United Healthcare Insurance Coverage

If you’re looking for drug and alcohol treatment for you or a loved one, you likely have some questions about the financial side of things: how much does it cost, and will insurance cover all or some of the expenses? If you have United Healthcare insurance, there’s a good chance your plan will provide assistance for drug and alcohol rehab treatment. Your out-of-pocket expenses will vary based on your policy, location, and which rehab center you choose.

United Healthcare Insurance Coverage

United Healthcare is one of the largest health insurance providers in the United States and offers health benefit programs for all ages and lifestyles, including those living with substance use disorder. The company offers a convenient online portal for policyholders, including virtual visits and tools to help you estimate how much you’ll pay for specific healthcare procedures and services.

UHC provides a wide range of health insurance plans to more than 115 million customers across the country.1Policyholders select the plan that makes the most sense for them and their family’s healthcare needs.

Is United Healthcare Accepted Everywhere?

United Healthcare offers a large, well-established network of partnerships with healthcare organizations and rehabilitation facilities throughout the country. The company partners with more than 1.3 million physicians and healthcare providers as well as 6,500 hospitals and other care facilities nationwide.2 If you are a United Healthcare policyholder, you can log in to your health plan online to find an up-to-date list of network providers (e.g., doctors, hospitals, and other care providers) that accept your plan to help cover medical care expenses.

United Healthcare insurance is accepted at many rehab centers throughout the United States, including most American Addiction Centers (AAC) facilities. AAC offers treatment for drug and alcohol addiction as well as co-occurring disorders.

To learn more about United Healthcare coverage options at an AAC facility, call us at 1-888-685-5770 to talk with an admissions navigator today. We can help verify your insurance while you’re on the phone to determine what costs will be covered. Alternatively, you can complete the online form below to verify your insurance.

United Healthcare Plan Details

United Healthcare offers many plan choices to fit you and your family’s needs. The plans vary from state-to-state. No matter where you live, United Healthcare offers many levels of care to choose from. Each plan covers different things at varying rates. Options include:3,4,5,6

United Healthcare Choice: This plan offers in-network coverage that includes more than 895,000 providers across the United States. This plan offers fixed copay amounts, and you can obtain specialty services without a referral as long as you stay in-network. If you choose an out-of-network provider under this plan, your insurance will not help cover expenses.

United Healthcare Choice Plus: This plan allows you to choose both in-network and out-of-network providers. Your costs will be reduced when you stay in-network. If you choose an out-of-network provider for addiction treatment services, you will have higher out-of-pocket costs.

United Healthcare Options PPO: This plan offers savings for out-of-pocket costs when you get care from a member of the preferred provider network. You can receive treatment and services from any provider, but choosing in-network providers will help you keep your out-of-pocket costs down.

United Healthcare members can attend drug and alcohol rehab anywhere in the country as long as they choose an in-network provider. With United Healthcare Choice Plus or United Healthcare Options PPO, you can work with an out-of-network provider, but your co-pay and other out-of-pocket expenses will be higher.

Within these United Healthcare insurance plans, there are also varying levels of coverage: bronze, silver, and gold. Bronze policies generally have lower monthly premiums and higher deductibles and are best for those who do not access care frequently. Silver plans offer slightly higher premiums and lower deductibles. Gold plans have the highest premiums but the lowest deductibles and out-of-pocket costs for services received—best for those who frequently see doctors or require healthcare services. United Healthcare plans can also be used with coinsurance policies to pay for drug and alcohol addiction treatment services.

Does United Healthcare Cover Alcohol or Drug Abuse Treatment?

Yes, United Healthcare covers alcohol and drug abuse treatment for its members throughout the United States. The insurance provider has partnerships with drug and alcohol addiction centers to provide in-network detox and treatment services at discounted rates to members. Your plan may also allow you to choose out-of-network providers, often at a less discounted rate. The number of days at a rehab facility covered by your specific plan will be discussed with a counselor at the facility before admission.

Attending drug and alcohol rehab may require a referral from your primary care provider before insurance coverage kicks in to pay for treatment. In most cases, United Healthcare does not require prior authorization before covering drug and alcohol treatment programs. However, they do ask members to give them a heads-up before receiving these services. In some cases—for example, if you need medical detox services—you may be required to present evidence that these services are medically necessary for coverage to be authorized.

