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Does Optum Insurance Cover Rehab?

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Does Optum Cover Addiction Treatment?

If you have been struggling with substance use disorder and feel it’s time to end the vicious cycle, you are not alone. According to the most recent National Survey on Drug Use and Health, more than 24 million Americans aged 12 and older have used some form of illicit substance in the past month. It’s also important to note that addiction does not discriminate; people belonging to every age group, race, gender and income level are affected.

Alcoholism, for example, is a major problem in every state. In 2018, more than 26% of adults aged 18 and over reported being involved in binge drinking at least once in the prior month.

According to the Centers for Disease Control (CDC), children are highly at risk of being introduced to addictive substances now more than ever. These substances include cigarettes, alcohol and illicit drugs like cocaine, meth and heroin. In a recent survey conducted by the National Institute of Drug Addiction (NIDA) involving 8th, 10th and 12th graders, more than 30% of respondents said they had used a drug at least once in the prior year.

These addictive habits often stick with children and teenagers into adulthood and become addictions, and the struggle to overcome these addictions can become severe or even life-threatening. Treatment for chronic addiction is necessary, and Optum insurance coverage can help you pay for a large portion of it.

If you are not sure that your substance use problem has reached a critical stage, you can watch for several signs and symptoms that are almost always indicative of severe drug and/or alcohol addiction. These include:

  • Having an intense urge to use the substance, despite the negative consequences you have
    experienced or are experiencing
  • Using much more than you expected to use and experiencing intense withdrawal symptoms
  • Spending more money than you can afford on the substance
  • Doing questionable things to obtain the substance, including stealing and other forms of illegal activity
  • Attempting to stop using with no lasting success

If you have been experiencing more than one of these symptoms, you more than likely need treatment. Enlist the help of Optum insurance to help you cover your treatment.

What Kind of Optum Insurance Do You Have?

You need to understand what treatments Optum insurance will pay for before you take the next step. Generally, Optum will pay for treatments that help you get sober and stay that way. The kind of coverage you receive will depend on the specific insurance plan you have, and there are various plans. First, you need to find out if you have an Optum HMO or PPO insurance plan.

With the Optum HMO insurance program, you will need to choose a primary care physician that is a member of your HMO, or health maintenance organization. HMO plans have fixed networks of health care providers, hospitals and doctors. For instance, if you have a family doctor you go to for other health issues, this would be your primary care provider. If you don’t have a primary care provider, you need to find one within your network.

If you have an Optum preferred provider organization (PPO) or prospective payment system (PPS) insurance plan, there is a preferred network of hospitals, doctors and specialists you will have to pick from. You will have more freedom to choose which doctors, specialists and treatment centers to pick from with a PPO or PPS plan. However, if you pick treatment options that are outside of the preferred network determined by the PPO or PPS, you will need to pay more. If you need to save money, it’s recommended that you choose from within the network.

What to Know Before Seeking Treatment

Every treatment or procedure that is not an immediate emergency requires prior authorization from the Optum Medical Network. These include most inpatient procedures and treatments for substance use disorder. Your doctor can help you acquire this authorization, but you should verify the benefits of your particular insurance plan beforehand. For instance, inpatient treatment for substance use disorder is on the list of such treatments. Behavioral health treatments, which will probably be necessary after the detox phase of treatment, are also subject to this rule. Please check your insurance plan to make sure so that you don’t have problems later when you need help the most.

For outpatient services and treatments that might be necessary for your rehabilitation, an ALERT authorization is required. ALERT is Optum’s clinical risk management service. A unique algorithm is used to determine the treatment needs of clients before treatment begins. If you need outpatient services, start by filling out the one-page ALERT Wellness Assessment.

After you have completed this, your treatment provider will soon receive a letter informing them about risks associated with receiving this treatment, if there are any. They will be instructed in the best ways to implement this form of treatment for the most beneficial results, according to your particular health history. This way, Optum can collaborate with treatment providers to make the most effective treatments readily available to their clients, or refuse to finance those that have a high chance of being ineffective.

