Does UMR cover Inpatient Alcohol and Drug Rehab Centers?

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UMR is UnitedHealthcare’s third-party administrator (TPA) solution and represents the nation’s largest TPA. 1A third-party administrator (TPA) delivering solutions for self-funded companies. UMR isn’t an actual insurance company, but under its umbrella and in its network are over 3,000 healthcare providers. Inpatient alcohol and drug rehab centers are a part of that network as well. UnitedHealthcare has several plans and policies that will cover this inpatient treatment. These plans are:

  • UnitedHealthcare Choice: Choice plans provide well-rounded coverage for many services, including:2 UnitedHealthcare Choice plans:
    • Preventive care (100% at network facility).
    • Physician and specialist office visits.
    • Lab, X-ray, and diagnostic services.
    • Urgent care, emergency services.
    • Inpatient hospital services.
    • Rehabilitation and skilled nursing facility services.
    • Mental Health services.
    • Includes out-of-network coverage for emergency services only.
  • UnitedHealthcare Choice Plus: Choice Plus plans provide well-rounded coverage for many services, including:3UnitedHealthcare Choice Plus plans:
    • Preventive care (100% at network facility).
    • Physician and specialist office visits.
    • Lab, X-ray, and diagnostic services.
    • Urgent care, emergency services.
    • Inpatient hospital services.
    • Rehabilitation and skilled nursing facility services.
    • Mental health services.
    • Coverage for out-of-network providers.
  • UnitedHealthcare Options PPO: Options PPO plans provide well-rounded coverage for many services including: 4UnitedHealthcare Options PPO plans:
    • Preventive care (100% at an in-network facility).
    • Physician and specialist office visits.
    • Lab, X-ray, and diagnostic services.
    • Urgent care, emergency services.
    • Outpatient care services.
    • Pregnancy and newborn care.
    • Prescription drugs.
    • Rehabilitation and skilled nursing facility services and devices.
    • Mental health and substance use disorder services.
    • Wellness services.

The rehabilitation centers are able to check specific coverage under all 3 plans. You will have to call the telephone number on the back of your card for specific coverage information. The amount insurance will cover can depend on your length of stay, treatment intensity, and where you receive treatment.

What will UMR cover?

Coverage under UMR providers varies according to the selected insurance plans. They provide comprehensive coverage for inpatient and residential rehab, partial hospitalization programs, intensive outpatient programs, and outpatient rehab therapy.8 Dignity Health Arizona Premier Summary of Benefits and Coverage The aforementioned types of therapy are defined below:

  • Inpatient/residential rehab: Inpatient rehab generally lasts anywhere between a few months to 1 year. During treatment, patients receive around-the-clock care and live at the facility throughout the duration of treatment.5 Treatment options: Types of treatment, section 5
  • Partial hospitalization program (PHP): A PHP is a hospital-based form of outpatient drug rehabilitation that is furnished as a distinct and organized intensive ambulatory treatment service of less than 24-hour daily care.6 Definition of partial hospitalization, in the abstract
  • Outpatient rehab: In this program, people receive treatment at a program site while they reside at home. Patients attend regular appointments and counseling sessions.5 Treatment options: Types of treatment, section 4
  • Intensive outpatient program (IOP): These programs are direct services for people with substance use disorders or co-occurring mental and substance use disorders who do not require medical detoxification or 24-hour supervision.7Substance Abuse Intensive Outpatient Programs: Assessing the Evidence, in the abstract

Coverage under the UMR providers varies according to the selected insurance plans. The level of coverage for each listed below varies from year to year: 8 Dignity Health Arizona Premier Summary of Benefits and Coverage:

  • Inpatient/residential rehab
  • Outpatient rehab
  • Intensive outpatient programs:
  • Partial hospitalization programs

You should contact UMR for your plan specifics.

Does UMR Cover Inpatient Mental Health treatment facilities?

