Optum Health Insurance Coverage for Drug and Alcohol Rehab
Optum Health provides care to millions of members.1 If you have Optum Health, drug and alcohol rehab treatment will be at least partially covered by your insurance policy. To learn more specific coverage information, you can call the number on the back of your card or verify your benefits below.
What Is Optum Health Insurance?
Optum Health is a nationwide organization that serves over 19 million people, helping them access healthcare, in-person or virtually.2 Optum offers a range of services for its members, from primary care to specialty services, such as addiction treatment and behavioral health treatment.
Optum offers high-quality care at a lower cost and aims to make accessing healthcare easy by providing case managers who organize appointments and tests for members.2 Optum helps members connect with medical specialists, mental health professionals, and urgent care, and when you need them. Optum is currently in the following states:3
- New Jersey
- New Mexico
- New York
Optum accepts most health insurance plans, including:4
- Blue Cross
- Blue Shield
- Cigna Behavioral Health
As with most insurance plans, your Optum coverage can vary depending on your location. Your coverage for healthcare services you access depends on the state you live in, your plan, and whether you have an HMO or PPO plan.
For example, with an Optum HMO, you choose your primary care physician and a medical network that is in-network with your insurance provider. An HMO plan tends to have lower monthly premiums, but coverage will not be provided if you see a healthcare provider outside of the network.5
With an Optum PPO plan, you can see any healthcare provider you wish, without a referral, both in and out of your health insurance plan’s network.6 If you stay within the PPO network, you will pay less, but if you see a provider out-of-network, you may pay more.
Optum has several accreditations from regulatory agencies, trade associations, and other governing bodies, including the NCQA Accreditation for Population Health Program (PHP), URAC Accreditation – Health Utilization Management, Joint Commission: Home Care, and more.7
Does Optum Health Cover Drug and Alcohol Rehab Treatment?
Coverage for drug and alcohol rehab treatment varies depending on your insurance plan, and the type of treatment you are accessing. Be sure to check with your insurance plan to determine which services and healthcare providers are covered by your plan.
Optum offers members resources and support to help achieve stability, resilience, and sustained recovery from a substance use disorder (SUD).8 Optum provides immediate assistance and provider referrals to members through their Substance Use Disorder Helpline.9
Types of Addiction Treatment That Optum Health Insurance May Cover
Several treatment types may be covered by your Optum Health insurance plan, including:
- Medical detox: Medical detox helps patients withdraw from drugs and alcohol comfortably and safely to help facilitate the transition to ongoing addiction treatments, such as inpatient or outpatient rehab.
- Inpatient programs: Inpatient rehab provides intensive, structured care. You will live at the center for the duration of the program, attending individual and group therapy sessions with around-the-clock medical care.
- Outpatient programs: Outpatient rehab allow you to live at home while attending treatment. With outpatient rehab, you will attend individual and group counseling to learn about addiction, how to control it, and strategies for ongoing recovery and sobriety.
- Intensive outpatient programs: Intensive outpatient programs (IOPs) involve attending treatment several days a week for a few hours at a time. This is more time-intensive than a typical outpatient program, but you can still live at home.
- Partial hospitalization programs: Partial hospitalization programs (PHPs) offer a treatment structure like inpatient treatment, where you attend around 4 to 6 hours a day for approximately 5 days a week, but you can still live at home.
- Aftercare: Aftercare programs provide ongoing counseling or treatment after attending inpatient or outpatient rehab. Aftercare programs are designed to help you maintain recovery, find ways to prevent relapse, and achieve a fulfilling, rewarding life free from substance use.
Check Your Optum Health Rehab Coverage
Knowing exactly what is covered in regards to addiction treatment can provide you peace of mind so you can focus on what matters: getting and staying sober. To learn more about what your insurance plan covers, you can call the number on the back of your insurance card, verify your insurance online, or fill out the form below.
What Rehab Centers Take Optum Health Insurance?