Rehab Treatments Covered by Optum Insurance

Remember that Optum connects its clients with intensive treatment programs for their substance use disorders. This is because they collaborate with their networks of health care providers continuously, following well-researched guidelines for treating patients struggling with addiction and the mental health issues associated with it. That being said, realize that Optum will not pay for treatments that are experimental and have not been proven to be effective in fighting substance use disorder.

The first stage of addiction treatment is the diagnosis process, and this is covered by Optum. During this stage, you will sit down with your doctor and discuss your situation. He or she will then run a few tests to decide how serious your condition is and what kinds of treatments will help you recover. When they are satisfied with their decisions, they will write a letter to the providers who will administer treatment. The letter will focus on your specific needs and what treatments will be most effective for you as an individual.

After you have been placed in a treatment center of your and your doctor’s choosing, the medical detox process can begin, and Optum usually covers this as well. Depending on the severity of your substance use disorder, you might have to spend anywhere from three days to a full week in detox. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency. You will have to remain under medical supervision 24/7 during this time and will be given medications to help ease your body and mind through the withdrawal process. Intense and uncomfortable withdrawals are what keep people from coming back to their substance of choice over and over again. Once the offending substance(s) has left your system, the recovery process can begin.

Types of Continued Treatment Plans

It’s now time to decide what kind of continued treatment plan suits you best. Decide if you will be receiving counseling and other therapies in an outpatient or inpatient setting after detox. Optum does cover outpatient treatments and may require that you try these first before attempting any of the inpatient varieties. Optum might also limit you to certain therapies and exclude others.

Outpatient treatments include various types of counseling, including one-on-one counseling and group counseling sessions. There will be specific times of the day when these will be held, and the focus of the sessions will depend on the particular treatment center that you and/or your doctor choose.

Inpatient treatments are conducted in an environment similar to that of a hospital or a more residential setting. Inpatient treatments are scheduled by the month, and you could spend 30, 60 or even 90 days in an inpatient facility. The amount of time that you spend in the program will be based on the severity of your substance use disorder and the damage it has caused both physically and mentally.

Although Optum might cover the expenses of up to 30 days for some institutions, it might not cover longer periods. Check with your insurance plan details beforehand to avoid any confusion. Remember, you want everything to go smoothly during your treatment. The last thing you need is the stress that can come with being ill-prepared.

Forms of Medically-Supervised Therapy

Medication-assisted treatment (MAT) is a highly effective therapy for fighting addiction. If you have been prescribed long-term medications, you will be monitored for their effectiveness. If the medications are not working or giving you problems, these can be changed. Optum is pleased to have the largest medication-assisted treatment network in the United States, so you will be in a good place. Only medications that will benefit you by ultimately helping you to stay drug-free will be considered as part of your treatment plan.

Drug replacement therapy is another option for treatment that Optum will usually pay for if it is part of a more extensive treatment plan. With this form of treatment, the illicit drug of choice is replaced with a less damaging drug that is prescribed by a doctor. The doses are controlled and reduced incrementally over some time. This treatment is most effective for people struggling with addiction to certain prescription and hard illicit drugs like cocaine, heroin and methamphetamines.

Methadone and buprenorphine are the drugs most widely used for this form of treatment, although others can be effective. While methadone has been restricted in the United States, it can still be highly effective in ceasing intense cravings associated with prescription and illicit drug use.

Buprenorphine is an opioid that has been used to treat chronic pain and acute pain as well as addiction to prescription pain relievers. Less regulated than methadone, buprenorphine is highly effective and might be a safer and more effective option than methadone for some people.

Get the Help You Need Today

We understand that making the choice to seek treatment for substance use disorder is a big decision that could change the course of your life for the better. We are here to answer any questions you may have before deciding to take this critical step. Addiction ruins the lives of millions of men, women and teenagers every year. Don’t let an addiction to any substance ruin your chances for a productive and satisfying future. Our staff members can refer you to treatment centers that will meet your needs and accept your insurance plan. Call us today to learn more about the options available to you for permanently overcoming your substance use disorder.