Your United Healthcare policy may cover the following addiction treatment services:7

  • Detoxification.
  • Inpatient medical detox (including medications to help ease symptoms of withdrawal).
  • Inpatient and outpatient care.
  • Group therapy provided by licensed counselors, psychologists, and/or physicians.
  • Individual and family therapy sessions.
  • Medications needed for both drug and alcohol treatment plus other conditions you may have.

United Healthcare also offers health insurance via Medicare for those who meet the criteria for government-subsidized insurance policies. Drug and alcohol treatment programs are often covered. Medicaid coverage provides up to 190 days of inpatient rehabilitation in a psychiatric hospital throughout an individual’s lifetime. There may be exceptions to this rule, and an extended inpatient stay may be covered if it is documented as a medical necessity. For those with United Healthcare policies under Medicaid, there are currently no limitations on coverage of the length of time in outpatient drug rehabilitation programs.

How to Pay for What Insurance Doesn’t Cover

In some cases, your specific insurance policy may not cover all of the expenses of attending drug and alcohol addiction rehab facilities. Admissions navigators and counselors are available to discuss any out-of-pocket expenses, additional financing options, and a potential payment plan. Some rehab facilities offer scholarships and other benefits to help offset your expenses.

Even if your United Healthcare insurance policy doesn’t cover some or all of your rehab expenses, don’t let that keep you from starting on the road to recovery and sobriety. Getting treatment now is more important than waiting until you have insurance coverage or the means to pay in cash. Drug and alcohol addiction treatment saves lives. There are financial and scholarship options available at many rehab centers for you or your loved one.

Verify Your United Healthcare Benefits

The cost of coverage for substance abuse treatment varies according to your plan. Call the number on the back of your insurance card or log in to your United Healthcare online account to determine what is covered (and in some cases, for how long). You can also call AAC today and speak with an admissions navigator to determine what your plan will cover.

How to Check Your United Healthcare Coverage

United Healthcare has partnerships with drug and alcohol rehab centers throughout the United States. It is accepted at most AAC facilities across the country, where we offer treatment for substance use disorder and co-occurring health issues. To learn more about AAC and how your rehab costs will be covered, call us at 1-888-685-5770 . You can also verify your insurance online by filling out the form below.

Sources
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[1] Top Ten Reviews. (2018). United Healthcare.

[2] United Healthcare.(2021). About us.

[3] UnitedHealth Group. Group benefit plans.

[4] UnitedHealth Group. UnitedHealthcare Choice.

[5]UnitedHealth Group. UnitedHealthcare Choice Plus.

[6]UnitedHealth Group. UnitedHealthcare Options – PPO.

[7] United Healthcare. (2020). Alcohol, Chemical and/or Substance Abuse: Detoxification and Rehabilitation

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Insurance Providers

United Healthcare

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Under the ACA, United Healthcare provides coverage for an Essential Health Benefits (EHB) package in 10 benefit categories. Mental health and substance abuse services, including behavioral health treatment, is included as one of those 10 benefit categories. These services are covered in all non-grandfathered Individual plans and non-grandfathered, fully insured Small Group plans for both in-exchange and off-exchange plans. Large Group fully insured, Self-funded (ASO) plan, and Grandfathered plans are not required to include these benefits.

All United Healthcare plans that cover EHB have removed annual dollar and lifetime dollar limits for those services, including Large Group (insured and ASO). Lifetime dollar limits must be removed from Individual grandfathered plans, but they are not required to remove annual dollar limits.

In reviewing a sample plan from United Healthcare, both inpatient and outpatient services are covered:

United Healthcare chart

WellPoint Group

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Wellpoint Group, which is now known as Anthem Blue Cross, includes an Optum Behavioral Health Benefit. These benefits are provided at the same levels as those covered under the IBEW Local 18-sponsored Anthem Blue Cross medical plans. In some cases, services require pre-authorization, copayment, and/or deductible, depending on the Anthem Blue Cross plan elected.

The benefits do not charge for obtaining a referral, and they allow members to access information and develop personal goals at liveandworkwell.com as often as you want at no additional cost. Those interested can get more information by contacting Optum Behavioral Health at 877-449-6710.

WellPoint Group chart

Kaiser Permanente

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Kaiser Permanente covers several different services qualifying as substance use disorder treatments. While most of its HMO plans require a Plan Physician to refer the member before care can be received from a specialist, referral or prior authorizations are not required to receive most care from mental health services or substance use disorder treatment. Hospital inpatient care for Substance Use Disorder Treatment is also covered.

