Does UnitedHealth Group Insurance Cover Addiction Treatment?

If you have UnitedHealth Group Insurance, then you probably have some substance misuse treatment coverage. The amount of coverage that you have varies based on your particular insurance policy. It also varies depending on your state of residence. Therefore, you should look at the back of your United Healthcare Group Insurance card to locate the customer service number. Then, call to ask about your substance misuse treatment coverage.

In most cases, UnitedHealth Group Insurance covers treatment. You have several options, so you need to be an educated consumer.

About UnitedHealth Group

Two companies make up the UnitedHealth Group. They are UnitedHealthcare and Optum. Coverage is available in all 50 states and more than 140 other countries.

UnitedHealthcare is the largest health insurer in the United States. The company was started in 1974 as Charter Med Incorporated before changing its name to United HealthCare Corporation in 1977. In 1998, the company’s name was changed again to the UnitedHealth Group.

Ever since its formation, UnitedHealthcare has been a leader in innovative health care solutions. It was one of the first providers of network-based health plans, one of the first to allow patients to track their records online and the first to create a report card on health care access.

When UnitedHealthcare was first formed, it consisted of five companies, but in 2020, there are only two under the umbrella organization. Optum provides informational technology health care services.

UnitedHealth Group Insurance has a strong relationship with many rehab facilities, so you may be able to get treatment for your addiction to alcohol, opioids or other drugs completely covered.

Coverage Levels and Coverage Plans

There are many variations between UnitedHealth Group plans. There are also variations depending on where the policy was issued, so it is essential to contact the company about your coverage. Generally, however, there are three levels of plans available.

  • UnitedHealthcare Choice: While there is no coverage for out-of-network providers, you can receive treatment from 895,000 providers and care at over 5,600 hospitals within the company’s extensive network. While you do not have to choose a primary care physician, choosing one to help you manage your care is often a great idea. You also do not need a referral before you see a specialist. Treatment under this plan requires you to make a co-payment for doctors and medicines. You will reach a maximum co-pay. Then, you will not need to pay anymore costs out of pocket.
  • UnitedHealthcare Choice Plus: You get a substantial saving if you choose to use one of the in-network providers, but you can see any doctor or use any hospital that you prefer. While you do not have to select a primary care physician, UnitedHealthcare always suggests that you do as a partner in getting you the best health care possible. You do not have to obtain a referral before you see a specialist. Except for preventative care, you will need to pay a certain amount before coverage begins. Then, you will pay a co-pay until you reach the maximum amount under your plan. Once you reach the maximum, then 100% of your health care is covered.
  • UnitedHealthcare Options Preferred Provider Organization: You can choose any provider or specialist under this PPO plan, but you will pay less when sticking with United Healthcare’s in-network doctors and facilities. You can also use the company’s UnitedHealthcare Care Coordination, and the online portal to help you find in-coverage providers. Under this plan, you may need to seek pre-approval before seeing your primary care physician or a specialist.

United Healthcare Group also provides coverage to some Medicare recipients. The coverage that is available to you may depend on your state of residence. Generally, United Healthcare Group Advantage Plans include:

  • UnitedHealthcare HMO: Under these plans, you work with a primary care physician to determine what type of treatment is right for you. Additionally, you may qualify for UnitedHealthcare Passport so that you have coverage from in-network doctors when you travel.
  • UnitedHealthcare Preferred Private Organization: You can choose any doctor under these plans, and you do not need a referral to a specialist. You may need to pay more if the doctor is not in UnitedHealthcare’s network.
  • UnitedHealthcare Private Fee for Service: These plans allow you to see any doctor that accepts the plan’s terms and conditions of payment. It eliminates the network, and you may need another prescription plan.
  • UnitedHealthcare Special Needs Plan: These plans have an exclusive network. You must have financial need and an exceptional health condition to qualify for these plans.

Many federal employees can get United Healthcare Group Insurance. Most federal employees can choose the Choice plan or the Choice Plus plan. Additionally, federal employees may qualify for United Healthcare Group Health Savings Accounts. If you work for the federal government in Washington, D.C., Virginia or Maryland, you may also get essential coverage under an MD-Individual Practice Association, Incorporated plan.

Generally, there is no requirement to live in a specific location when seeking substance abuse treatment from UnitedHealthcare. You may, however, need to choose an in-network provider or be prepared to pay more money out of your pocket. Your level of coverage could vary by where you live.

