UMR Insurance Coverage for Substance Abuse Treatment

Addiction to alcohol and drugs is actually a kind of disease, and a very frightening one at that if left untreated. Not only does it affect the individual, but it also affects that person’s loved ones, and the community as a whole. If left untreated, addictions are like other progressive, chronic diseases, in as such that they can be fatal. Fortunately, if you are a member of United Medical Resources (UMR), then you can be comfortable in the knowledge that the company will be doing everything to make sure you receive the treatment that you need.

How UMR Can Help

UMR is a third party health care plan administrator, which is the largest in our country. It provides management and organizational services for coalitions of employers, self-funded companies, and state governments. UMR is an element of United Healthcare, and its goal is to make sure that members are able to get the treatment that they need, including for substance abuse and addiction. Regardless of how serious your addiction is, whether you have any co-occurring disorders, and what your current financial condition is, UMR is there to help you by connecting you directly to a provider within its network.

UMR, as such, isn’t a provider of health insurance. Rather, it is an administrator. Hence, it does not cover any type of health service, which includes detox and rehab. That said, this company is known all over the country for its dedication to making sure that client companies get the help that they need, and this includes pointing customers to the best mental health solutions available in the country. It is a very reliable resource for helping in the negotiations between customers and insurers in terms of payments for mental health services. In fact, it even has ongoing campaigns specific to mental health services.

Addiction Recovery Options Through UMR

If you are a UMR member, you have access to the different addiction recovery providers included in its network. You must speak to an insurance expert to determine your preferred providers in terms of your personal needs and financial capabilities. These recommendations could be about:

1. Addiction treatment facilities. UMR generally provides access to inpatient and outpatient centers. Both of these options have specific advantages and disadvantages and these should determine your choice of treatment. Inpatient treatment, due to its intensive, monitored nature, is generally more expensive. However, you may also receive more financial assistance for it.
2. Transitional housing. This is a service often necessary for recovering patients who are starting to transition back into the “real world”. By providing a transitional house, which is partially supervised, they are more likely to avoid relapse and remain in safe respite care while slowly readjusting to daily life.
3. Counseling and support groups. These groups include the 12 step group. Many of these are free to attend because they are nonprofit, but you may also require psychiatric or psychological support, which you do have to pay for. UMR can put those connections in place and find what would be the best fit for your finances.

If, for whatever reason, UMR cannot cover your costs for addiction recovery, other rehabilitation assistance can still be available to you. This is because addiction now counts as a form of mental illness. When you speak to your patient care advocate, you will be made aware of your different options.

UMR Coverage for Rehab

Because UMR is not an insurance provider, it does not directly offer coverage. However, within its network, there are some 3,000 healthcare providers. UMR works with each of these to ensure that customers can access various mental health services, which include drug and alcohol rehab. It understands how effective rehab is, which is why it encourages all of its providers to cover it.

As a third party administrator, its job is to make sure that claims are managed properly so that people receive fair coverage. Customers of UMR usually are self-insured companies and they work with UMR to administer their policies and to make sure insurance claims are paid for.

How Long Will UMR Cover Your Addiction Treatment?

Health insurance companies listed under UMR do not have to cover a set period of time when it comes to treatment. That said, UMR does understand that rehab treatment, besides being confidential, has to be tailored to the needs of the patient and that includes the length of time required for treatment. Furthermore, it officially recognizes the Mental Health Parity and Addiction Equity Act of 2008. This Act expanded the types and quantity of mental health services that providers of insurance must offer to their customers.

Because of UMR’s commitment to mental health, the majority of its members have excellent benefits for behavioral treatment, including a range of services found within the realm of addiction treatment. These include such things as:

  • Regular outpatient programs
  • Partial hospitalization
  • Day treatment
  • Intensive outpatient programs
  • Residential inpatient treatment programs
  • Medical detox centers

Aside from the benefits for addiction treatment, UMR members can also access the company website to find healthcare providers which are approved, dental claim and medical claim forms, and a wealth of resources and tools, including a flex expense calculator. The UMR website is a comprehensive source of information, even including access to the Healthy You magazine. This magazine is vital in providing people with:

  • Tools and resources that are exclusive to members of UMR
  • Nutritional tips, including recipes
  • Wellness and health guidance
  • Information on how to finding and obtain the care that is needed

UMR and Specialty Drug and Alcohol Treatment

Under the Mental Health Parity and Addiction Equity Act of 2008, UMR and all its providers recognize that specialty drug and alcohol treatment is included as a form of therapy. While UMR does not directly offer treatment, its 3,000 nationwide providers do. The level of coverage that is offered depends on each provider. Generally speaking, luxury and executive rehab facilities will receive less coverage overall. However, there are no UMR imposed rules on its providers in terms of how they cover exclusive and luxury treatment. Rather, it offers guidelines that help to facilitate access to all patients.