Kaiser Permanente chart

These services are covered only when the Services are for the diagnosis or treatment of Substance Use Disorders. A "Substance Use Disorder" is a condition identified as a "substance use disorder" in the most recently issued edition of the Diagnostic and Statistical Manual of Mental Disorders ("DSM").

Humana

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Humana provides evidence-based treatment options based on behavioral health guidelines for common behavioral health conditions. Humana psychiatrists review these guidelines biannually and aid in standardizing treatment options based on the most effective interventions available.

Humana no longer offers individual health plans.

Aetna

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Aetna provides coverage for drug addiction and substance use disorder and also provides a range of literature to their members on a variety of related topics:

Aetna also offers providers a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program to help identify alcohol and drug abuse and reduce and prevent dependence on these substances. The program allows health care professionals to get reimbursed to screen for alcohol and substance use.

Healthcare Service Corp.

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Health Care Service Corporation is an Independent Licensee of the Blue Cross and Blue Shield Association and the largest customer-owned health insurer in the United States. They operate through Blue Cross and Blue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.

Under one of its sample Blue Cross and Blue Shield® Plans in Illinois, the following is covered:

Healthcare Service Corp.

Blue Cross and Blue Shield® Plans in Illinois outline how they cover substance abuse as part of their Behavioral Health Services. Some of the covered services include:

  • Alcohol or drug treatments
  • Care during a hospital stay
  • Community-based behavioral health services
  • Crisis services
  • Day treatment at a hospital
  • Intensive outpatient program
  • Medication-assisted treatment
  • Outpatient services, such as medication management, therapy, and counseling
  • Residential treatment of substance abuse

These plans do not cover experimental procedures or non-drug therapies or services from non-licensed providers.

As outlined in the member handbook, care may be provided in a community setting, such as a day program or a doctor’s office, or in a person’s home. A member can access behavioral health services by communicating with their Care Coordinator and other members of the Care Team. These people can assist in finding help and help you schedule appointments or screenings. A member’s Care Team may also include health outreach workers (community health workers) or other mental health experts.

Cobra Coverage

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Coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA), allows you to remain on your employer’s group health insurance plan even after you no longer remain an employee. The full premium amount is likely your responsibility through COBRA, but the benefits of the plan should remain in full effect so long as you are current on your payments. If your health insurance plan covered substance abuse treatment and other mental and behavioral health services, that should continue for as long as your COBRA coverage lasts.

Compsych

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ComPsych offers employee assistance programs, including behavioral health and wellness programs. ComPsych serves over 109 million people throughout the U.S. and 160 other countries. The company works with organizations to provide behavioral health programs to their employees, including high-quality care. ComPsych matches employees in need of behavioral health services with the appropriate level of care and case management to ensure the best outcomes.

With ComPsych insurance plans, pre-approval is required for specific treatment; however, the plans may cover one or more forms of rehabilitation. In some cases, the insurance may cover up to 80 percent of inpatient or outpatient costs at in-network facilities.

Managed Health Network (MHN)

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Managed Health Network (MHN) provides coverage for behavioral health services, including mental health services and substance use disorder treatment. These benefits usually cover:

  • Therapy, psychiatry, or psychology sessions.
  • Various levels of care at a treatment facility based on each individual’s unique needs. Treatment ranges from care administered several hours per day to multiple days each week to 24-hour care (inpatient treatment).
  • Follow-up and aftercare following treatment.

While MHN does not provide or administer prescription drug or pharmacy benefits, individuals should contact MHN or refer to the Summary Plan Description or Evidence of Coverage documents for information about prescription drug coverage. Those documents can also provide guidance on:

  • Eligibility for plan benefits.
  • Preauthorization required for certain services.
  • Covered services by MHN network providers.
  • Covered services for out-of-network providers.
  • Out-of-pocket costs.
  • Exclusions and limitations to benefits.

People with MHN coverage who feel they need help with mental health or substance abuse issues can call the toll-free number listed on their ID card. MHN has behavioral health representatives available 24/7 who can:

  • Assess your needs and possible referrals via telephone.
  • Answer questions about substance use/behavioral health benefits.
  • Provide crisis intervention.
  • Help secure an appointment with a provider (urgent cases can secure an appointment within 48 hours; less urgent cases can secure an appointment within 10 business days).
  • Authorize initial sessions on the phone if a practitioner is selected on the call. Alternatively, callers can take the time needed to find an appropriate counselor and call back to receive an authorization once they have a practitioner in mind.

