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UnitedHealth Insurance Coverage for Cocaine

What Kind of Coverage Does UnitedHealth Insurance Offer for Cocaine Addictions?

Doctor reviews insurance coverage for cocaine addictionUnitedHealth Group offers behavioral health treatment and cocaine addiction rehab through its subsidiary, United Behavioral Health – which is now known as Optum Provider Express or Optum Behavioral Solutions – and has in-network providers all over the country. For the purposes of this article, United Behavioral Health (UBH) and Optum are interchangeable.

United Behavioral Health is a ‘personal health improvement service’ that has been in operation for more than 20 years. For those battling cocaine addiction, UBH has select coverage for health and wellness programs, support helplines, general pharmacology, therapy, integrated behavioral and medical care, and coverage for forms of inpatient and outpatient treatment centers.

Coverage depends on the plan that you or your employer has purchased. Optum has set up a member website, which has information on coverage and even provides a search tool to help locate a treatment facility.

United Behavioral Health provides and manages all behavioral health and substance abuse services for UnitedHealthcare Plan members. UBH also partners with both Medicaid and Medicare. Unlike some other insurance plans, UBH/Optum does not require pre-authorization for certain outpatient services.

It is important to note that not all programs are covered, even if a treatment is described on the UnitedHealth website. Refer to your Summary Plan Description for a list of all covered benefits under your health plan.

How Much of the Cost of Rehab is Covered by UnitedHealth Insurance?

Some diagnostic and detoxification services may be covered completely through United Health Insurance plans. It is also possible that withdrawal management medications are completely covered.

For some in network providers, UnitedHealth Group Insurance requires a zero percent copay but do require you to meet an annual deductible. Out of network inpatient or outpatient services generally range around 20 percent for a copay as well as an annual deductible amount.

Optum has a good reputation for a high level of coverage for substance abuse rehabilitation and even has a treatment decision support team charged with helping members make informed, cost-effective decisions.

Can I Pay Above What My Insurance Will Provide to Receive Treatment?

You are allowed to pay above the standard UnitedHealth Insurance coverage for cocaine addiction rehab. Some plans do have ‘Out-of-Pocket Maximum’ limitations.

There are limitations on UnitedHealth Insurance coverage amounts for cocaine addiction treatment, and some treatments or treatment centers may not be covered at all. You should request a copy of your policy for more information.

Inpatient Addiction Treatment vs. Outpatient Therapy

“United Behavioral Health is a ‘personal health improvement service’ that has been in operation for more than 20 years.”

Cocaine addiction treatment and rehabilitation programs can be classified into two broad categories: inpatient and outpatient. That said, the nature of cocaine abuse could mean that partial hospital/day treatment programs are necessary (which are substantively different that most inpatient or outpatient options).

Both services offer traditional treatments, including 12-step programs, group therapy or counseling sessions, education, medication prescriptions, family therapy, etc. Outpatient services include clinician visits and standard therapy. Inpatient treatment centers act as short-term residencies and include a range of psychological, physiological and other intervention techniques in a community setting.

According to Optum preferred provider guidelines, cocaine addicts should only be admitted to outpatient services under the following circumstances:

  • individual is not an imminent risk for harm to self or others;
  • individual exhibits adequate behavioral control to be treated in outpatient setting;
  • co-occurring substance abuse is unlikely to undermine treatment;
  • there is no risk of withdrawal, or withdrawals can be safely managed;

If treatment is deemed to require observation and interaction for a minimum of 6 hours per week, Optum recommends intensive outpatient services.

Should I Choose a Residential Rehab Center?

Residential rehab centers are treatment facilities that combine detoxification services, psychological counseling and after-care services. Keep in mind that UBH/Optum will review, recommend and authorize all inpatient services.

The admission criteria for residential rehab programs for most Optum providers includes:

  • no risk of withdrawal, or withdrawal can be safely managed;
  • physical complications, if present, can be safely managed;
  • there is imminent or current risk of relapse which cannot be safely, efficiently and effectively managed in a less intensive level of care;

If you or your loved one is experiencing acute impairment of behavior or cognition that interferes with daily life, or if there are psychological or environmental problems which present threats to safety, then you should consider a residential rehab center.

