UnitedHealthcare Insurance for Drug and Alcohol Rehab Treatment

Table of Contents

UnitedHealthcare (UHC) serves over 45 million people around the world and contracts directly with more than 1.2 million physicians and 6,500 hospitals and treatment facilities in the U.S. alone.1

But how do they handle drug and alcohol rehabilitation?

The good news is that the majority of people with a UnitedHealthcare insurance policy will have coverage for addiction treatment. However, insurance plans can be confusing, and it’s sometimes hard to tell what treatment options are covered by your plan and what you’ll owe out-of-pocket. This page will break down the substance abuse treatment options included in UnitedHealthcare insurance coverage.

Please note: While American Addiction Centers strives to provide you with the most updated information on each carriers’ addiction insurance coverage, policy changes and errors do occur. This is meant to be a brief overview of how UnitedHealthcare insurance covers addiction treatment and not a comprehensive guide. Please check with your insurance carrier directly or call 1-888-744-0069 to confirm coverage levels.


UnitedHealthcare Insurance Coverage Levels

There are several levels of healthcare provided by UnitedHealthcare. These include:

  • Group benefit plans (provided by your employer). These include:2
    • Open access plans, which limit you to receiving care within the UnitedHealthcare network (with some exceptions). These plans offer:
      • Fixed dollar copayments.
      • Lower out-of-pocket costs for care within the UHC network.
      • Optional additional benefits.
    • Preferred provider organization (PPO) plans that also cover visits to doctors outside of the network (for a higher cost).
  • Affordable Care Act (ACA) plans.
  • Individual and family plans. These are generally supplemental insurance plans to either fill gaps between insurance or provide supplemental coverage to a group benefit or ACA plan. These include:3
    • Short-term insurance.
    • Insurance bundles, which allow customers to pick and choose their preferred coverage.
  • Government assistance plans. These include:
    • Medicare plans (for people 65 years old and older). Standard Medicare is provided by the federal government and covers hospital stays and doctor visits. However, UnitedHealthcare offers Medicare plans that offer additional benefits, such as prescription drug coverage.4
    • UnitedHealthcare Community Plans (Medicaid plans available to qualifying low income Americans).5

Most healthcare plans require you to pay a deductible—a fixed dollar amount you have to pay per year before your insurance begins covering costs—when you opt for treatment.6 Additionally, most levels of care require a copayment for outpatient services (e.g., $40 for a doctor visit) after you have reached your deductible.7 Most plans also include co-insurance costs, which is a percentage of any bill you’ll have to share with your provider.8 For example, if your co-insurance percentage is 20%, that’s the percentage you’ll pay while UnitedHealthcare insurance covers the remaining 80%.

There’s one final, very important cost aspect of your UnitedHealthcare insurance plan you should keep in mind: Your out-of-pocket limit. This is the maximum dollar amount you’ll pay for healthcare the whole year, and it includes all your network payments. Often, this will be the amount you end up owing for drug and alcohol treatment.


UnitedHealthcare Insurance Coverage Plans

Available UnitedHealthcare insurance plans vary between states and employers. However, most group insurance plans are part of one of the following categories:2

  • UnitedHealthcare Choice (open access plan). This plan only covers facilities and doctors inside the UHC network.
  • UnitedHealthcare Choice Plus (open access). With this plan, you are able to use services outside the network, though you will likely have a higher deductible and coinsurance rate in these instances.
  • UnitedHealthcare PPO. There are no restrictions on which doctor or facilities you choose. However, it is your responsibility to seek approval beforehand and file claims for reimbursement if you seek treatment outside the network. Out-of-pocket costs are higher when you opt for non-network treatment.

Each level of care covers mental health and substance use disorder (SUD) services. While PPO plans provide coverage when you receive treatment from facilities that are outside your UnitedHealthcare insurance network, choosing a facility in your network is almost always the most cost-effective option.

The specifics of your particular UnitedHealthcare insurance coverage may vary, but generally, UHC plans cover:2*

  • Inpatient treatment.
  • Partial hospitalization.
  • Residential treatment.
  • Outpatient treatment.

Before you enter rehabilitation, make sure your treatment has been pre-authorized by your Mental Health/Substance Abuse (MH/SA) Administrator.

*Note: This may not apply to short-term insurance plans. Also, the substance abuse and mental health coverage provided by Medicaid varies greatly between states.


Does UnitedHealthcare Insurance Cover Inpatient Rehab?

Your UnitedHealthcare insurance plan coverage may vary based on:

  • The state you live in.
  • Your employer.
  • The plan you chose and how many family members are on the plan.11

However, in most cases, UnitedHealthcare insurance covers inpatient rehab, though the co-insurance percentage, deductible, copayment, and out-of-pocket maximum amount may vary.

