An Overview of UnitedHealth Insurance Services
UnitedHealth Group is a Minnesota-based health care company that offers a variety of insurance packages. As the largest health care company in the country, this group provides insurance to millions of people. Sold under the name of UnitedHealthcare, the company’s insurance plans are often provided through employers, government health care providers and private health care providers.
Because UnitedHealthcare has such a big share of the market, it is one of the names that gets brought up the most when people start wondering about whether their insurance covers addiction treatment. This guide to UnitedHealthcare’s addiction-related services will help you learn all about seeking treatment as a UnitedHealthcare member.
Does UnitedHealthcare Cover Addiction Treatment?
The short answer to this question is yes. UnitedHealthcare’s addiction treatment policy states that its plans cover both mental and physical health problems. The organization believes that substance use disorders count as a disease that you deserve to get treatment for. Therefore, the plans will provide treatment for both the mental struggles of a substance use disorder and the physical problems that often come from repeated drug abuse. Anyone who has a problem with excessive and compulsive use of alcohol, drugs or medication can use the company’s health insurance to treat their addiction.
However, this does not necessarily mean that you can just walk in to any addiction treatment center and have all the costs covered by UnitedHealthcare. Like any other insurance plan, the organization has some rules in place about the types of treatment it will pay for. The exact regulations will vary depending on what state you are in and what sort of plan you have. Generally, you need to find an addiction recovery center that is part of your insurance network, and you may need to pay various coinsurance or copay fees until you reach a deductible.
Types of Addiction Treatment Covered by UnitedHealthcare
Your addiction treatment options may vary depending on where you live and what type of addiction you have. UnitedHealthcare typically decides whether or not to cover a treatment based on whether it is medically necessary, so more luxurious or experimental addiction treatments might not be covered on your plan. Here are some of the types of addiction treatment that may be covered on your health care plan.
Detox is a type of addiction treatment that focuses on providing medical care while a patient goes through withdrawal and removes all traces of the drugs from their system. Depending on the drugs you have been using, you may need medication to manage symptoms like dehydration, vomiting, unstable heart rates, seizures and more. Some types of withdrawal, such as opioid withdrawal, can also be directly treated with medications that halt cravings and other symptoms.
Because detox primarily gives medical care to those undergoing health problems, it is generally covered by UnitedHealthcare. Detox is almost always covered for alcohol and benzodiazepine withdrawal since the symptoms can be deadly when left untreated. Even in cases where detox is not physically dangerous, it may be covered for mental reasons. Since detox typically involves intense drug cravings, having support during this time can make it easier to stay sober.
Outpatient Rehab Programs
Both during and after detox, many patients choose to go to outpatient rehab. This is a type of rehab where you live at home but regularly visit an addiction treatment clinic for help. People in outpatient rehab may undergo a variety of counseling and treatments, ranging from traditional psychotherapy to things like hiking and art therapy. It may include both one-on-one sessions with therapists and group sessions where a professional guides a group of patients through discussions. Some clinics charge per session, but most will charge for an entire treatment plan that consists of weeks of sessions. Outpatient rehab works well in cases where patients have a mild addiction or need to remain at home to manage family and work responsibilities.
UnitedHealthcare covers a wide variety of outpatient rehab programs. Anything that is provided by trained mental health professionals is typically covered as long as the provider is in the UnitedHealthcare network. Even outpatient rehab that contains a blend of clinically proven and holistic treatment may be covered as long as the holistic treatment is part of a defined treatment plan. Usually, the only type of outpatient rehab not covered by UnitedHealthcare is rehab that solely offers more experimental and faith-based therapies without any clinically proven benefits.
Inpatient Rehab Programs
Also called residential rehab, this is a type of program where clients live in the facility while they get substance use treatment. Patients are able to completely leave triggering surroundings and habits behind and get a fresh start in a new location. With the ability to get around-the-clock medical care and constant support from counselors, residential rehab tends to be recommended for patients who have more severe or long-lasting substance use issues.