First Health

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First Health insurance provides plans through its First Health network, Cofinity network, and First Health Complementary Network. The First Health network is a national PPO network that has over 5,500 hospitals, nearly 115,000 ancillary facilities, and over 1.5 million health care professional service locations. The Cofinity Network is a leading PPO network in Michigan and Colorado that offers negotiated rates to remain competitive in the marketplace. The First Health Complementary Network is a broad national network that can provide savings outside of the primary network. This offers lower out-of-pocket costs via in-network doctors and hospitals.

The best way to find out which substance abuse services are covered, members should call the number on the back of their insurance card or visit the website and log in to view member benefits.

Beacon Health Options

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Beacon Health Options offers more than 30 years of experience and its reputation as a leader in delivering specialty mental health and substance use disorder (MHSUD) solutions. Beacon Health Options focuses solely on behavioral health and has in-house clinical staff that can provide the highest standard of care. This insurer works with employers to provide unique solutions to employees in order to improve health outcomes and boost productivity.

The MHSUD offerings cover the following:

  • Autism Program: This program provides comprehensive support for children with autism. The program also offers support to families via Applied Behavioral Analysis services, coordinated care management, and coaching support.
  • Opioid Management Program: Opioid use disorder (OUD) is treated as a chronic illness. As such, the treatment utilizes a chronic disease model of care that promotes community-based care coordination, medication-assisted treatment, and other recovery-oriented interventions. Beacon Health Options provides comprehensive opioid management via analytic, network, and clinical expertise. The program helps to support providers in caring for members through the recovery journey towards long-term improved health.
  • Depression Management: Depression management services offer support, coaching resources, and clinical care for people who suffer from depression at every level. These services include advanced case management for individuals who may need more intensive services.
  • Psychiatric Disability Management: Psychiatric Disability Management provides transition support for employees coming back to the workplace after an extended absence spent recovering from behavioral health issues.

Beacon’s provider networks are built around behavioral health and substance use disorder needs so that members are able to work with skilled specialists and receive timely care. The national network includes more than 100,000 behavioral health providers and facilities, including custom networks for individual specialties such as autism, opioid use disorder, and diagnostic specialty units.

Magellan

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Magellan Healthcare provides solutions for behavioral and specialty healthcare and provides integrated, quality care backed by over 50 years of experience and expertise. When it comes to addiction and substance abuse treatment, Magellan deploys an integrated approach to identify at-risk individuals early and proactively. Early intervention can reduce the need for higher levels of care. Magellan offers members a network that includes more than 118,000 credentialed providers and health professionals that are equipped to combine behavioral health clinical expertise with advanced data analytics and technologies.

Magellan specializes in working with complex populations, including those with serious mental illness (SMI), autism, and opioid and substance use. Due to its specialization, the health plans are bespoke behavioral health solutions built around:

  • Predictive modeling and multi-model stratification. Providers can identify undertreated individuals and can intervene early to change the trajectory of the disease course.
  • Multi-dimensional engagement and interactions. Providers use personalized digital tools that are tailored to the individual needs of each patient.
  • Organized behavioral health delivery system. This system simplifies the member and provider experience, leading to improved quality and cost outcomes.
  • Integrated medical and behavioral care. Magellan utilizes integrated medical and behavioral care rounds, medical and behavioral care gap closures, and co-located case management.
  • Guided identification and treatment. The medical delivery system provides guided treatment by proactively finding patients within the primary care environment and referring them to evidence-based behavioral health resources.

Emblem Health (GHI)

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Emblem Health (GHI) provides covered behavioral health and substance use disorder services within its plans. Emblem health offers a network of mental health professionals to help people who may be using alcohol or drugs to self-medicate. No referral is needed and members can call Beacon Health Options at 888-447-2526, 24/7 to find a mental health provider nearby.

Members can also use the Find a Doctor tool to search “Mental Health and Substance Abuse”. This will take members to the Beacon Health Options “Find a Provider” search, which has information specific to the member’s plan.