UMR covers mental health care and treatment as well as co-occurring disorders. According to the Diagnostic and Statistical Manual of Mental Orders, Fifth Edition (DSM-5), co-occurring disorders may include any combination of 2 or more substance use disorders and mental disorders.9U.S. Department of Health and Human Services Statistics below help to paint a picture of how many people are affected: 10Comorbidity: Substance Use and Other Mental Disorders:

  • It is estimated that 7.7 million adults have co-occurring mental and substance use disorders. This doesn’t mean that one caused the other, and it can be hard to determine which came first.
  • Of the 20.3 million adults with a substance use disorder, 37.9% also had a mental illness.
  • Among the 42.1 million adults with mental illness, 18.2% also had a substance use disorder.

According to the National Institute of Mental Health (NIMH), some examples of mental health disorders that “co-occur” with mental health conditions are:9Co-occurring disorders and other health conditions.:

  • Anxiety and mood disorders.
  • Schizophrenia.
  • Bipolar disorder.
  • Major depressive disorder.
  • Conduct disorders.
  • Post-traumatic stress disorder.
  • Attention deficit hyperactivity disorder.

The Affordable Care Act (ACA) is a comprehensive reform law that was enacted in 2010 and increases health insurance coverage for the underinsured and implements reforms to the health insurance market. 11Understanding the Affordable Care Act, paragraph 1

The ACA also provides greater access to substance abuse treatment through major coverage expansions, regulatory changes requiring coverage of substance use treatments in existing insurance plans, and requirements for substance abuse treatments to be offered on par with medical and surgical procedures.12The Affordable Care Act Transformation of Substance Use Disorder Treatment, paragraph 5

How Long Does UMR Cover Inpatient Drug Rehab Programs?

UMR coverage length varies for inpatient drug rehab programs. This variation is due to several factors, including:

  • The treatment facility.
  • How long treatment will last.
  • Other potential issues, like whether or not you have a co-occurring disorder that will be simultaneously treated.

Ultimately, the UMR plan manager will work with you to determine how long they will cover your treatment. Everyone has different types of tiers of coverage and policy types, and this factors into how long coverage will be. In order to find out more information on what your plan covers, you can call the number on the back of your insurance card.

The National Institute on Drug Abuse (NIDA) is the leading federal agency that supports scientific research on drug use and addiction. This agency provides recommendations about treatment program specifics and treatment effectiveness. Research by NIDA indicates that most of those with a substance use disorder need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. 13Principles of Drug Addiction Treatment: A Research-Based Guide Third Edition, page 5, item number 5

What if my UMR policy does not cover Inpatient drug rehab programs?

Different rehab centers may offer financing or scholarship options in order to pay for treatment. To find out, you can contact the rehab center you are interested in. Most rehab centers will assess your personal financial situation and provide you with several options. These options can be lowered treatment costs, free rehab, or grants.

Regardless of whether or not you can afford treatment, it is imperative that you exhaust all means in order to obtain needed help. Treatment is critical and should be gained sooner rather than later.

UMR in Network vs. Out of Network Alcohol and Drug Rehab Centers

UMR in-network vs. out-of-network alcohol and drug rehab centers greatly differ. In-network rehab centers will prove to be more cost-effective in that the co-pays are cheaper or nonexistent. Out-of-network drug rehab centers are more expensive but still have some benefits. Those interested will have to contact their UMR provider to determine which is best.

How to find UMR Covered alcohol and drug rehab centers?

UMR provides some of the most comprehensive plans for the treatment of alcohol and drug addiction. As stated, they have several caveats and policies that provide people with the best bang for their buck. Coverage for treatment can range from full coverage to partial coverage, all depending on your specific plan. To verify your insurance coverage, the American Addiction Centers (AAC) can assist. These centers have helped thousands of people get their lives back on the right track.

You are encouraged to call their helpline to further discuss treatment options. This helpline is open 24/7 and is 1-702-847-7887.

One of the best AAC is Desert Hope Treatment Center in Las Vegas, Nevada. Desert Hope Treatment Center provides individualized treatment plans that speak to each client’s addiction, co-occurring mental health issues, and medical conditions. This center has several treatments and services listed below:

  • Co-occurring disorder treatment
  • Safe medical detox
  • Addiction focused healthcare
  • Inpatient residential
  • PHP / day treatment
  • IOP / intensive outpatient
  • Outpatient therapy
  • Telehealth addiction treatment
  • Coronavirus testing
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