Consider the following factors before entering any specific residential rehab center:

  • cost and coverage
  • treatment methodologies
  • effectiveness (this can be difficult, since not all rehab facility organizations publish success rates)
  • your own professional career / family impact

Will UnitedHealth Insurance Pay for Local Rehab and Out-of-State Treatment? The Optum portion of UnitedHealth Group Insurance is actually comprised of three separate, but related companies: Optum Health, Optum Insight and Optum RX. The coverage options available to you for local rehabilitation services or for out-of-state treatment can vary based on your plan.

You can also visit to find a clinician or certify visits.

Does UnitedHealth Insurance Pay for Private or Luxury Treatment?

Private and luxury treatment rehabilitation centers may be covered through your UnitedHealth health plan. High-end treatment services come in both inpatient and outpatient clinics, but you should be aware that private, luxury and executive treatment options are very expensive. Some luxury treatment programs can cost in excess of $25,000 per month.

What Does Executive Treatment Offer Over Other Rehabs?

Unlike more traditional treatment facilities, executive and luxury rehab centers are designed to have a resort-style feel. These can be excellent options for those who have excellent coverage or the financial resources on hand to afford executive-level services.

Common luxury amenities include private rooms, gourmet meals, swimming pools and spas, conference rooms, horseback riding and other accommodations.

For those who need to conduct business while going through an cocaine rehabilitation program, these centers offer the ability to meet with business associates and maintain a comfortable working lifestyle while receiving help.

What Treatment Lengths Will UnitedHealth Insurance Pay For?

UnitedHealth Insurance for cocaine addiction rehab covers inpatient services ranging from 6 days to 90+ days. Some forms of treatment may not have established treatment lengths. Most UnitedHealth rehab centers or programs are outpatient, and some have treatment options that can run in excess of a full year. Your plan may have limitations on the number of days in which you can receive either inpatient or outpatient behavioral health services.

Important: Many facilities will offer different treatment lengths, but not all facilities are covered through your health plan. If you have questions, contact a UnitedHealth Group or Optum plan representative.

What if I Have No Insurance?

UnitedHealth Group insurance coverage for cocaine addiction treatmentIf you or your loved one is suffering from cocaine addiction but does not have insurance, you still have some options available to you.

Many treatment facilities understand that rehab programs are expensive (especially inpatient centers) and offer flexible payment plans. Some treatment centers are even free.

Additionally, the Affordable Care Act (more commonly known as “ObamaCare”) includes a program known as Screening Brief Intervention and Referral to Treatment, which is designed to stop substance abuse. SBIRT services may be useful for those with drug and cocaine dependence. Those with Medicaid are guaranteed this program.

You can also speak with our specialists to identify your coverage options and potential treatment programs.

Using Our Helpline to Determine Your UnitedHealth Group Insurance Rehab Options

Sometimes the best way to determine the appropriate rehabilitation program is to speak with a professional, third-party advisor. We can help you or your loved one identify what your options are and help you understand the right choice given your specific situation. If you are looking to make the transition to a healthy lifestyle, call .

Questions and Answers

Will UnitedHealth Insurance Cover Multiple Rehab Stays?

Maybe. While coverage depends on each plan and individual member’s history of benefits use, UnitedHealth Insurance (or Optum Behavioral Solutions) may cover multiple stays.

Your plan is more likely to evaluate and limit the total number of days, not the total number of stays, in rehab.

Does Insurance Pay for Aftercare?

Yes. UnitedHealth Group Insurance does offer select coverage for aftercare programs. Member benefits are subject to change based on network options, individual coverage and treatment methodologies.

Could Rehab Make My Insurance Premiums Higher?

This is a common fear among members of all health insurance plans, not just UnitedHealth plans. Ultimately, whether or not premiums rise depends on plan and treatment types. After a certain number of treatment days, member co-pays are likely to increase.

Has the Affordable Care Act (ObamaCare) Affected Substance Abuse and Mental Health Insurance Coverage?

Yes. The Affordable Care Act lists addiction treatment one of its ‘ten essential health benefits’ required of insurance exchange companies. The ACA has also made it illegal for companies to deny coverage to those with preexisting conditions, such as addiction and mental illness.

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