Additional details about substance use disorder services and coverage can be found below:

Emblem Health (GHI) services and coverages

Additionally, preauthorization is not required for a Covered Prescription Drug used to treat a substance use disorder, including a prescription drug to manage opioid withdrawal and/or stabilization and for opioid overdose reversal. Ancillary charges apply, per your Member Contract. A list of covered medications can be obtained from the website. Payment information based on a 30-day supply of covered drugs is below:

Emblem Health (GHI) payment information

Amerihealth

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Amerihealth is a family of companies that provide both locally-focused health insurance plans and national-scale programs. Many of their programs cover behavioral Health Services, including all mental health, drug, and alcohol services. Plans that do cover these services allow members to self-refer to behavioral health service providers. In some cases, primary care physicians or another physical healthcare provider will need to recommend that a Member access behavioral health services.

Plans may cover diagnostic, assessment, referral, and treatment services including:

  • Inpatient and outpatient psychiatric services.
  • Inpatient and outpatient drug and alcohol services (detoxification and rehabilitation).
  • EPSDT behavioral health rehabilitation services for Members up to age 21.

Coventry

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Coventry was acquired by Aetna in 2013, making it the third-largest health care benefits company in America based on membership.

Former Coventry members can look to Aetna’s covered services, which include drug addiction and substance use disorder. Former Coventry members can also refer to the range of literature Aetna provides to their members on a variety of related topics:

Coventry (now Aetna) also offers providers a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program to help identify alcohol and drug abuse and reduce and prevent dependence on these substances. The program allows health care professionals to get reimbursed to screen for alcohol and substance use.

Government Employee Health Association (GEHA)

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Government Employee Health Association (GEHA) plans cover behavioral health conditions, including alcohol addiction, drug dependency, and mental health disorders. Members of a GEHA health plan who have been diagnosed by a qualified medical professional with one or more behavioral health disorders are eligible for health insurance coverage. Under GEHA health plan rules, substance abuse problems, and mental health difficulties are treated the same as any other type of physical illness.

GEHA health plans include extensive drug and alcohol addiction treatments, initial evaluation and diagnosis, detox services, inpatient or outpatient treatment programs, and some essential aftercare services. To receive these benefits, a member’s eligibility must be certified by a GEHA health insurance representative by providing documentation that states the treatment is medically necessary.

Most addiction treatments under GEHA plans require precertification. Treatments include intensive day treatment, partial hospitalization, and intensive outpatient plans. Plans may also cover regular inpatient or outpatient recovery programs. Alcohol and drug rehabilitation facilities should take care of the precertification protocol with GEHA.


Verify My Benefits

We accept many insurance plans and can work with you on a manageable payment schedule so that finances aren’t a roadblock to getting the help you deserve.

Use the form below to quickly check what your insurance benefits cover.


Insurance Coverage Information

Specialized Programs Offered by Treatment Facilities

Alcohol and substance abuse treatment may combine both behavioral and pharmacological approaches. More than 14,500 specialized drug treatment facilities exist in the U.S., providing different forms of treatment that include behavioral therapy, medication, counseling, case management, and other services.

Combining Behavioral Health with Addiction Treatment

Alcohol and substance abuse treatment may also include treatment within a physician’s office and/or mental health clinics and may be delivered via inpatient, outpatient, and residential settings.

These treatments may be administered by one or more medical professionals, including physicians, nurses, psychiatrists, counselors, psychologists, and social workers. More often than not, alcohol and substance abuse treatment entails a unique combination of various methods and settings, depending on an individual’s specific needs.

How the Affordable Care Act (ACA) Is Helping Combat Substance Abuse

Since the implementation of the Affordable Care Act (ACA), individuals struggling with alcohol and substance abuse have more access to treatment and coverage for addiction and other behavioral health issues.

Depending on the type of insurance, many carriers are now required to cover these services at the same rate as they would cover other necessary medical services.

This parity has resulted in more insurance plans covering rehab, inpatient and outpatient treatment programs, detox, counseling, therapy, medications, and follow-up care.

Additionally, many rehab programs provide financing options for those who are not able to pay the entire cost upfront.

Before Insurance Coverage of Addiction Treatment

Prior to the enactment of the ACA, drug addiction was considered a pre-existing condition. With roughly 20 million Americans that have substance use disorders, it has become critical to understand how insurance coverage applies and can be used to treat drug addiction.

While not all facilities or services may accept insurance as a form of payment, many public addiction treatment programs do. Some programs may accept health insurance for at least a portion of treatment.

American Addiction Centers, Inc.

Alcohol.org is an American Addiction Centers, Inc. subsidiary. Not sure what this means? Learn more about AAC.