Understanding the specifics of a UnitedHealthcare health insurance plan is important for individuals in need of treatment for a drug or alcohol addiction. If coverage is included, this knowledge could allow a person more financial freedom and options for treatment.
Cost is one of the biggest stumbling blocks individuals face when pursuing addiction treatment. Fortunately, a large number of treatment facilities work with major insurance carriers to make treatment more affordable and attainable. Using insurance benefits to obtain access to UnitedHealthcare’s provider network may provide a person with a greater number of addiction treatment options.
What Is UnitedHealthcare?
UnitedHealthcare writes that “Our mission is to help people live healthier lives and help make the health system work better for everyone.” For an addicted individual, an inpatient addiction treatment program can help them lay the foundation for a healthier, sober life.
UnitedHealthcare offers individual, family, and employer-based insurance plans. Options also include Medicare plans, such as Medicare Advantage, and Medicaid plans offered through UnitedHealthcare Community Plan.
UnitedHealthcare provides coverage to millions of Americans across the United States. These benefits are provided by networks made up of 1.2 million doctors and health care professionals and roughly 6,500 hospitals and facilities. Access to these benefits and medical care may help a person obtain life-changing treatment for a substance use disorder.
Prior to obtaining coverage, a person may have to prove that the substance abuse treatment services they are seeking are medically necessary. This means that there must be documentable evidence that a substance use disorder is present and that drug rehabilitation is the best line of treatment. UnitedHealthcare may ask that a person submit medical records and correspondence from their medical team or doctor to fulfill this requirement.
UnitedHealthcare encourages providers to use screening tools to ensure that substance use disorders are identified and promptly treated. These include:
- CAGE-AID – Adult Alcohol and Drug Use Questionnaire
- CRAFFT – Adolescent Alcohol and Drug Use Questionnaire
- SBIRT – Screening, Brief Intervention, and Referral to Treatment
Once a substance use disorder is identified, any insurance benefits which cover treatment services may be employed. Our treatment specialists can contact UnitedHealthcare to determine what coverage a person has and how it can be best utilized to obtain addiction treatment.
Will My Insurance Pay For
Does UnitedHealthcare Cover The Cost Of Treatment At An Inpatient Rehab Center?
UnitedHealthcare’s benefits may include services for inpatient alcohol or drug detoxification and residential care. The exact benefits and amounts covered will vary per plan and state to state.
Moderate to severe addictions are best treated in an inpatient, residential program. The therapies and treatments offered in an outpatient setting may not be intensive enough to build a solid recovery. Outpatient treatment is a good option for individuals wishing to transition from an inpatient program to their home and community.
According to UnitedHealthcare,“ when medical complications occur or are highly probable,” detoxification may be covered in an acute care setting. Withdrawal from alcohol, benzodiazepines, and opioid drugs (like heroin and prescription painkillers) can become very serious, making a medically-supported detoxification a strong consideration for individuals seeking treatment.
When looking at potential treatment programs, it’s important to determine if a facility is considered an in-network or out-of-network provider. This distinction could have a significant impact on the cost of a person’s treatment. In-network, participating providers are typically cheaper, while out-of-network facilities generally require a larger out-of-pocket contribution.
A 90-day stay is considered to be the most effective length of treatment, however, any length that a person can afford can have a favorable impact on their life. Treatment lengths also include 28 to 30 days, 60 days, and one-year programs (or longer).
Before committing to a program, it’s a good idea to find out what length of treatment is covered. Certain insurance plans may only cover a certain length, while others cover a set amount per day. At this time, it’s also helpful to examine copayments, coinsurance, deductibles, and out-of-pocket maximums, as these factors can all influence a person’s financial responsibility as well.
Does UnitedHealthcare Cover the Cost of Suboxone?
In order for a medication to be covered, UnitedHelathcare may request proof that the medication is medically necessary and also that certain treatment criteria be met. To do this, a prior authorization request may be required. This is a document submitted by a person’s doctor to the insurance company which details the need for the medication.
Suboxone is an evidenced-based medication used in medication-assisted treatment programs for the treatment of opioid use disorders. Suboxone contains two drugs, naloxone which discourages drug misuse, and buprenorphine, which reduces cravings and withdrawal symptoms.
Suboxone is typically excluded from UnitedHealthcare coverage, however, in certain instances it may be covered. A patient must try the preferred combination product, Zubsolv, before being considered for Suboxone. Should there be an inadequate response, adverse effects, or a contraindication to Zubsolv, a 12-month authorization for Suboxone may be issued.
Does UnitedHealthcare Cover The Cost Of Methadone Maintenance?
Methadone is another evidenced-based medication used in medication-assisted treatment programs for opioid use disorders. Like buprenorphine-based products, methadone reduces cravings and symptoms of withdrawal.
Methadone has a higher potential for drug abuse when compared to buprenorphine products, making the prescription and use of this drug heavily regulated. Methadone can only be administered by an opioid treatment program certified by the Substance Abuse and Mental Health Services Administration.
Methadone is often used as a maintenance medication. This means that it’s used beyond the detoxification process to help a person reduce or quit their opioid drug abuse over longer periods of time.
For maximum effectiveness, methadone should be used, at minimum, for 12 months. Determining insurance coverage of this drug can help make this long-term treatment more affordable. UnitedHealthcare methadone coverage will vary state to state. When coverage is available, prior authorization may be required.
Finding A Rehab Center That Accepts UnitedHealthcare
Attention should be granted to all aspects of a person’s life as a treatment plan is being built. The best treatment programs are individualized, addressing the emotional, mental, physical, behavioral, and social impacts of addiction.
Individuals who currently face mental health conditions, such as depression and anxiety, should consider choosing a rehab center that offers dual diagnosis care. UnitedHealthcare’s benefits may help a person obtain treatment for both the addiction and mental health disorder.
Some people require a medically-supervised detoxification prior to addiction treatment for the psychological and behavioral effects of the addiction. This is frequently the case for individuals striving to overcome an addiction to alcohol, benzodiazepines, or opioids.
If a person is still responsible for paying for a portion of treatment out of pocket, other options exist. Individuals and their loved ones can look into scholarships and grants and program-specific financing options to help ensure their treatment needs become a reality. Treatment specialists can help look into these alternate financing options.
Contact InpatientDrugRehab.org to find out more about insurance coverage for addiction treatment.
Substance Abuse and Mental Health Services Administration — Methadone
UnitedHealthcare — Facts 2017 Q4, Three Steps to Help You Screen, Diagnose and Treat Members with Substance Use Disorders, UnitedHealthcare Pharmacy Clinical Pharmacy Programs