Optum Insurance Coverage for Drug & Alcohol Rehab Treatment

Are you trying to get help with your alcohol or drug use but worried about the cost of rehab treatment? You wouldn’t be alone; over 20 million Americans live with addiction daily. Sadly, only a tiny percentage of that massive number receive the help they need. Keep reading to find out how your health insurance works with rehab and to verify your insurance with Resurgence Behavioral Health.

What Is Optum Insurance & How Does It Work?

Optum Insurance has been a subsidiary of UnitedHealth Group since 2011. It was created by merging the existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight, and OptumRx. Optum is a nationwide network of providers, like hospitals, doctors, labs, and pharmacies. These providers have agreed to set a fixed fee for their services, of which Optum covers a portion. These agreements are called in-network. Providers that don’t have a contract are referred to as out-network and can charge whatever they wish, usually higher fees. Optum Insurance will also cover out-network procedures but may require pre-approval and only pay the in-network cost leaving you to make up the balance.

What are Optum Insurance Types of Plans?

Optum isn’t an insurance plan. Instead, it is a group of doctors who contract with most major health insurance plans. These include HMOs, PPOs, Original Medicare, Medicare Advantage, and supplement plans. These may vary by state. Optum has more than 3,700 primary care doctors and 11,000 specialty doctors in the Optum Care network in California. Each state varies in the number of providers, but you can expect networks with tens of thousands of providers in each state. Arizona has 53,000, and so on. 

Rehab Facilities That May Accept Optum

Resurgence Behavioral Health accepts Optum Insurance and is an in-network provider for Optum. Part of the benefits of belonging to a large, nationwide insurance plan is that you can travel to a different state to access care. This is helpful if you’re concerned about privacy or need to put some space between you and your social life. Call us at 1-855-458-0050 to verify your insurance today.

Does Optum Insurance Cover Rehab Treatment?

Several acts dictate what insurance companies must cover.  The Substance Abuse and Mental Health Services Administration (SAMSHA) mentions, “The Affordable Care Act makes health insurance more affordable for individuals, families, and small business owners. People with mental health challenges or substance use disorders often have problems getting private health insurance. Now there are special insurance protections to help.” The law requires Optum Insurance to pay for rehab treatment for substance use disorders. 

How to Check Your Optum Insurance Coverage

Check your insurance coverage with Resurgence; simply fill out our online form and verify your insurance in minutes. You can also check the Optum Insurance website to see providers in the Optum Insurance network.

What Does Optum Insurance Cover?

Many different treatment therapies happen during and after rehab, and the law requires Optum to cover costs. You can expect to participate in therapies such as

• Cognitive Behavioral Therapy
• Dialectical Behavioral Therapy
• Rational Emotive Behavioral Therapy
• SMART Recovery
• Medication Assisted Therapy
• Therapy for co-occurring disorders

After rehab, attending an aftercare program is crucial to continue your recovery momentum. Narcotics and Alcoholics Anonymous are the two most well-known aftercare programs, but secular options also exist for those uncomfortable with faith-based material. Your care team at Resurgence may recommend an outpatient program after an inpatient stay to ease your transition into society.

Does Optum Insurance Cover Mental Health & Substance Abuse Treatment?

The same acts requiring insurance companies to cover substance use disorders also cover mental health disorders. Almost half of people with addiction have mental health disorders like PTSD, anxiety, depression, schizophrenia, and ADHD. These are called co-occurring disorders, and it is essential for recovery that they be treated alongside addiction.  SAMSHA mentions the Mental Health Parity and Addiction act “The Mental Health Parity and Addiction Equity Act of 2008 requires insurance groups offering coverage for mental health or substance use disorders to make these benefits comparable to general medical coverage. Deductibles, copays, out-of-pocket maximums, treatment limitations, etc., for mental health or substance use disorders, must be no more restrictive than the same requirements or benefits offered for other medical care.”

Does Optum Insurance Cover Inpatient Rehab?

If your Resurgence Behavioral Health doctor determines that your best chance at recovery is an inpatient rehab stay, Anthem Insurance treatment must cover the costs. Inpatient rehab is the most costly treatment due to the requirement of living at the facility during rehab. It is ideal for someone who recently completed a medical detox, someone who has been using drugs and alcohol for a long time, or someone who may not have a safe home environment.

Does Optum Insurance Cover Intensive Outpatient Rehab?

An intensive outpatient program is a good choice for someone experiencing a less severe addiction who has obligations they cannot set aside for full-day treatment programs. Expect to spend up to 20 hours weekly in therapy sessions based on your schedule. Optum Insurance is also required to cover the costs of an outpatient program.

Does Optum Insurance Cover Partial Hospitalization?

A partial hospitalization program is a great way to bridge an inpatient rehab stay with the task of re-entering society. During this program, you’ll attend full days of therapy, returning home or to a sober living house at night. Optum Insurance is required to cover costs for a partial program too.

How Long Will Optum Insurance Cover Rehab?

Your Resurgence care team will work with your insurance company to find the right time for your program. Rehab stays are allocated in 30-day allotments, usually up to 90 days. If more time is needed, Resurgence doctors will write a letter of medical necessity to get Optum Insurance to cover a more extended period.

Optum Insurance May Offer Treatment Coverage for the Following Addictions:  

• Addiction to alcohol (alcoholism)
• Addiction to illicit drugs
• Addiction to prescription drugs
• Co-occurring disorders
• Trauma-related disorders
• Mental health disorders

Some substances are more dangerous to detox from, such as alcohol, benzodiazepines, and opioids. More acute care is required in these cases in the form of a medically supervised detox.

What are the Options if Optum Insurance Does Not Cover the Cost of Rehab?

The law requires Optum Insurance to cover your treatment for addiction and co-occurring disorders. If they refuse to cover your costs, you may have to file an external appeal with the government. Each state is responsible for enforcing insurance laws; you may need to contact a representative within your state government. If you can’t wait for these administrative processes, contact the rehab center you wish to attend, many have payment plans or private financing. Addiction is tough on your health, so starting treatment as soon as possible is critical.

Verify Your Insurance with Us

Using Resurgence Behavioral Health to verify your insurance is quick and easy with our online form. Our admissions specialists are standing by 24/7 to help you navigate the administrative process of insurance and attending rehab.

Next Steps with Insurance Coverage for Rehab Treatment with Resurgence Behavioral Health

Give your family peace of mind knowing you are safe and cared for at Resurgence. We have years of experience helping people break free from alcohol and drug use, and many of our staff were once at the same point as you are. Now they dedicate themselves to helping others enter recovery. Our treatment facility is a home, not a hospital. You’ll benefit from our comfortable, bright, and beautifully appointed spaces and enjoy amenities like a private chef preparing nutritious meals. We allow pets and welcome couples who would begin their journey to recovery together. However, you must make the first step on your road to recovery; the time for change is now. Call us at 1-855-458-0050 to unlock your new way of life.