Navigating any insurance policy is difficult, but it can be especially challenging when a person is searching for the right drug and alcohol addiction treatment program. UnitedHealthcare is one of the top insurance providers in the country, and the company offers a variety of policies that cover at least some level of addiction treatment services.
Insurance Plan Levels
Metal levels indicate different cost brackets for monthly premiums and out-of-pocket expenses:
Platinum is the highest metal level, and it will have a low deductible or no deductible but a higher monthly premium. Bronze is the lowest metal level and comes with a lower monthly premium but a higher deductible.
Does UnitedHealthcare Cover Drug and Alcohol Detox?
In most cases, UnitedHealthcare will cover at least some of the cost of drug and alcohol detox as long as the care team deems it necessary. How much the insurance policy pays depends on the type of policy and the metal level. In an emergency situation where drug and alcohol detox is conducted at a hospital, UnitedHealthcare may cover a different percentage of treatment.
Does UnitedHealthcare Cover Inpatient Rehab?
Yes, most UnitedHealthcare policies cover inpatient addiction treatment programs. The amount the insurance policy covers will depend on the type of policy and the metal level. Plans are available in two groups:
- HMO – Health Maintenance Organization
- PPO – Preferred Provider Organization
UnitedHealthcare HMO plans include:
UnitedHealthcare PPO plans include:
Each plan is available in different metal levels and benefit options.
UnitedHealthcare HMO Plans
Coverage is similar among the various UnitedHealthcare HMO plan metal levels, no matter what policy. In general, the coverage looks like this:
- Platinum plans — Expect to pay either a 30 percent coinsurance fee or a 10 percent coinsurance facility fee, along with a 10 percent physician fee.
- Gold plans — Patients pay either a 30 percent coinsurance fee or a 20 percent coinsurance facility fee, along with a 20 percent physician fee.
- Silver plans — Expect to pay either a 40 percent coinsurance fee or a 20 percent coinsurance facility fee along with a 20 percent physician fee.
- Bronze plans (when offered) — Patients pay either a 30 percent coinsurance fee or a 30 percent coinsurance facility fee, along with a 30 percent physician fee. Some bronze plans cover the entire bill, but bronze plans tend to have the highest deductibles.
UnitedHealthcare PPO Plans
UnitedHealthcare PPO plans offer more variety in coverage levels than HMO plans. If preauthorized, UnitedHealthcare may cover 50 percent of treatment costs for out-of-network providers. If not preauthorized, expect a $1,000 fee per admission.
Platinum PPO plans offer either 10 or 20 percent coinsurance, and the deductible does not apply.
- Gold PPO plans mostly offer 20 percent coinsurance and no deductible.
- Silver PPO plans require 20 to 40 percent coinsurance, and the deductible does not apply.
- Bronze PPO plans require 10 to 100 percent coinsurance.
Not all PPO plans require out-of-network preauthorization. In some cases, out-of-network facilities are not covered at all. The differences in UnitedHealthcare plans mean a policy needs to be examined closely to determine coverage limits on inpatient care.
Does UnitedHealthcare Cover Outpatient Rehab?
As with inpatient services, UnitedHealthcare outpatient drug and alcohol rehab coverage varies based on the plan and metal level.
UnitedHealthcare HMO Plans
HMO plans offer the following coverage:
- Platinum — Platinum plan copays range from $15 to $20. Some of these higher-level HMO plans have a 20 percent coinsurance charge instead of a copay. All other outpatient services may be covered in full.
- Gold — Gold HMO plans have copays ranging from $25 to $30, with no charge for other outpatient services.
- Silver — Silver HMO plans require copays for office visits, ranging from $45 to $50.
- Bronze — Bronze HMO plans cover outpatient addiction treatment at anywhere from 40 percent coinsurance to no coinsurance. Patients pay from zero to 30 percent coinsurance on related outpatient services.
UnitedHealthcare does not provide out-of-network services for HMO plans.
UnitedHealthcare PPO Plans
PPO plans offer the following coverage levels for outpatient drug and alcohol rehab:
- Platinum plans require a $10 copay.
- Gold plans require a $25 copay.
- Silver plans range from $25–$45 copay.
Some bronze plans have no charge, while others require a 40 percent coinsurance fee for both office visits and other outpatient services.
Some UnitedHealthcare PPO plans pay 50 percent for out-of-network outpatient treatment. In most cases, preauthorization is required or the patient pays a penalty of $1,000. This is not the case for all plans however, so double-check the policy to get the specifics for outpatient rehab coverage.
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Does UnitedHealthcare Cover Medication-Assisted Treatment?
UnitedHealthcare does cover medication-assisted therapies if medically warranted. Prior authorization is required for this type of therapy, though. Medications covered as part of a medication-assisted treatment plan may include:
- Suboxone (buprenorphine)
- Zubsolv (buprenorphine/naloxone)
- Bunavail (buprenorphine/naloxone)
UnitedHealthcare may also fully cover methadone maintenance treatment.
Does UnitedHealthcare Cover Sober Living Houses?
UnitedHealthcare may pay for follow-up care after drug rehab, including sober living houses. Sober living homes provide a practical option for anyone transitioning from an inpatient drug rehab center back to independent life. UnitedHealthcare will likely require the sober-living stay to be preauthorized and to be in-network.
What’s the Difference Between In-Network and Out-of-Network?
In-network healthcare facilities work as partners with UnitedHealthcare. The insurance company and the treatment center have an agreement on rates. This allows the insurance company to have more control of overall healthcare costs.
Out-of-network physicians and facilities do not have this arraignment. In most cases, a patient will pay more out-of-pocket expense if they choose an out-of-network provider.
Even if a person’s preferred treatment center appears to be out-of-network, coverage may still be provided. Drug and alcohol rehab centers perform a verification of benefits as part of admission, and the results can vary if the verification is not performed correctly. Call Vertava Health today for a verification of benefits you can trust.
How To Find Drug And Alcohol Rehab Centers That Accept UnitedHealthcare
- Call Vertava Health for immediate verification of benefits. Vertava Health can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.
- Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.
- Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.
Vertava Health accepts many forms of insurance. For a free, confidential verification of insurance benefits, call us today.