Finding a rehab center that takes your insurance policy is important. This can make it easier for your insurance coverage to begin when accessing treatment and provide comfort knowing that you are financially taken care of while you focus on your recovery.
AAC has rehab centers across the U.S. that accept Optum, including:
- AdCare Rhode Island: With a variety of locations in the state, AdCare Rhode Island offers high-quality addiction treatment in a secure environment.
- Recovery First Treatment Center: Located in Hollywood, Florida, Recovery First Treatment Center is a leading alcohol and drug rehabilitation center offering high-quality addiction treatment.
- Sunrise House Treatment Center: Located in Lafayette Township, New Jersey, Sunrise House Treatment Center offers high-quality addiction treatment.
Do Rehab Centers Need to Be In-Network?
To ensure that your addiction treatment is at least partially covered by your insurance policy, choose a rehab facility that is in-network with your insurance company. In-network means that your insurance company has an agreement with the rehab center to provide services at a discounted rate.
Out-of-network means that the rehab center does not have an agreement with the insurance company to provide treatment at a discounted rate. While some insurance companies will provide some coverage for out-of-network providers, others will not. This means you will end up paying more out-of-pocket for treatment or potentially be responsible for paying all of the costs.
Whenever possible, it’s important to choose a rehab center that takes your health insurance, to keep your out-of-pocket costs down.
Does Optum Health Cover Mental Health Treatment?
Optum Health provides some level of coverage for mental health disorders.11 The Affordable Care Act (ACA) states that insurance companies must provide coverage for 10 essential health benefits, which include mental health and substance use disorder treatment.10 This law ensures that everyone who needs access to mental health care can access it when they need it.
If you struggling with a substance use disorder and a mental health condition such as anxiety or depression, this is known as a co-occurring disorder or dual diagnosis. Many rehab facilities throughout the country offer dual diagnosis treatment.
Mental health treatments that may be covered by Optum Health include:
- Group counseling.
- Inpatient/outpatient rehab.
- Talk therapy/psychotherapy.
- Virtual counseling (telehealth).
Does Optum Health Cover Private and Luxury Rehabs?
There are times when private rehab or luxury rehab might be the best option for your needs. These programs may come at a higher cost, but your Optum insurance may provide some coverage. Whatever rehab you choose, verifying your benefits ahead of time can help you know what to expect in terms of coverage.
How Much of the Rehab Cost Does Optum Health Cover?
Optum Health coverage will vary depending on the specific plan you have. The percentage of treatment costs covered depends on your plan and the treatments you receive. For the most part, health insurance provides you with financial protection when you need to access healthcare, including addiction treatment.
Beyond the monthly premium you pay to maintain your health insurance coverage, you are also responsible for paying:12
- Deductible: The amount you must spend before health insurance coverage kicks in (e.g., $1,800).
- Copayments/coinsurance: Payments you make each time you receive a medical service
- Out-of-pocket maximum: The highest amount you have to pay for covered services in a calendar year. After you reach this amount, your insurance coverage will pay 100% for covered services.
What Should I Do if the Cost of Rehab Is Not Fully Covered?
While the cost of rehab is often a deterrent for accessing treatment, it doesn’t need to be. There are several options to help pay for your out-of-pocket expenses for treatment, including:
- Loans or lines of credit: Many banks and credit unions offer loans or lines of credit to individuals to help them pay the costs of healthcare (e.g., rehab).
- Payment plans. Treatment facilities often allow you to pay back your out-of-pocket costs over time.
- Fundraising and crowdfunding: Family members and friends may be able to help you cover the costs of rehab. You can also raise money through crowdfunding websites, such as GoFundMe.
- SAMHSA grants: The government offers grants to individuals who are low-income or belong to specific populations (e.g., veterans).
Getting Help for Addiction
AAC is dedicated to helping individuals struggling with addiction achieve and maintain sobriety. If you are looking to learn more about addiction treatment or have questions about your Optum Health coverage, you can contact us at