Addiction can cost up to $200 per day.
What would you do with that money if treatment was affordable? Find out if your insurance covers treatment now!
(Please note: Rehabs.com strives to provide you with the most updated information on each carriers’ addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. Rehabs.com is an informational site only and is not affiliated or sponsored by UnitedHealth.)
Optum Provider Express (formerly United Behavioral Health, also known as Optum Behavioral Solutions) is the organization which handles most of the substance abuse and chemical dependency coverage for UnitedHealth Group Insurance plans.
For the purposes of this article, United Behavioral Health (UBH) and Optum are interchangeable.
Optum Provider Express is a ‘personal health improvement service’ with an excellent reputation for behavioral disorder insurance coverage. For those with an addiction to opiates, UBH plans offer select coverage for many types of treatment, including:
Optum has set up a member website, which has information on coverage and even provides a search tool to help locate a treatment facility. Additionally, UBH/Optum does not require pre-authorization for certain outpatient services. It is important to note that not all programs are covered, even if a treatment is described on a UnitedHealth website. Refer to your Summary Plan Description for a list of all covered benefits under your health plan.
UBH partners with both Medicaid and Medicare.
Certain diagnostic and detoxification services may be covered completely through United Health Insurance plans, and it is possible that withdrawal management medications are completely covered. The benefits made available for plan members through UBH may vary depending on the year of their enrollment. Insurance companies are required to provide coverage for chemical dependencies and substance abuse as though they were medical or surgical conditions (per the Mental Health Parity and Addiction Equity Act of 2008). This helps ensure coverage, but also means that you may have to become pre-certified to receive treatment.
Yes, although some plans do have ‘Out-of-Pocket Maximums.’ Optum insurance uses the DSM definition of Opioid Dependence, so make sure that you understand whether or not you qualify for insurance coverage. You should request a copy of your policy for more information. Speak with a UnitedHealth Group or Optum representative to discuss the best / most cost-effective rehabilitation services for you or your loved one.
“Certain diagnostic and detoxification services may be covered completely through United Health Insurance plans, and it is possible that withdrawal management medications are completely covered.”
Opiates addiction treatment and rehabilitation programs can be classified into two broad categories: inpatient and outpatient. The primary differences between outpatient and inpatient therapy revolve around residency; inpatient treatment programs require that the patient lives on site for the duration of treatment. Most outpatient programs are less expensive than inpatient programs, but offer fewer services and do not have 24-hour supervision. Optum preferred provider guidelines stipulate that opiates addicts should be admitted to outpatient services under the following circumstances:
Optum recommends intensive outpatient services or inpatient programs if treatment is deemed to require observation and interaction for a minimum of 6 hours per week.
Residential rehab centers are treatment facilities that combine detoxification services, psychological counseling and after-care services. Keep in mind that UBH/Optum will review, recommend and authorize all inpatient services. The admission criteria for residential rehab programs to qualify for Optum coverage includes:
If you or your loved one is experiencing acute impairment of behavior or cognition that interferes with daily life, or if there are psychological or environmental problems which present threats to safety, then you should consider a residential rehab center. Before you are admitted into any residential center, consider the costs of the program and your coverage options. Also keep in mind that treatment methodologies vary between different centers, and not all centers are equally effective at providing treatment. Lastly, weight the impact on your own professional career or family life.
UnitedHealth Group has a network of treatment centers across the country. It is very likely that you will be able to find a treatment center nearby. If you have trouble locating a center or clinician, visit liveandworkwell.com. The Optum portion of UnitedHealth Group Insurance is actually three separate companies: Optum Health, Optum Insight and Optum RX. The coverage options available to you for local rehabilitation services or for out-of-state treatment can vary based on your plan.
Private and luxury treatment rehabilitation centers may be covered through your UnitedHealth health plan. Ask your preferred treatment facility if they are a preferred provider. Private, luxury and executive treatment options are very expensive, even in outpatient form. Some luxury treatment programs can exceed $25,000 per month.
Executive treatment amenities include private rooms, gourmet meals, swimming pools and spas, conference rooms, horseback riding and other accommodations. These are good options for members with excellent coverage or those with the financial resources to afford executive-level services on their own. These centers offer the ability to meet with business associates and maintain a comfortable working lifestyle while receiving help while going through opioid detoxification and rehabilitation.
Optum does not always offer a clear explanation of what — and for how long — treatments are covered. Inpatient programs typically last between 30-90 days, while outpatient programs might not even offer a set treatment program length. Your plan may have limitations on the number of days in which you can receive either inpatient or outpatient behavioral health services. Important: Many facilities will offer different treatment lengths, but not all facilities are covered through your health plan. If you have questions, contact a UnitedHealth Group or Optum plan representative.
If you or your loved one is suffering from opiates addiction but does not have insurance, you still have some options available to you. Most treatment centers understand that rehab programs can be cost prohibitive and offer flexible payment plans. Some treatment centers may charge nothing to admitted patients. The Affordable Care Act (more commonly known as “ObamaCare”) includes a program known as Screening Brief Intervention and Referral to Treatment, which is designed to stop substance abuse. SBIRT services may be useful for those with drug and opiates dependence. You can also speak with our specialists to identify your coverage options and potential treatment programs.
Sometimes the best way to determine the appropriate rehabilitation program is to speak with a professional, third-party advisor. We can help you or your loved one identify what your options are and help you understand the right choice given your specific situation. If you are looking to make the transition to a healthy lifestyle, call your insurance provider to learn more details about your plan.
Depending on the policy and the individual member’s past use of benefits, UnitedHealth Insurance (and Optum / UBH) may cover an additional visit. Your plan is more likely to evaluate and limit the total number of days, not the total number of stays, in rehab.
UnitedHealth Group Insurance plans do offer coverage for aftercare programs. However, member benefits are subject to change based on network options, individual coverage and treatment methodologies.
This is a major fear among members of all health insurance plans. After a certain number of treatment days, member co-pays are likely to increase. Whether or not premiums rise depends on your coverage and type of plan.
Yes. The Affordable Care Act made addiction treatment one of its ‘ten essential health benefits’ required of insurance exchange companies. Additionally, the ACA made it illegal for companies to deny coverage to individuals with preexisting conditions such as addiction and mental illness.