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UPMC Health Plan Insurance Coverage for Drug & Alcohol Rehab

If you’re a UPMC member and are struggling with drug or alcohol use, your insurance plan may cover some, if not all, of the cost of addiction treatment. This page will help you understand the types of addiction treatment your insurance plan may cover, including detox, inpatient and outpatient rehab, and long-term residential treatment.
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As you consider your options for addiction treatment and hope for a life in recovery, you know you’ll need tools to get you there. It takes a lot of strength to make this journey, and having the right support is essential. One of the biggest resources you have is your health insurance.

Does UPMC Cover Addiction Treatment?

Does UPMC cover drug rehab? Fortunately, every permanent health insurance plan has to provide at least some level of addiction treatment coverage. This coverage is considered an essential benefit under the Affordable Care Act (ACA). However, each insurance company and plan covers addiction and mental health differently. The goal of this page is to help you use your UPMC Health Plan to address your addiction treatment needs.1

UPMC mental health coverage and addiction treatment are administered through UPMC Addiction Medicine Services (AMS).2 UPMC therapy coverage can assist you with a wide range of addictions, including alcohol, opiates, sedatives, cocaine, marijuana, and even gambling and tobacco. To get started with detox or withdrawal management, contact UPMC directly. Their nurses will give you an assessment and review treatment options.3 Because of how common it is that mental health issues and addiction issues coincide, UPMC offers treatment options that address both in either an inpatient and outpatient setting.

The amount of coverage you have can vary widely based on your state of residence, whether the facility is in- or out-of-network, the length of your stay, and your insurance plan level. The cost of drug and alcohol addiction treatment will vary from person to person and will also depend on the rehab center, the type of program attended, and specific services received.

Rehab Centers That Take UPMC Insurance

UPMC offers many of its addiction treatment programs within its own hospital. The insurance plan will likely direct you there first.4

However, sometimes those drug and alcohol rehab programs are full or aren’t the best option for you. You may also be able to get coverage for outside treatment programs depending on your specific insurance. Some UPMC healthcare coverage plans only provide coverage within the network, while others have out-of-network coverage as well.

It’s likely that any out-of-network addiction treatment will have higher out-of-pocket costs and lower levels of coverage. Be sure to check with the insurance provider before making a final decision on your treatment program.

What Different Types of Addiction Treatment Does UPMC Cover?

UPMC focuses strongly on a range of evidence-based comprehensive services for drug and alcohol addiction treatment. They include rehabilitation treatment of substance abuse and co-occurring disorder in all inpatient and outpatient programs. They are also a Center of Excellence for opioid use disorders.

There are several types of addiction treatment that can be effective, depending on your needs.9

  • Detoxification: Most programs start with detoxification. This is the process of getting off the drugs you’ve been using and allowing your body to adjust to not having the substances stimulating it. It can be a very difficult process, but it’s well worth it. Some detox programs are medically supervised.
  • Inpatient treatment: An inpatient treatment program has you live in the facility. You receive counseling to address the underlying issues that may have caused you to start using drugs, and you learn coping mechanisms to live life substance-free. From an inpatient program, you often move to outpatient or transitional treatment.
  • Outpatient treatment: Outpatient treatment allows you to live at home and continue to work, go to school, and manage other daily life tasks. However, you go to the treatment facility several hours each week for counseling and learning how to handle challenging situations without drugs.
  • Partial hospitalization program (PHP): Partial hospitalization programs are full-time, but you spend nights at home instead of within the facility. You’ll be in treatment 4-6 hours a day, five days a week.

The exact treatment program you’ll participate in will depend on your use history, which substances you struggle with, and other factors.

What Are the Coverage Levels and Plans for UPMC?

There are a variety of insurance plans  available through UPMC. Coverage is available throughout Pennsylvania.6

For individuals and families, you can choose between three types of coverage:

  • An Exclusive Provider Organization (EPO) plan, which costs less per month but includes a limited number of providers
  • A Health Management Organization (HMO) plan, which has a bit more choice and costs a little more per month
  • A Preferred Provider Organization (PPO) plan, which gives you more treatment options but also costs the most per month

Within each plan type, you can choose a variety of options that will give you different deductibles, copayments, and monthly premiums.

If you have Medicaid in Pennsylvania, you may get your coverage through UPMC. Medicaid through UPMC includes prescription drugs, dental insurance, vision, and coverage for medical needs.7

Finally, UPMC offers Medicare Advantage plans as well. These all-in-one replacement plans for Original Medicare give you additional benefits and more predictable out-of-pocket costs, but your provider network may be more limited.8

What Should I Do if UPMC Won't Cover the Total Cost of Rehab?

Although addiction treatment and mental health are essential benefits in any insurance plan, it’s possible that the plan will not cover the total cost. You may have out-of-pocket costs that include deductibles, copayments, or other expenses.

The specific insurance plan you have will determine how much the UPMC insurance coverage will pay for. You may also decide that the program you’re interested in is not one that UPMC pays very much toward, if anything.

Fortunately, you have other options. Some treatment programs have scholarships for those in need, or you may be able to access community assistance or get a loan for your treatment program. Here are a few resources that can help:

Choosing to get drug addiction treatment is extremely courageous. Your UPMC health insurance plan can help support your efforts. By understanding exactly what your plan covers, you can make the right choice for your recovery.

Sources

  1. Healthcare.gov. Mental health & substance abuse coverage.
  2. UPMC. (2021). About UPMC Addiction Medicine Services.
  3. UPMC. (2021). UPMC Addiction Medicine Services.
  4. UPMC. (2021). Addiction Medicine Services and Programs.
  5. UPMC. (2021). MyHealth Online Registration.
  6. UPMC. (2021). Individual and Family Health Plans.
  7. UPMC. (2021). What’s Covered with UPMC for You.
  8. UPMC. (2021). UPMC for Life.
  9. National Rehabs Directory (2020). What are the Different Types of Addiction Treatment Programs?
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