United Healthcare Insurance Coverage for Substance Abuse Treatment
United Healthcare is one of this country’s largest and most popular health insurance providers. If you, or someone you care about, suffers from a substance abuse problem, you will be happy to know that this company covers a number of treatment services, so long as it can be demonstrated that there is a medical need. Sometimes, this means that you will have to provide documentation of that need. The company also recommends that customers contact their customer service department before they agree to sign up to a particular treatment and want their insurance policy to cover it.
Under United Healthcare programs, you should be able to receive coverage for behavioral and emotional health problems, which include alcohol and drug abuse issues. This is offered specifically through United Behavioral Health (UBH), or Optum Provider Express, which is a subsidiary of the company. UBH calls itself a “personal health improvement service”, which has been around for over two decades. It offers health and wellness programs, support forums, helplines, integrated medical and behavioral care, therapy, and various forms of inpatient and outpatient rehab treatments. Additionally, UBH partners with both Medicare and Medicaid. What sets UBH apart, as well, is that it doesn’t need pre-authorization for a number of outpatient services. That said, it does not cover every program, even if this program offers a treatment that is described on the United Healthcare website. This is why you should always look at your personal Summary Plan Description and contact United Health to make sure you understand what you are covered for.
The Health Insurance Plans Offered by United Healthcare
United Healthcare has a number of programs available, including family plans, individual coverage, Medicaid coverage, Medicare coverage, and group coverage for national, large, and small businesses. Some of the most popular plans offered include the United Healthcare Options Planned Provider Organization (PPO), United Healthcare Choice Plus, and United Healthcare Choice. The benefits under these plans for addiction treatment vary. They include different service types, such as general pharmacology. It is very important to look at your individual policy to find out what treatment is covered.
Will My Entire Stay in the Rehab Center Be Covered?
There are a number of detoxification and diagnostic services that are fully covered through some of the plans offered by United Healthcare. There are also some that cover withdrawal management medication in full. Again, you must check your personal policy to find out what coverage you receive.
Standard United Healthcare Insurance Coverage
Under United Healthcare, you can receive coverage for “chemical aversion therapy”, which means that medication used to treat substance dependence is covered. The most commonly used for alcohol addiction are apomorphine, emetine, and lithium. None of these, however, have been approved for detox by the U.S. Food and Drug Administration (FDA), which means they can only be used under full medical supervision. According to United Healthcare, medical detox can also be offered in an outpatient service so long as documentation is provided to demonstrate that there is a medical need for this. For those who have an opiate addiction, th company will cover any medication that is administered by a doctor that is classed as “reasonable and necessary”.
United Healthcare does not cover all detox services, however, so you will not receive cover for:
- Inpatient detox that is offered solely to remove a patient from an environment that could trigger a to return to substance abuse
- Outpatient care activities, such as meals and transportation costs
- Methadone maintenance
- Electrical aversion therapy
- Drug testing that is court ordered, unless there is a medical necessity for this testing
Someone who has a substance abuse disorder must firstly go through detox. Detox, however, is not considered as a type of treatment. After detox, patients have to receive further intensive treatment offered through psychotherapy, which helps them stay clean and sober. Inpatient drug addiction treatment is covered by United Healthcare, so long as it meets the coverage requirements under Medicare. However, remember that:
- United Healthcare will only cover 190 days in an inpatient center, including psychiatric hospitals, for the lifetime of their customers.
- If multiple admissions are required for alcohol rehab, for each of them, medical need has to be confirmed. They will not be classed as extensions on the previous stay. This means that further documentation may be required in order to demonstrate that it is needed to improve the condition of the patient.
- If you want to enroll in a center that offers both detox and rehab, you must be able to demonstrate medical need for both.
What United Healthcare Covers
United Healthcare covers a number of specific forms of treatment for those enrolled in inpatient treatment:
- Personal therapy sessions
- Group therapy sessions
- Extended care in an inpatient facility if medically necessary
- Psychotherapeutic and emotional services through group settings
- “Chemical aversion therapy”, which is generally used for treating alcohol addiction
- Family therapy
Meanwhile, there are also a number of treatment services that will not be covered if someone is in inpatient treatment:
- Additional services that do not have a medical connection, such as transportation, meals, recreational activities, employment assistance, and life coaching
- Electric convulsive therapy (ECT)
- Electrical aversion therapy
- Court ordered testing, unless there is a medical need
- Methadone maintenance
- Outpatient aftercare, unless it is included in the plan. Any medication must then be obtained from a network-approved provider.
How Much Does United Healthcare Cover?
How much United Healthcare covers will depend greatly on the type of treatment that is required. State regulations also come into play, as they vary when it comes to what coverage should be provided for the treatment of substance abuse, mental health problems, and addictions. For example, there are network plans that state a zero percent copay should be in place, but holders must meet a certain annual deductible. If the service is out of network, the copay is usually around 20%, on top of an annual deductible. Either way, you must speak to your Mental Health/Substance Abuse Designee in order to receive the benefits.
Furthermore, the costs that United Healthcare will pay through the group insurance and the UBH will depend on:
- Who it is for, such as group, family, individual and spouse, or individual
- What the plan type is, such as HMO or PPO
Can I Pay Extra?
