UnitedHealthcare Drug and Alcohol Rehab Treatment Insurance Coverage

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 aged 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 coinsurance costs, which is a percentage of any bill you’ll have to share with your provider.⁸ For example, if your coinsurance 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.

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 treatment facility in your network is almost always the most cost-effective option.

The specifics of your particular UnitedHealthcare rehab coverage may vary. Generally, though, UHC drug rehab plans cover:^2*

• Inpatient treatment (28- or 30-day, 60-day, or 90-day programs).
• 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.

You may be wondering, ‘does my UnitedHealthcare plan cover inpatient drug rehab?’ or ‘does UnitedHealthcare cover alcohol detoxification programs?’ The answer is ‘yes’. 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 rehabilitation, though the coinsurance 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 copayment.
  • 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 for up to 60 days per year. This person would be required to pay:
  • A $300 copayment.
  • 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 rehab 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.

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

• Outpatient or office services require this person to pay:
  • A $25 copayment 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 previously met).

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 Treatment?

You may be wondering, ‘does UnitedHealthcare cover therapy?’ UHC provides mental health service coverage as well. The insurance benefits for mental health services fall under the same category as those of substance abuse. In our New Mexico example, the UnitedHealthcare coverage provided if you needed to receive mental health treatment is the same as what you would receive for substance abuse.¹⁰

Many people suffer from mental health issues like depression, anxiety, stress, and isolation. Resources are available to help you feel better and return to your normal self. Coverage for mental health services depends on your health plan benefits. Calling the number on your member ID card can help you determine what services you are eligible for.

You may be wondering, ‘what are some rehab centers that accept UnitedHealthcare?’ If you want to learn more about UnitedHealthcare drug rehab providers or you are wondering, ‘how can I find rehab centers near me that are covered by UHC?’, there are several ways to check your UnitedHealthcare insurance benefits to see if you are covered for substance abuse treatment. 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
  • UnitedHealthcare member ID/subscriber number and group policy number from your UHC card. OR
  • Social security number and zip code.
• Call customer service.

In most cases, UnitedHealthcare insurance will provide coverage for drug and alcohol addiction programs and mental health services, provided you have insurance through your employer or the ACA. However, the degree of health insurance coverage varies depending on your chosen plan, the state you live in, and whether you choose 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.

Additional Resources on Health Insurance Providers and Coverage Levels

If you think you may need rehab, visit the links below to find out more about your health insurance coverage levels, how to get your insurance company to pay for drug and alcohol rehab, and also how to pay if you don’t have insurance.

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