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Does UnitedHealthcare Insurance Cover Addiction Treatment?

Under the ACA, UnitedHealthcare plans offer coverage for addiction treatment. The level of coverage can vary depending on the personal plan selected and the state of residence.

UnitedHealthcare insurance can be used to pay for addiction treatment services.

UnitedHealthcare

One of the largest and most comprehensive health insurance providers in the United States, UnitedHealthcare provides health care coverage to nearly 30 million Americans.

With a wide range of insurance coverage options and plans that can vary state to state, both group and individual choices are available. UnitedHealthcare also provides coverage to Medicare beneficiaries with Medicare Advantage plans.

Under the 2010 Affordable Care Act (ACA), substance abuse, behavioral health services, and mental health treatment are all listed as essential health benefits. This means that these services must be covered under all insurance plans sold on the federal marketplace.

Types of Plans

UnitedHealthcare plans are different in each state where coverage is provided, and there are many options in which to choose.

Medicaid and Medicare Advantage plans are federally and state-funded insurance programs that offer low-cost or even free health insurance to qualified applicants. These plans cover addiction treatment services at the same rate that surgical and medical services are provided due to mental health parity laws that ensure equal coverage and expanded access to care.

Commercial health care coverage through UnitedHealthcare can vary, as there are many different coverage options and care plans. A UnitedHealthcare representative can walk you through your specific plan, explain how coverage works, what is considered covered, and how to use your insurance to pay for services.

You can find out what plans are available in your state here. If you are already a member, you can log into MyUHC to find out more information on your plan.Generally speaking, UnitedHealthcare plans with higher monthly premiums will have lower deductibles and fewer out-of-pocket costs while covering services at higher rates. A high-level plan may include treatment services at 80 percent as compared to a budget plan that covers services at 60 percent. You will be responsible for the remaining costs, which is called your coinsurance amount. Services are covered at these rates after your annual deductible is reached.

Generally speaking, UnitedHealthcare plans with higher monthly premiums will have lower deductibles and fewer out-of-pocket costs while covering services at higher rates. A high-level plan may include treatment services at 80 percent as compared to a budget plan that covers services at 60 percent. You will be responsible for the remaining costs, which is called your coinsurance amount. Services are covered at these rates after your annual deductible is reached.

UnitedHealthcare offers both preferred provider organization (PPO) plans, and health maintenance organization (HMO) plans in many states. PPO plans allow individuals to seek care from out-of-network providers for a higher cost, while HMO plans require individuals to remain in-network for most services.

UnitedHealthcare contracts with providers to offer discounted rates on treatment services to members under both HMO and PPO plans. The company has a comprehensive network of care, providing a wide variety of medical and mental health services to members and beneficiaries.

Coverage for Drug Addiction Treatment 

Drug addiction treatment services can include both inpatient and outpatient services that can range from detox and therapy to pharmacological and medication management options to peer, transitional, and recovery support services.

Many UnitedHealthcare plans are classified as “open access,” which means that you can seek care from a specialist without needing a referral or preauthorization. In other cases, to receive specialty services like drug rehabilitation, you will need first to see your primary care physician (PCP) to obtain a referral and preapproval for services.

Addiction treatment services commonly need to be classified as:

  • Medically necessary
  • Appropriate
  • Reasonable
  • Within reason

Treatment services and coverage provided for addiction treatment through UnitedHealthcare can vary based on the following:

  • Substance of abuse
  • Length of time substance was abused
  • Dosage levels
  • Emotional stability
  • Medical issues

Services may be covered for a specific amount of time, or days, in a calendar year. Some plans also have maximum lifetime limits for the duration of time in a drug rehab program.

You might pay a copay for addiction treatment services, which is a set amount that is required at the time services are provided.

UnitedHealthcare also offers health savings account (HSA), and health reimbursement account (HRA) plans where employees can put tax-protected money and then use it to pay for medical services.

Finding Rehabs That Accept UnitedHealthcare Insurance

There are more than 14,5000 specialized drug addiction treatment centers throughout the United States that provide treatment services. Many accept private health insurance, including UnitedHealthcare plans or public insurance plans under Medicaid and Medicare, to cover some of the costs of services.

To obtain more information on specific drug addiction treatment services in your area, SAMHSA’s Behavioral Health Treatment Services Locator can help. This tool offers current information on treatment providers, including whether or not they accept public or private health insurance and what types of services are provided.

Talk to an admissions coordinator at a specialized drug addiction treatment facility to understand how best to use UnitedHealthcare insurance coverage for your treatment. Ensure the facility accepts your insurance prior to enrolling.


Sources

(2019). Health Insurance Made Simple. United Healthcare Services. Retrieved March 2019 from https://www.uhone.com/

What Marketplace Health Insurance Plans Cover. HealthCare.gov. Retrieved March 2019 from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

(2019). What is Mental Health Parity? National Alliance on Mental Illness. Retrieved March 2019 from https://www.nami.org/find-support/living-with-a-mental-health-condition/understanding-health-insurance/what-is-mental-health-parity

(2019). Health Plans By State. United Healthcare. Retrieved March 2019 from https://www.uhcprovider.com/en/health-plans-by-state.html

Myuhc.com. United Healthcare. Retrieved March 2019 from https://www.myuhc.com/member/prewelcome.do?currentLanguageFromPreCheck=en

(October 2018). Treatment of Drug Abuse (Chemical Dependency). United Healthcare. Retrieved March 2019 from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/t/treatment-drug-abuse-chemical-dependency.pdf

(January 2018). Drug Addiction Treatment in the United States. National Institute on Drug Abuse. Retrieved March 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states

Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://findtreatment.samhsa.gov/

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