If you want treatment above and beyond what your United Healthcare plan provides, you are within your right to pay for that. There may, however, be an out of pocket maximum in place. Again, this is something that you must consult with your provider for. For alcohol addiction treatment, there are often limitations on how much is covered, and some centers and treatment options are not covered at all. In all cases, pre-authorization is required, but you can always go to a non-covered provider if you can pay for the service yourself.
Inpatient or Outpatient Treatment
Alcohol and substance abuse treatment programs can broadly be categorized as being either inpatient or outpatient. For both, traditional treatments like counseling, group therapy, and 12 step programs are usually included. Furthermore, they may include family therapy, medication prescriptions, and education. In an inpatient center, people essentially take on a short term residency. During their time there, they will be exposed to various intervention techniques, including physiological and psychological ones, in a community setting.
Outpatient rehab, meanwhile, offers:
- Chemical dependency and substance abuse evaluations
- Medication management
- Treatment planning
- Intensive outpatient therapy
- Short term therapeutic services for individuals, families, and groups
- Crisis intervention
The best known outpatient treatment services for alcohol and substance abuse issues are Alcoholics Anonymous and Narcotics Anonymous. These are nonprofit organizations and do not charge for their services. However, there are also some other outpatient services that do charge for their services. Since there is no room and board involved, their cost is generally lower.
Residential, or inpatient, services, meanwhile, combine detox, counseling, and self-care opportunities. UBH will review whether inpatient treatment is necessary and will recommend and authorize it to their policy holders. Sometimes, it will recommend network and non-network services. If so, this is generally limited to a 30 day per calendar year time period. If you do not receive authorization, meanwhile, you will have to pay a premium before your benefits are covered, and this is usually around $500.
UBH has released a specific guideline for people to find out whether or not they will be covered: “Check the member’s specific benefit plan document for the applicable penalty and provision for a grace period before applying a penalty for failure to notify Optum as required.”
Before you enter an inpatient facility, consider:
- The coverage and cost of the program
- What kinds of treatment they offer
- How effective the center is
- How attending will impact your career and family
Local or Out of State Rehab
Some people prefer to go out of state for their treatment, as it removes them from the environment in which their addiction was facilitated. United Healthcare is a national organization, and has a national network of treatment providers. Whether or not you are covered for an out of state option, however, depends on various circumstances, so it is best to contact the company to find out.
Private, Luxury, and Executive Treatment
Some people prefer private, luxury, or executive treatment. Some of the cost for this may be covered under United Healthcare. These types of facilities also exist in inpatient and outpatient clinics. However, they are usually very expensive, sometimes reaching as much as $25,000 per month. This is because these types of facilities offer high class amenities and facilities. They actually feel somewhat like a resort, offering private rooms, swimming pools, gourmet meals, horseback riding, yoga, conference rooms, and more.
Executive treatment is designed specifically for senior executives who cannot take lengthy periods of time away from their work. Through these private and luxury centers, they will be able to continue to link with their business associates and clients, while at the same time receiving treatment.
How Long Can I Receive Cover for Treatment?
Generally speaking, an inpatient treatment program ranges from one to six weeks in length for alcohol addiction, and from one to 12 months for drug addiction. United Healthcare, meanwhile, offers coverage for between 28 days and 90+ days. The majority of treatment facilities have different lengths of treatment, but they may not all be covered. Again, it is important to speak to your insurance representative.
Sometimes, treatment is offered without a specific length of time. This is often the case in outpatient treatment services, and this can run for periods of one year or more. It is possible that there is a limitation on your plan in terms of how long you can remain in treatment and receive coverage.
I Don’t Have Insurance, Now What?
If you do not have insurance or if you have insufficient coverage for addiction disorders, or if United Healthcare does not cover your preferred service, there are a number of other options available to you. As always, speak to a company representative to make sure you definitely cannot get the coverage you need.
Generally speaking, treatment facilities know that rehab is incredibly expensive, and that many people who suffer from an addiction have limited financial means, due to the fact that much of their money has gone towards supporting their addiction. As a result, payment plans are quite common. Furthermore, under the Affordable Care Act, everybody can now access the Screening Brief Intervention and Referral to Treatment service, which helps to stop substance abuse. If you have Medicaid, you will be guaranteed to be accepted.
Other United Healthcare Benefits
If you have United Healthcare insurance, there may be a number of other benefits that you haven’t accessed yet. These include the mobile app and online resources. You are paying for an extensive insurance plan, and probably quite an expensive one, and you must receive as many benefits as you possible can from it.
If you navigate to the United Healthcare website, you can:
• View the status of your claim
• Find a physician near you
• Print your ID card
• Estimate how much a procedure will cost
• Access healthy living resources
You can also download the apps (one is for regular policy holders, the other for students) and use them to manage your healthcare properly.
It is easy to see why United Healthcare has been ranked as one of the World’s Most Admired Companies for five consecutive years. Operating out of Minnesota, it has been in business for four decades and has some 200,000 employees, serving some 70 million individual customers.