The majority of insurance companies, and certainly those that are part of the UMR network, will cover drug and alcohol rehab. However, they generally do not cover the add-ons that may be provided alongside. Generally, in high end luxury and executive facilities, you will be charged more for being in a luxury environment, a private room, acupuncture, massage therapy, and so on. It is important, therefore, that you receive a full breakdown of the costs that you will be charged, so that your insurance company can tell you what is and isn’t covered and how much you will have to pay out of your own pocket.

Inpatient and Outpatient Treatment

UMR understands that both inpatient and outpatient treatment services can be beneficial to people, depending on their circumstances. It is often more difficult to find coverage for outpatient care depending, but this is true for all insurance providers across the country. Usually, residential care is preferred for those dealing with a drug or alcohol addiction. In 2010, the Centers for Disease Control and Prevention (CDC) reported that there were some 31,000 residential rehab centers in operation across the country. The 3,000 insurance companies that are part of the UMR network cover virtually all of these between them. This means that, if you have an insurance plan that is affiliated by UMR, you stand a very good chance of finding the treatment center that you need.

Out of State Rehab and UMR Coverage

Many people prefer to find out of state rehab centers so that they can remove themselves from the environment in which their addiction was facilitated. This is very complex in terms of insurance policies, however. This is why, if you intend to do this, you should contact UMR and your actual insurance provider to find out whether or not this is possible. While there is logic in going out of state, there are also some significant benefits in staying near home, including having a support network around you and ensuring that you can have realistic expectations. Additionally, you may not be aware of some of the opportunities that are out there. Again, contacting your insurer and UMR is a good practice.

What about When Insurance Won’t Cover It?

It is possible that your insurance company won’t cover what you need, or not in full at least. Generally speaking, providers within the UMR network are known to offer a wealth of options when it comes to ental health treatment, but they have limitations. The ultimate goal for you, however, should be to become free from addiction and how you will pay for that should take secondary importance. There are a number of options out there should you find that your insurance doesn’t cover your treatment, or doesn’t cover it sufficiently. These options include charity addiction treatment, medical credit lines, medical discount services, grants through the Substance Abuse and Mental Health Services Administration, and payment plans.

Understanding Your Plan

Insurance plans are complex legal documents that can be frustrating and confusing to understand properly. The language that is used in your plan, and particularly on the finer points, can be incredibly complex to grasp, and this makes it very difficult for you to calculate what you will and won’t get paid for. If you work with the UMR network, however, you have a far greater chance of easily working out what type of coverage is available to you. The company can help you identify what is available to you, thereby ensuring that you know exactly what you should pay and how you should pay it.

UMR can also help you to find discount services that you may be able to apply for. For instance, it can get discounts for people with certain disabilities, students, or those of a certain age. Hence, whatever your personal circumstances are, UMR should be able to find you exactly what you need when you reach the point where you are ready for treatment.

If you do have to make an out of pocket payment towards your treatment, then UMR can help you to receive a credit approval as well. This means that you won’t have to pay the full outstanding balance in one go. For many people, the fact that they have to pay something themselves is a significant barrier to their getting any treatment at all. UMR is there to help signpost you towards payment options, so that your medical expenses become manageable, thereby ensuring you can get the help you so desperately need.

Last but not least, you can speak to UMR in order to find a charity or nonprofit organization that may be able to help you receive a donation for the services that you receive. It can be very difficult, without UMR’s help, to find an organization that is willing to pay for rehab treatment, even though this type of treatment is generally required by a lot of people.

Conclusion

It is very difficult to make sure people with an addiction go into rehab. The process is long and difficult. If there are people who really want to get help in order to become sober, but don’t get the guidance they need, it is likely that they will not receive treatment at all unless they receive this guidance. By working with UMR as a mediator, who will negotiate between you, the insurance providers, and the different treatment centers, you should be able to access the best possible help towards handling your problem. An addiction is more than a single individual can generally handle, which is why the UMR services are so vital to anyone who wants to recover from addiction. In fact, it could make all the difference between staying gripped by addiction and living a happy, healthy life. UMR, as such, truly has the power to save lives, while simultaneously taking into consideration people’s personal financial situations.