Does Optum Health Insurance Cover Alcohol and Drug Rehab?

Optum Health Insurance Coverage for Substance Abuse Addiction Treatment

Optum health insurance plans, which are available to certain people in certain states, often provide coverage for drug rehab in some capacity. Optum Care is a network of more than 53,000 doctors and 1,450 clinics across the states in which plans are available.¹ Optum health insurance Care provides health care coverage to over 19 million people.¹

Optum health insurance coverage is currently available in the following 15 states:²

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

If you have an Optum health insurance Care plan and need to seek treatment for alcohol or drug rehab, you should call the number on the back of your insurance card to learn more about your specific health plan’s coverage details. Your plan may provide some (or full) coverage for your treatment. You can also call your desired treatment facility and ask if they can verify your benefits for you.

What does Optum Health Insurance Cover?

The exact details of your Optum health insurance coverage and benefits will vary based on your plan and location, as some plans will have higher coverage levels than others. However, certain health benefits must be covered in some capacity. The Affordable Care Act (ACA) mandates that 10 essential health benefits be covered under all health care plans, including mental health services.³ This means that treatment for a mental health or substance use disorder must be covered in some capacity under your health plan.

The following common treatments are often covered under Optum health insurance Care plans:⁴

• Inpatient or residential rehab: Inpatient or residential rehab services are typically recommended for those who need round-the-clock observation or care. With this type of treatment, intensive medical care and/or therapy takes place in a facility where the patient will reside for until they are discharged.^{4, “How are behavioral therapies used to treat drug addiction?”} If you need inpatient or residential drug rehab treatment, your Optum health insurance care plan will typically provide coverage in some capacity.
• Outpatient rehab or therapy: For those who don’t necessarily need intensive care but still need to receive some level of care, outpatient rehab or therapy is often recommended. With this type of care, you’d go to a facility for treatment and then go home. ^{4, “How are behavioral therapies used to treat drug addiction?”} Your Optum health insurance Care plan will typically cover this type of treatment in some capacity.
• Intensive outpatient programs (IOPs): For those who don’t need 24-hour care but still need more structure than a basic outpatient program, IOPs are typically the recommended course of treatment. ^{5 (under section after conclusion)} Your Optum health care plan will typically provide IOP coverage in some capacity.
• Partial hospitalization programs (PHPs): Another common treatment method that combines elements of inpatient and outpatient programs is a partial hospitalization program. A partial hospitalization program typically involves attending a structured in-person day program and then going home at night.⁶ Your Optum health insurance drug rehab coverage will generally cover partial hospitalization programs in some capacity.

Please note that this list is not exhaustive and there may be other common treatments covered by your Optum Care plan. As always, verify your benefits and coverage with your Optum health insurance Care plan before you obtain treatment to avoid any surprise medical bills.

Does Optum Health Insurance Cover Inpatient Mental Health Treatment Facilities?

Under the ACA’s essential health benefit mandate, all health plans—including your Optum health insurance Care plan—must provide some level of coverage for treatment and services related to a mental health or substance use disorder.³ More specifically, your Optum health insurance Care plan must provide partial or full coverage for behavioral health treatment, inpatient care for mental and behavioral health, and substance use disorder treatment.

This mandate means that you will be able to receive coverage in some capacity for treatment of your mental health disorder or substance use disorder—or, if you’re struggling with both, your co-occurring disorder. People experience a co-occurring disorder more often than you’d expect. According to the National Institute of Drug Abuse (NIDA), 7.7 million Americans have a co-occurring disorder.⁷ Treating the substance use and mental health disorder concurrently is essential for full recovery. Due to the ACA mandate, your Optum health insurance Care plan must cover such treatment for a co-occurring and stand-alone drug or heroin rehab.

How Long Does Optum Health Insurance Cover Drug Rehab?

How long your Optum health insurance Care plan will cover rehab depends on your location, plan, and your recommended course of treatment, which is set by your doctor. As such, there is no standard length of treatment time that is covered. Despite this, it’s important to note that research shows that treatment should last at least 3 months in order to be as effective as possible and reduce the risk of any negative outcomes.^{8, (Numbered list number 5)}

Your coverage for your treatment will vary based on your selected facility and provider (in-network vs. out-of-network), your personal treatment, and your location. The only way to determine this is by talking to your provider and coming up with a treatment plan. Then, you can contact Optum Care at the number on the back of your card to discuss benefits and coverage. You can also have a facility provider contact Optum health insurance Care for you. If you’re choosing care at an American Addiction Centers facility, an agent can help you verify your benefits and coverage and see how long your plan will cover treatment.

What if Optum Health Insurance Plan does not cover total cost of Rehab?

In the event that your Optum Health insurance plan doesn’t cover rehab (which may be due to your facility of choice being out-of-network), or if they don’t fully cover your treatment, you may be responsible for paying for it yourself. However, there may be some ways to offset this cost and get the care you need.

One option is to ask the facility whether they offer financing options. You may be able to pay for your care in installments, by credit card, or on another line of credit. Your care facility may also offer scholarship opportunities so you can receive treatment at a discounted rate. It never hurts to ask about these options, and you shouldn’t be ashamed to do so.

If your facility choice is not an in-network provider, another option may be to gather all invoices and receipts related to care and submit them to your Optum health insurance Care plan for reimbursement. Some plans may offer this benefit to help you to recoup some of your costs. However, this is not the case with every plan.

Figuring out how to pay for your treatment can be stressful. Still, it’s important that you seek care. Pushing off treatment will only set you back on your road to recovery.

Optum Health Insurance In-Network vs. Out-of-Network Rehab Centers 

You may have heard the terms “in-network” and “out-of-network,” but may not understand what they mean. Knowing the difference can help you keep your health care costs low. An in-network provider is one that has entered into an agreement and negotiated rates with your Optum Care network. This means you’ll receive care from them at the lowest possible price. An out-of-network provider is one that does not have an agreement with Optum Care, meaning lower levels of coverage (if any at all) and higher out-of-pocket costs for you.

Your Optum health insurance Care representative can help you identify in- and out-of-network providers in your area. In addition, an American Addiction Centers representative can help you determine whether their facility is in-network or out-of-network over the phone.

How to check Optum Health Insurance coverage for detox or rehab centers?

If you have an Optum Care health insurance plan, your addiction treatment will likely be covered in some capacity. What’s more, American Addiction Centers has a variety of facilities in the northeast and across the country where you’ll be able to receive high-quality care. These facilities work wide a wide range of insurance providers, including Optum health insurance Care, which means they may be considered an in-network provider under your plan.

To learn more about your benefits and coverage, including whether your treatment at an AAC facility would be covered under your Optum health insurance Care plan, please call our helpline today to quickly verify your benefits and addiction treatment coverage.