United Healthcare insurance covers 6.1 million Americans. This means that many people are dependent upon them for accessing United Healthcare drug rehab coverage. It is vital that all people insured by the company understand what their policy covers and how to use United Healthcare for substance abuse rehab.
Learn About United Healthcare Insurance Coverage For Drug Rehab:
Does United Healthcare Cover Drug Rehab?
United Healthcare insurance plans do cover drug rehab in most circumstances. However, even when United Healthcare (UHC) coverage for substance abuse rehab is part of an individual’s plan, that does not mean that the drug rehab coverage is offered without restrictions.
Both the patient and the treatment provider they select will need to meet certain criteria for coverage to kick into effect, and there are also other concerns, such as deductibles, copays, and coinsurance, to consider.
Still, the vast majority of people with United Healthcare health insurance should be able to have their rehab covered in part or in full by the provider.
United Healthcare Substance Abuse Coverage Options
When a policy does cover United Healthcare insurance coverage for drug rehab, it tends to be comprehensive. This means that, in general, UHC covers all vital aspects of substance abuse rehabilitation and even some that might not be considered essential. However, things like alternative therapies, luxury accommodations, and other services rehabs might offer often do not get covered by the company.
This may make users wonder what, exactly, is covered by United Healthcare individual and group insurance for drug rehab. Most policies will extend to detoxification, inpatient rehab, and outpatient rehab.
United Healthcare Substance Abuse Benefits
United Healthcare insurance plans often offer benefits that are specific to substance abuse. They cover all vital aspects related to rehab and even extend to smoking cessation programs.
The following benefits are covered at hospitals, alternate facilities, and doctor’s offices:
- Diagnostic evaluations and assessment
- Treatment planning
- Treatment and/or procedures
- Referral services
- Medication management
- Individual, family, therapeutic group, and provider-based case management services.
- Crisis intervention
- Partial Hospitalization/Day Treatment
- Services at a Residential Treatment Facility
- Intensive Outpatient Treatment
For these to be covered, these services must be rendered by a state-licensed, approved, or certified program or practitioner. There are also specific criteria a patient may need to meet to be eligible for UHC coverage.
Detoxification is part of a United Healthcare substance abuse coverage. However, not all people recovering from substance abuse will qualify for it. Some drugs of abuse and alcohol can cause dangerous withdrawals that require medically supervised detox. Others can be unpleasant but are not life-threatening.
UHC insurance company may choose not to extend coverage to detoxification if they do not feel the drug being withdrawn from could become dangerous during the detoxification process.
Inpatient rehabilitation is generally covered in United Healthcare insurance plans. In most cases, this will cost the insured a 20% coinsurance. The company may choose to only cover certain aspects of inpatient care. For example, luxury accommodations and spa services are likely to be declined, while medications and traditional therapies are usually covered. In most cases, UHC coverage will be for a limited time, sometimes only 30 days.
Outpatient rehab is generally charged at $35 per office visit. United Healthcare insurance coverage for outpatient rehab often extends the long term, making it easier for patients to engage in continued care. Insured individuals can choose to start with outpatient rehab or step down from inpatient care.
United Healthcare Mental Health Coverage Of Co-occurring Disorders
It is rare for substance abuse to be present without some underlying mental health condition fueling it. United Healthcare coverage plans extend to the treatment of co-occurring disorders through their behavioral health services. This makes sense, as without treatment of underlying conditions, relapse is all but inevitable.
Some of the mental health conditions covered by the company are:
- Eating disorders
If someone is battling substance abuse fueled by any of these conditions, they can seek substance abuse treatment with United Healthcare insurance coverage.
In-Network vs. Out-Of-Network United Healthcare Rehab Coverage
United Healthcare substance abuse coverage divides providers into two categories: those that are in-network and those that are out-of-network. This is not unique to the company as most insurance providers will do this with some or all of their plans.
An in-network provider is a doctor or facility that has negotiated with United Healthcare and agreed to charge them lower prices. An out-of-network provider is a doctor or facility that has not reached an agreement with the company and therefore charges them their standard rates.
Sometimes, United Healthcare insurance for drug rehab will only cover in-network providers and not extend any coverage to those that are out of network without prior approval. In other cases, they will cover the out-of-network provider without requiring special permission but will make the insured take on a greater percentage of the costs. As a result, it is generally better for the insured to seek an in-network provider whenever it is possible.
HMO vs. PPO UHC Insurance Plans For Drug Rehab Coverage
HMOs and PPOs are two different structures of United Healthcare group insurance that people can obtain through their employer.
With HMOs, providers either work for the HMO or negotiate with it to set special rates. Users are required to seek their care with in-network providers. In most cases, the insured will need to select a primary care provider, and this person will create referrals for the patient to get the services they require, including substance abuse rehab. Pre-approval is often required for medical services.
PPOs have providers that have negotiated prices with them. However, those with PPOs can still use their benefits outside of their network. In most cases, there is no need to have a primary care provider, and the insured can see specialists without a referral. Some services will still require pre-approval.
This means that the process for using United Healthcare coverage for substance abuse rehab can vary depending on the type of plan. It is possible the user will need to get a referral from their primary care provider and then get their treatment pre-approved.
COBRA Coverage With United Healthcare
Sometimes, an insured person may lose their job, and as a result, be at risk of not having health insurance. For people with substance abuse problems, losing their job can be a side effect of their disease. It is possible to enroll in COBRA coverage, so UHC health insurance is not lost, and use that coverage to access substance abuse rehab treatment.
To qualify, someone has to have lost their jobs for one of three reasons:
- They voluntarily left their job
- They were let go for reasons other than gross misconduct
- Their hours were cut, and they no longer qualify for benefits
United Healthcare COBRA insurance covers drug rehab and everything else that is covered when the person was employed. However, the insured will need to pay all fees associated with the policy, including those the employer used to pay. However, COBRA does not last forever, so if someone wants to use UHC coverage to get clean, they should act fast and seek treatment.
Verify United Healthcare Rehab Insurance To Start Treatment
Anyone with United Healthcare insurance for rehab has access to the care they need to turn their lives around. All they need to do is verify UHC coverage and find out what restrictions there are on the providers they choose. With a little help, it is possible to get clean.
- Certificate of Coverage (sample). UnitedHealthcare Insurance Company. https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/MY-7.pdf.
- Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services. UnitedHealthcare. 2016. https://www.uhc.com/content/dam/uhcdotcom/en/IndividualAndFamilies/PDF/2017-SBC-Sample-MM508.pdf.
- What is an HMO or PPO? UnitedHealthcare. 2019. https://www.uhc.com/individual-and-family/understanding-health-insurance/hmo-ppo-networks.