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United Healthcare Group Insurance Coverage for Opioid/Opiate Rehab Treatment

Optum Provider Express (formerly United Behavioral Health, also known as United Healthcare Group) is the organization that handles most of the substance abuse and chemical dependency coverage for UnitedHealth Group Insurance plans.

For the purposes of this article, United Healthcare (UHC) and Optum are interchangeable.


Does United Healthcare Cover Opioid/Opiate Addiction Rehab?

Yes, Optum Provider Express is a ‘personal health improvement service’ with an excellent reputation for behavioral disorder insurance coverage. The benefits made available for plan members through UBH may vary depending on the year of their enrollment. Insurance companies are required to provide coverage for chemical dependencies and substance abuse as though they were medical or surgical conditions (per the Mental Health Parity and Addiction Equity Act of 2008). This helps ensure coverage, but also means that you may have to become pre-certified to receive addiction treatment.

Additionally, UBH/Optum does not require pre-authorization for certain outpatient rehab services. It is important to note that not all programs are covered, even if a treatment is described on a UnitedHealth website. Refer to your Summary Plan Description for a list of all covered benefits under your health plan. UBH partners with both Medicaid and Medicare.

Check Your United Healthcare Opioid Rehab Coverage

Knowing exactly what your Optum plan covers can give you peace of mind while you or your loved one is in rehab for opioid/opiate addiction. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Optum insurance plans and to check what your plan covers, call us on or use the form below to check your insurance coverage for opioid rehab treatment.


UnitedHealth Inpatient Opioid Rehab vs. Outpatient Treatment

“Certain diagnostic and detoxification services may be covered completely through UnitedHealth Insurance plans, and it is possible that withdrawal management medications are completely covered.”

Opioid or opiate addiction treatment and rehabilitation programs can be classified into two broad categories: inpatient and outpatient rehab. The primary differences between inpatient and outpatient programs revolve around residency; inpatient treatment programs require that the patient lives on-site for the duration of  rehab treatment.

Most outpatient rehab programs are less expensive than inpatient programs, but offer fewer services and do not have 24-hour supervision. Optum preferred provider guidelines stipulate that Opioid/opiate addicts should 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.

Optum recommends intensive outpatient services or inpatient rehab programs if treatment is deemed to require observation and interaction for a minimum of 6 hours per week.

 



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