Are you or a loved one suffering from addiction? Are you ready to seek treatment, but wondering: does United Healthcare cover drug and alcohol rehab?
You’re not alone.
According to SAMHSA, the government association that tracks mental health and substance abuse trends,
- Over 20 million adults suffer from substance abuse disorder. That’s nearly 1 in 12 adults.
- 7.7 million adults have a dual-diagnosis, meaning that they have a substance abuse disorder and a mental health condition.
According to the CDC, 10% of people over 12 have used illegal drugs in the past month.
Substance abuse can begin early and continue into adult life. Without treatment, few addiction sufferers escape the hold that their substance of choice has on their lives.
If you’re looking at treatment options, you need to know if United Healthcare will cover some or all of the rehab treatments. Not understanding what United Healthcare covers and any rules or restrictions that may apply could lead you to having to pay more.
In this article, we’ll look at:
- What United Covers
- What if any Prior authorizations you may need
- What if any restrictions there might be
Please Note: Coverage varies based upon individual policies. Additional restrictions may apply. This is intended to help you better understand coverage options with United. You should additionally refer to your policy.
If you need assistance better understanding your individual policy, working through financial barriers or finding effective treatment centers, our compassionate professionals are ready to assist you when you call our free, confidential helpline.
Identifying your United Healthcare Rehab Network
Do you have an HMO or a PPO?
HMO – You have a limited network that you must use. You will choose a primary care doctor (PCP). This doctor refers you to specialists and facilities who work together to deliver you comprehensive care. While it’s great to work with a network that’s working together to treat you as a whole person, HMO’s do have a downside.
Going outside your network or not seeing your PCP first may mean that United will not cover rehab or other related services.
PPO – You have a network, but can go outside the network if you’re willing to pay more. You don’t have to see your PCP first, but it’s recommended.
To make sure United Healthcare covers your treatment, follow the policy’s rules related to referrals and networks.
Do you need a prior authorization?
United does require a prior authorization for all inpatient stays and scheduled procedures and treatments in a facility.
Treatment in a doctors office may be subject to the referral policy.
What Does United Healthcare Insurance for Rehab Typically Cover?
Diagnosis – The first step is diagnosis. You will meet with a doctor or doctors to discuss your condition. They will run tests to help determine the severity of your addiction.
You’ll receive a formal diagnosis and then the doctor will sign a doctor’s order (prescription) for the appropriate treatment. United covers diagnosis.
Medical Detox – In medical detox, a person is kept under medical supervision as they eliminate the drug from their systems. United covers Medical Detox.
Inpatient medical detox must be for a medical reason like the potential for organ failure — not just to take the person out of an unhealthy environment or to prevent their access to drugs and alcohol.
Drug Replacement – In drug replacement therapy, you’re given a “less harmful” drug in place of your drug of choice. The doctor will then slowly lower the dosage until you are free of the drug’s physical effects. This method is used to prevent harsh withdrawal symptoms or a severe medical emergency like organ failure.
Drug replacement is covered if you have prescription coverage.
In maintenance therapy, however, dosages remain the same, in effect trading one drug for another more manageable, but almost as harmful drug like methadone long term. This is harm reduction without the commitment to getting on the healing path. Because United’s goal is getting you well, they don’t cover maintenance that essentially allows you to remain an addict.
Outpatient Rehab – Outpatient treatment includes intensive outpatient, which is several days a week for several hours a day of counseling, classes, group therapy and treatments.
It could also includes less intensive treatment over a longer period of time with similar treatments.
Both are covered by United. They are subject to United’s requirements regarding “outpatient clinics and doctors”.
The length of treatment covered is not pre-determined by United. It’s based upon unique individual needs as determined by medical necessity. Certain treatment methods may be excluded.
Inpatient Rehab – Inpatient drug and alcohol rehab can be in a traditional hospital setting or in residential setting. United covers Inpatient in both settings, but limits the stay to 190 days during a person’s lifetime. The average length of stay is 60 – 90 days, so this limit should not be a barrier.
Getting Help With Your Insurance Questions
Adrugrehab.org is dedicated to helping those suffering from addiction find healing and hope through treatment. If you have questions about what to expect in rehab or need help finding an effective treatment program in your area, we’re here to help.
Our compassionate team of mental health professionals, licensed counselors and those in recovery work with you, helping eliminate barriers to finding lasting healing on the recovery path.
Call our free, confidential helpline today.