This is the level of care where UnitedHealthcare’s coverage gets trickier. No health care providers are federally mandated to provide residential rehab, but some states may have additional regulations that mean residential rehab must be covered. Whether or not UnitedHealthcare will cover residential rehab often depends on whether the organization believes your addiction is severe enough to necessitate residential treatment. When insurance does cover stays at a residential rehab, it may place limits on how long patients are allowed to stay there. Luxury rehab centers that offer resort-like facilities may not be approved for coverage if UnitedHealthcare does not believe that level of amenities is necessary for the addiction.
Understanding How Your Coverage Level Affects Your Treatment Options
One of the most important things to consider when looking for addiction treatment as a UnitedHealthcare member is your coverage level. The company has several different types of plans, and the plan you have will affect what types of treatment UnitedHealthcare will help you pay for.
UnitedHealthcare Select: This is an exclusive preferred provider organization plan, which means you don’t need to find a primary care physician to get addiction treatment. Instead, you just have to pick from addiction treatment specialists within a predetermined network and get preauthorization before you make your visit. If you pick someone outside of the network, you have to pay the complete bill yourself. Typically, you then pay a discounted price for each visit instead of having to pay a monthly fee on this plan.
UnitedHealthcare Select Plus: UnitedHealthcare Select Plus is very similar to UnitedHealthcare Select, but you can have a primary care physician on the plan to coordinate your care. If you have this plan, you will not have to get referrals before visiting your addiction care specialist.
UnitedHealthcare Choice: This is a standard HMO plan where you pay a monthly fee to get coverage for addiction care. Addiction treatment is generally only covered for in-network providers. Once you meet your deductible, treatment may be free. Depending on the type of plan you get, you may be able to pay for your substance use treatment with a copay where you pay the same set cost every time, or you might have coinsurance where you pay a certain percentage of the care.
UnitedHealthcare Choice Plus: This plan is similar to the Choice plan, but it also provides coverage at a reduced rate when you go out of network. This can give you more flexibility when selecting an addiction treatment center.
Generally, the main difference between these plans is which addiction clinics are part of your network and whether the plan will cover any of the costs for addiction clinics you visit that are outside of the network. Some of the plans also require a referral or authorization from UnitedHealthcare before visiting a clinic, which can add a little extra time to the process of seeking treatment.
How to Show Your Addiction Treatment Is Medically Necessary
Since some UnitedHealthcare plans require you to seek approval or get a referral before going to an addiction treatment center, it is important to understand how to advocate for yourself. One of the simplest ways of getting your planned treatment approved is with a clinical assessment. Depending on your plan, you may be able to get this through a primary care physician or through a treatment provider.
In this assessment, you need to be up front about the ways that addiction has affected you. Be honest when asked about how often you use drugs and how long you have been using them. Explain to the provider the ways that your substance use has harmed your mental health, life and physical health. It can be rough to talk about all of this with someone in a setting that is not devoted to addiction care, but it can be the first step in making sure UnitedHealthcare will cover your treatment.
Keep in mind that any treatment you are trying to get needs to be something medically necessary for your mental or physical health. This covers things like medications to manage the health symptoms of withdrawal and cognitive behavioral therapy to teach you how to fight cravings. However, it can also cover some more unusual treatments, like sports therapy or acupuncture, if the treatment has been proven to help with addiction or mental health. Never be afraid to ask for coverage on treatments even if they do not fall under traditional ideas of rehab. You might be surprised to discover how much UnitedHealthcare covers.
Final Thoughts on UnitedHealthcare Addiction Coverage
Insurance probably isn’t the first thing on your mind when struggling with addiction, but taking the time to make sure your rehab is covered can give you plenty of peace of mind. UnitedHealthcare works to make sure clients get the mental and physical care they need, so you can find addiction treatment that is covered by the company.
For more help with finding addiction treatment through UnitedHealthcare, give the organization’s substance use help line a call at 1 (855) 780-5955. This help line operates at all hours of the day, every day of the week. It is entirely free and confidential regardless of what UnitedHealthcare plan you are on. The help line can assist you with deciding to get treatment, learning about the cost of care, finding an in-network provider or answering other questions about addiction and your health.