To illustrate, let’s use a specific example. Here is the breakdown of a standard UnitedHealthcare Choice Plus plan benefits for a single person requiring inpatient treatment in New Mexico:10

  • Inpatient treatment requires this person to pay:
    • A $300 copayment.
    • A $100 deductible (if it has not already been met).
    • 20% of the remaining total cost of treatment at the chosen facility (up until they reach the $2,000 out-of-pocket maximum).
  • Partial hospitalization requires this person to pay:
    • A $150 co-payment.
    • A $100 deductible (if it has not already been met).
    • 20% of the remaining total cost (before they reach the $2,000 out-of-pocket limit).
  • Residential treatment is covered up to 60 days per year. This person would be required to pay:
    • A $300 co-payment.
    • The $100 deductible (if it has not already been met).
    • 20% of the remaining total cost (before they reach the $2,000 maximum cost).

In many cases, this person’s full charge would be the full $2,000 out-of-pocket cost.

Choosing a non-network inpatient facility in this example would require this person to pay the $500 deductible and UHC would only cover 30% of the remaining costs. No out-of-network coverage would be provided for partial hospitalization or residential treatment.10 However, in a PPO plan, this would likely not be the case.


Does United Healthcare Insurance Cover Outpatient Rehab?

Most UnitedHealthcare Insurance plans cover outpatient rehabilitation as well. If we use the same example insurance plan from the section above (Choice Plus in New Mexico for an individual recipient), outpatient rehab costs for UHC network facilities are as follows:10

  • Outpatient or office services require this person to pay:
    • A $25 co-payment per visit (maximum of 30 visits per year).
    • The deductible of $100 (if it has not already been met).
  • An intensive outpatient program (IOP) requires this person to pay:
    • $75 per visit (limit of 30 visits per year).
    • The $100 deductible (if this was not already been met previously).

If this person made 30 visits to a standard outpatient treatment facility, their total cost would be a minimum of $750. Please note that there may also be charges for pharmaceutical drugs administered in an outpatient setting. The copayment amount for pharmaceuticals administered is $25 per visit and the deductible also applies (essentially doubling the total cost).

If this person requires IOP treatment for 30 days in our example, they would hit their out-of-pocket maximum and owe $2,000.

If this person opted to use an out-of-UHC network facility in this example, UnitedHealthcare insurance benefits would only cover 30% of the total cost of treatment.10


Does UnitedHealthcare Cover Mental Health?

UHC provides mental health service coverage as well. The insurance benefits for mental health services fall under the same category as substance abuse. In our New Mexico example, the coverage provided if one needed to receive mental health treatment is the same as what they would receive for substance use.10


Checking Your Insurance Benefits

There are several ways to check your UnitedHealthcare insurance benefits. You can:

  • Look in the Summary of Benefits and Coverage (SBC) provided by your employer.
  • Log into the MyUHC benefits portal. If you have not already registered, you’ll need to create an account. This will require you to enter your:12
    • Member ID and group policy number. OR
    • Social security number and zip code.
  • Call customer service.

In most cases, UnitedHealthcare insurance will provide coverage for addiction and mental health services, provided you have insurance through your employer or the ACA. However, the degree of coverage varies depending on your chosen plan, the state you live in, and whether you chose to undergo treatment in a facility that contracts directly with UnitedHealthcare. When you decide on a rehabilitation facility, be sure to get your stay pre-authorized by a UHC Mental Health/Substance Abuse (MH/SA) Administrator.

You can also contact one of our admissions navigator at 1-888-744-0069 to see if your insurance policy covers addiction treatment, use the “Verify Your Insurance” portal, or fill out the form below.


Check if your insurance covers addiction treatment

To see if your insurance coverage includes rehab treatment for drug or alcohol addiction, use our verify insurance form.

We also explain insurance coverage levels of some household health insurance brand names via the links below:

We also have a guide on how to pay for rehab with or without insurance.


Sources

  1. UnitedHealthcare. (2020). About UnitedHealthcare.
  2. UnitedHealthcare. (2020). Group benefit plans.
  3. UnitedHealthcare. (2020). Health insurance for individuals and families.
  4. UnitedHealthcare. (2019). Coverage choices.
  5. UnitedHealthcare. (2020). About us.
  6. Healthcare.gov. Deductible.
  7. Healthcare.gov. Copayment.
  8. Healthcare.gov. Coinsurance.
  9. Healthcare.gov. Out-of-pocket maximum/limit.
  10. UnitedHealthcare. Benefit summary. State of New Mexico Open Access Choice Plus Plan.
  11. UnitedHealthcare. Summary of benefits and coverage example.
  12. UnitedHealthcare. Let’s get you registered.
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Kindra Sclar is a Senior Web Content Editor for American Addiction Centers and Rehabs.com. Before joining the company, she worked for more than 8 years as a print and web editor for several print and online publishers. Kindra has worked on content editing for first responders, including firefighters, public safety communications, and emergency medical services. She has a bachelor’s degree and a master’s degree in English.
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