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United Healthcare Drug Rehab Coverage

Last Updated: February 15, 2022

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

United Healthcare insurance covers 6.1 million Americans. It means that many people are dependent upon them for accessing United Healthcare drug rehab coverage. With United Healthcare substance abuse treatment, patients can expect detox, outpatient, and inpatient drug rehab centers to be covered. However, there are still some differences between insurance plans, so all people insured by the company need to understand what their particular policy covers and to what extent. Learn more about the specifics of United Healthcare drug rehab insurance.

Does United Healthcare Cover Rehab?

United Healthcare (UHC) insurance plans cover a stay in a drug or alcohol rehab center in most circumstances. However, even when United Healthcare rehab coverage for substance abuse is part of an individual’s plan, that does not mean that the drug rehab coverage is offered without restrictions.

Still, the vast majority of people with UHC health insurance should be able to have their addiction treatment covered in part or in full by the provider.

United Healthcare Substance Abuse Coverage Options

When a policy does cover addiction treatment services, it tends to be comprehensive. It means that, in general, UHC covers all vital aspects of the drug and alcohol rehabilitation program and even some that might not be considered essential. However, things like alternative therapies, luxury accommodations, and other services treatment centers might offer often do not get covered by the company.

It may make users wonder what exactly is covered by United Healthcare individual and group insurance for alcohol rehab. Most policies will extend to detoxification, inpatient rehab, and outpatient rehab.

UHC Addiction Treatment Benefits

United Healthcare insurance plans often offer benefits that are specific to addiction recovery. They cover all vital aspects of addiction rehabilitation 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 procedures
  • Referral services
  • Medication management
  • Individual, family, therapeutic group, and provider-based case management services
  • Crisis interventionat
  • Partial hospitalization
  • 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.

Detox

Detoxification is part of United Healthcare substance abuse coverage. However, not all people in recovery from substance abuse will qualify for it. For example, 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 health insurance may choose not to extend coverage to detoxification if they do not feel the drug being withdrawn could become dangerous and require help during the detoxification process.

Inpatient Rehab

United Healthcare inpatient rehab coverage is generally provided in most insurance plans. In most cases, this will cost the insured a 20% coinsurance. The company may choose only to cover certain aspects of inpatient care.

Doctor explaining something to the patient.

For example, luxury accommodations and spa services are likely to be declined, while medications and traditional therapy programs are usually covered. In most cases, UHC coverage will be for a limited time, sometimes only 30 days.

Outpatient Rehab

Outpatient rehab is generally charged $35 per office visit. United Healthcare rehab coverage for outpatient treatment often extends the long term, making it easier for patients to engage in continued care. Insured individuals can start with outpatient alcohol rehab or step down from inpatient care.

United Healthcare Therapy Coverage

Mental health is considered one of the ten essential health benefits under the Affordable Care Act. Therefore, United Healthcare, like any other insurance provider, does cover therapy. However, the level of coverage will depend on the health plan benefits.

United Healthcare therapy coverage also includes online therapy like Talkspace or the Sanvello app, which allows members to get emotional support without the need for office visits.

Addiction counseling may also be covered if it is deemed medically necessary. Frequently, addiction recovery requires a bit more than just detoxifying from a substance and getting addiction medication.

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 substance abuse treatment plans extend to the treatment of co-occurring disorders through their behavioral health services. It makes sense, as addiction relapse is all but inevitable without treatment of underlying conditions.

Some of the Mental Health Conditions Covered by the Company Are:

  • Anxiety
  • Depression
  • PTSD
  • Eating disorders

If someone is battling drug addiction 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. It 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 drug rehab insurance will only cover in-network providers and not extend any coverage to those out of it without prior approval. In other cases, they will cover the out-of-network treatment center without requiring special permission but will make the insured take on a more significant 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 UHC 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 necessary for medical services.

Professional psychologist consults a patient.

PPOs have providers that have negotiated prices with them. However, those with PPOs can still use their benefits outside their network. There is no need to have a primary care provider in most cases, and the insured can see specialists without a referral. Some services will still require pre-approval.

It means that the process for using United Healthcare drug rehab coverage can vary depending on the type of plan. The user may 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 addiction 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 treatment.

To Qualify, Someone Has to Have Lost Their Job 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 and alcohol 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.

Choosing United Healthcare Substance Abuse Treatment

If the cost of addiction treatment is an obstacle to seeking treatment, it’s essential to know that most insurance companies provide at least partial coverage of expenses associated with drug and alcohol treatment. Anyone with United Healthcare insurance for alcohol 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. United Healthcare therapy coverage allows patients to have counseling, CBT, or other therapies covered. With a little help, it is possible to get clean.

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Page Sources

  1. U.S. Department of Labor, Continuation of Health Coverage (COBRA). https://www.dol.gov/general/topic/health-plans/cobra
  2. United Healthcare, What are HMO, PPO, EPO and POS health insurance plans? https://www.uhc.com/understanding-health-insurance/types-of-health-insurance/understanding-hmo-ppo-epo-pos
  3. United Healthcare, Mental health programs and benefits. https://www.uhc.com/member-resources/health-care-programs/mental-health-services
  4. United Healthcare, Quit For Life. https://www.uhc.com/member-resources/health-care-programs/quit-for-life

Published on: October 2nd, 2019

Updated on: February 15th, 2022

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.