Alcohol And Drug Rehabs that Accept Optum Insurance

Updated on April 11, 2019

Millions of families struggle with addiction, and finding a way to pay for treatment often adds to the stress. Fortunately, insurance companies like Optum help reduce the cost of addiction treatment for members across the U.S.

Optum is part of UnitedHealthcare, which offers coverage in certain states throughout the country. Optum also partners with specific medical groups in order to offer local, accessible behavioral and mental health services.

The exact amount of treatment costs that Optum will cover will vary by your plan and location. Knowing the benefits of your plan can ease the process of finding a treatment center to best suit your needs.

Does Optum Cover Addiction Treatment Programs?

Health insurance plans with Optum are offered in:

• Arizona
• California
• Colorado
• Connecticut
• Florida
• Indiana
• Massachusetts
• Nevada
• New Jersey
• New York
• Ohio
• Texas
• Utah

Each of these states require insurance providers to offer behavioral health services coverage, including coverage for addiction treatment.

If you or your spouse have insurance through an employer, it’s likely that your plan will offer some level of coverage for addiction treatment. Employers that have more than 50 employees are required to offer substance abuse treatment coverage at the same level they cover other medical expenses.

Optum’s individual and family plans may have coverage levels that differ from employer-provided plans. An Optum representative will be able to explain the exact level of coverage your plan offers for addiction treatment programs.

Alcohol and Drug Rehab Services Covered By Optum Insurance

There are many levels of alcohol and drug rehab services, some of which include medication-assisted treatment and mental health counseling. No one approach to treatment is best. People benefit from a variety of different services, based on their unique needs.

Addiction treatment services often covered under Optum plans include:

• medical detox services
• inpatient treatment centers
• outpatient rehab programs
• drug screenings
• dual diagnosis treatment
• prescription medications
• support groups
• family counseling

Depending on your Optum plan, you may be responsible to pay for a portion of your rehab program costs. This is called a copay, and will contribute to your out-of-pocket expenses.

Some insurance plans also require a health assessment or medical referral. This means you or your doctor may have to fill out a form with Optum, before you are authorized for coverage.

Medically Assisted Detox

One of the first parts of addiction treatment is medical detoxification. A person who has been struggling with drug and alcohol abuse will likely have toxins in their body, that their body needs to clear. This can result in uncomfortable withdrawal symptoms.

It’s safest and most effective to detox in a medically monitored environment. Your Optum plan may provide coverage for certain detox services, including medication-assisted treatment.

Finding an in-network provider will increase your chances of receiving coverage for these services covered by Optum. Fortunately, Optum strives to offer in-network coverage that is easily accessed by members.

Inpatient Treatment

The most intensive level of addiction treatment takes place in an inpatient rehab center. In these residential settings, clients engage in therapies to help them overcome the physical and mental effects of substance abuse.

Clients temporarily live on-site, to ensure a stable and supportive environment. Many inpatient treatment programs last between 30-90 days. Each day, clients participate in a daily structure that may include individual therapy, wellness activities, and addiction education.

Optum may cover a portion or the entirety of the stay, depending on your plan. Finding an inpatient treatment program that is local and in-network could reduce your overall cost. Optum also states that in-network rehab centers increase a person’s chance of long-term recovery by up to 56 percent.

In-network treatment centers also place Optum members in rehab centers that offer evidence-based services. These services may include different types of therapy, counseling, and medication-assisted treatment.

Inpatient programs may be a good fit for Optum members who:

• do not have a drug- and alcohol-free living environment
• have tried other forms of treatment without success
• don’t live near an outpatient treatment center
• could benefit from building a strong recovery support system

Speaking with a treatment specialist will help you determine the best course of rehab services for you. You can then verify your coverage directly with Optum, in order to determine what will work best for you, financially.

Outpatient Treatment

Outpatient treatment is considered a less intensive approach to rehab services. Sessions may be held several times a week, in a hospital or doctor’s office. Outpatient rehab programs provide many of the same treatment services, on a more flexible schedule.

Outpatient programs may be beneficial for Optum members who:

• need to stay close to loved ones
• already live in an environment that supports sobriety
• have professional or family responsibilities
• are unable to pay for inpatient treatment

There are several types of outpatient treatment. These include standard programs, intensive outpatient programs (IOPs), and partial hospitalization programs (PHPs). The amount of coverage Optum will provide will vary by plan and location.

Standard outpatient treatment typically offers therapy sessions twice per week. These may include individual counseling or therapy in a group setting. IOPs offer three sessions per week, and may be offered in evening or weekend sessions. PHPs require sessions five days per week.

Medication-Assisted Treatment (MAT)

Many people benefit from the use of medication-assisted treatment, or MAT. Patients who use MAT receive medications that help reduce drug cravings and work to prevent relapse. MAT may also be used to keep patients comfortable during the withdrawal period.

Optum is required to cover prescriptions relating to substance abuse at the same level they cover medications for other medical conditions. If you are considering a rehab center that uses MAT, verify your prescription coverage with an Optum representative.

Using Your Plan With Optum To Cover Addiction Treatment

Once you have researched your treatment options, it may be helpful to contact the rehab center directly. Here, you can verify that they accept Optum and are considered in-network. You may also want to speak with a treatment specialist who can explain the range of services they offer.

An Optum representative can then walk you through the exact coverage your plan provides for each of these services. Understanding your coverage will help you know exactly what your costs may be, and will prevent any financial surprises down the line.

Frequently Asked Questions About Covering Treatment With Optum

Seeking addiction treatment is one of the most important decisions you may make. However, it’s easy to get bogged down in the details of rehab services and insurance coverage.

To better equip yourself for making an informed decision, consider having a list of questions on hand for your Optum representative. This will help you feel more knowledgeable, as well as empower you to get the most from your Optum plan.

Important questions to ask when using Optum to cover addiction treatment include:

• Do my benefits cover the cost of a medical detox program?
• Does my plan partially or fully cover the cost of prescription medications?
• Does my Optum plan provide coverage for outpatient treatment?
• What types of outpatient treatment does my plan cover?
• Do my benefits allow for inpatient treatment coverage? What lengths of stay are covered?
• What am I required to pay out-of-pocket?
• Is a medical referral or assessment required before seeking treatment?
• Is there any paperwork that I’m required to submit to Optum before attending treatment?

How To Find A Rehab Program That Accepts Optum

Knowing how to use your Optum insurance to reduce treatment costs can ease the process of selecting a rehab center. Using your insurance benefits can also help to make addiction treatment a more positive experience for you or your loved one.

For more information on alcohol and drug rehabs that accept Optum insurance, contact one of our treatment specialists today.