Part of UnitedHealthcare Group, Optum Care provides coverage in 16 states. Your coverage depends on where you live:

  • Arizona: Optum Care has a network of more than 600+ primary care doctors, 3,500 specialists and 17 hospitals.
  • California: Care is provided through 20 OptumCare Medical Group locations in the southern part of the state.
  • Colorado: People living in the Greater Pikes Peak Area, including Denver and Colorado Springs, can receive many different types of care.
  • Connecticut: Many types of care are available, including care for those with Medicare Advantage and those needing Advanced Directive care.
  • Florida: Coverage is provided to those in Central and South Florida along with those on Medicare Advantage plans.
  • Indiana: Under the American Health Network, coverage is provided by 200 doctors at over 70 locations across the state.
  • Massachusetts: Reliant Medical Group provides coverage for Optum in this state.
  • New Jersey: Riverside Medical Group provides coverage to New Jersey residents.
  • New Mexico: Coverage to people getting Medicare Advantage is provided.
  • New York: ProHEALTH provides coverage in this state.
  • Nevada: Optum Care works with over 3,000 providers and offers coverage to Medicare Advantage recipients.
  • Ohio: American Health Network provides coverage to Ohioans.
  • Texas: USMD Health System and WellMed provide coverage in Texas.
  • Utah: Residents living in Northern Utah have the choice of who they want to see from many different providers.
  • Washington: More than 1,400 providers are in-network within Washington.

Furthermore, in many areas of the country, Optum has partnered with the U.S. Department of Veterans Affairs to provide health care to veterans. Each of these plans has different benefits, so if you are a retiree or veteran struggling with substance use disorder, it is important to check directly with your UnitedHealthcare or Optum provider to determine coverage and benefits for addiction treatment.

Since Dec. 28, 2018, Optum has been a VA Community Care Network. Veterans living in the eastern half of the United States, Puerto Rico and the U.S. Virgin Islands have this choice.

Does UnitedHealth Group Cover Addiction Treatment?

Under most UnitedHealthcare plans, drug and alcohol treatments are covered. The company operates a special phone line that can be reached by calling 1-855-780-5955 to receive confidential help, and it’s available 24 hours a day, seven days a week. A concerned family member can also call the number. A loved one can receive tips on how to convince a person that they need help with an alcohol or substance abuse issue. Under most plans, inpatient treatment is covered because detoxing from alcohol or other substances can be dangerous if attempted without medical supervision.

During the call, you will speak to a licensed clinician about treatment options. Your provider can help you choose the right treatment option for your unique situation. When you call the number, in many cases, treatment can begin in under 24 hours. The sooner you start with treatment, the sooner you can move on to a healthy lifestyle.

Generally, the company classifies alcohol and substance abuse as a substance use disorder. Common symptoms include:

  • Mood swings
  • Unexplained personality change
  • Habit of ignoring responsibilities
  • Different friends
  • Changes in appearance
  • Weight loss
  • Decline in hygiene
  • Feelings of regret or shame
  • Risk for financial loss
  • Instances of putting oneself in physical danger

If you are covered under an Optum plan, then you need to contact your primary care physician. They will decide if you meet the medically necessary criteria for treatment and help you find the best treatment location. If you go to an out-of-network doctor, then they may not be aware of the requirements that you need to meet, and your treatment may cost you more.

Advantages of Using an In-network Provider for Treatment

According to Optum, there are many advantages to working with an in-network provider. They also handle all the paperwork for you, which allows you to concentrate on overcoming your substance misuse addiction. They can also get any needed prior authorizations.

Since there are so many variables involved, you must speak to the UnitedHealthcare Group about what treatment options are covered and any out-of-pocket costs you may need to pay. Do not let costs stop you from getting the treatment that you need to get well as there are often payment options available to those who need help.

Seek Substance and Alcohol Misuse Treatment

Substance or alcohol use disorder is a disease that often responds well to treatment. If you are a UnitedHealthcare Group insurance member, then start to seek treatment by seeing your local provider or calling the insurer’s phone number to talk to a licensed clinician who will help you carry out the next steps. Regardless of whether you have UnitedHealthcare or Optum, there is an outstanding chance that your insurance will help cover the cost. Check on the back of your insurance card and call the number to see what coverage may be available. The insurer can also help you locate an in-network doctor if you want one and do not already have one. Whether you choose an in-network provider or an out-of-network provider will influence how much your treatment will cost. UnitedHealthcare Group also has plans for federal employees and veterans.

Start to seek treatment today so you can be as healthy as possible for yourself, your friends and your family. Reach out to UnitedHealthcare to see what your options are for treatment.

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