexibility of living at home while attending treatment. They can be used alone or as part of an aftercare plan for someone who has completed inpatient programming.
• Prescription drugs: Depending on the plan, patients may be prescribed medications short- or long-term as needed.

Insurance plans may not provide coverage for treatment methods that are not empirically verified, such as experimental or alternative methods. Sometimes, however, alternative therapies (meditation, yoga, and expressive arts therapy, for example) may be offered at rehab facilities as a supplemental form of treatment used in conjunction with evidence-based approaches, such as:

• Cognitive behavioral therapy.
• Dialectical behavioral therapy.
• Motivational interviewing.
• Treatment medications (e.g., methadone, Suboxone, naltrexone, acamprosate) for opioid or alcohol use disorders.

Using United Healthcare to Pay for Addiction Treatment

In order to use insurance coverage when enrolling in a drug addiction treatment program, patients will often need to go through their insurance company or primary care provider (PCP) to obtain a referral for drug or alcohol rehabilitation.⁸

United Healthcare plans may stipulate that in order for services to be covered, a preauthorization, or verification, must be performed 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 in order for them to covered.⁹

Here are some general things to consider about applying health insurance coverage to addiction treatment and how it can affect out-of-pocket costs:

• 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.¹⁰
• Insurance plans typically have a coinsurance amount as well, meaning that individuals are required to pay a percentage even after they’ve reached their deductible. For example, if the coinsurance rate for a hospital stay is 20%, United Healthcare would cover the remaining 80%. Coinsurance amounts vary depending on the plan.¹¹
• Often, insurers will require a copay for outpatient services and prescription drugs, which is a set amount paid at the time services are provided.¹²
• There is also an out-of-pocket maximum amount; once reached each year, approved and eligible services will then be covered in full.¹³
• 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.

United Healthcare or Optum representatives and substance abuse treatment providers can each help individuals and families determine how to best use UnitedHealthcare insurance to cover the costs of addiction treatment services. Also, admissions navigators for Laguna Treatment Hospital are reachable at 24/7 and can guide you through the process before you start treatment.

You can also use the online verification of benefits tool below to check whether your specific policy covers care at Laguna Treatment Hospital.

UnitedHealthcare policyholders can also use the member site, myuhc.com, while Optum members can use the Live and Work Well site to find a provider, obtain a verification form, or get more information on coverage and referral requirements.

Even with insurance, many people may worry about paying for addiction treatment.¹⁴ In these instances, it may be helpful to review methods of paying for out-of-pocket costs, like financing, finding treatment centers that charge on a sliding scale (adjusting cost based on income), loans, scholarships, etc.