Health Insurance Coverage for Addiction Rehab with Optum

What is Optum?

Optum Care is a network of more than 53,000 doctors and 1,450 clinics across the states in which plans are available.¹

It is important to note that Optum is not a health insurance company. Operated by UnitedHealth Group, it is a network of health providers that contract with most health insurance plans.

Many American Addiction Centers (AAC) facilities contract with Optum. Call to verify coverage and learn more.

What Does Optum Cover?

While Optum is not itself an insurance company, your insurer may utilize Optum to ease the administrative burden of having to credential and contract directly with some facilities, such as drug rehab centers.

The Affordable Care Act (ACA) mandates that mental health services must be covered by most insurers.³ This means that treatment for a mental illness or substance use disorder will likely be covered in some capacity under your health plan.

The following common treatments are typically covered by insurance:⁴

• Detox. Often the first step in addiction treatment, detox is a level of care in which the primary goal is keeping the patient safe and stable through the acute withdrawal process before they continue treatment.
• 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. If you need inpatient or residential drug rehab treatment, your 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. Your health insurance 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 often a recommended course of treatment. ⁵ Your 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 health insurance 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 insurance plan. In addition, your insurer may only cover certain levels of care at a specific facility. As always, verify your benefits and coverage with Optum or the facility before you obtain treatment to avoid any surprise medical bills.

Are Optum Mental Health Services Covered?

Under the ACA’s essential health benefit mandate, most health plans must provide some level of coverage for treatment and services related to a mental health or substance use disorder.³

More specifically, your insurer that contracts through Optum should 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, addiction and a co-occurring disorder.³

Types of Mental Health Treatment Provided Through Optum

Your insurance policy that contracts with Optum to provide mental health treatment will likely be subject to the protections afforded by the The Mental Health Parity and Addiction Equity Act (MHPAEA), which mandates that the coverage provided for mental health treatment must equal the coverage they provide for medical treatment.⁷

Common types of mental health treatment covered by insurance include behavioral therapy (e.g., cognitive-behavioral therapy, dialectical behavior therapy) and medication (e.g., medications for substance use disorder, anti-anxiety medication, antidepressants). In order to obtain coverage, your provider will have to confirm that these interventions are medically necessary.

Alternative, non-evidence-based approaches are typically not covered. However, there are exceptions—for example, if you are admitted to a residential treatment center that offers yoga classes as an adjunct to evidence-based care.

How Long Does Health Insurance Cover Drug Rehab with Optum?

How long your health insurance 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.

Your coverage for your treatment may vary based on your:

• Insurance plan.
• Selected facility and provider (in-network vs. out-of-network).
• The kind of treatment prescribed.

You can have a facility provider contact Optum to determine your coverage. 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 Your Health Insurance Plan Doesn’t Cover Rehab?

Most insurers cover addiction treatment; however, some may only cover certain levels of care. Call the number on the back of your insurance card, explore your insurance company’s website, or verify your insurance through the treatment facility to obtain covered care. Make sure the facility is part of Optum or your insurer’s network and, if needed, get prior authorization before enrolling in treatment. Admissions navigators at American Addiction Centers (AAC) can assist you with this process.

Even if you have coverage, there will likely be some out-of-pocket costs, such as deductibles, copayments, or co-insurance rates. There are a few ways you may be able to offset these costs.

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 Optum or your insurer 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 can be dangerous and will likely cost you more in the long run.

Optum Health 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 insurer. 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 or your insurer, meaning lower levels of coverage (if any at all) and higher out-of-pocket costs for you.

Your Optum 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 Health Insurance Coverage for Optum Detox or Rehab Centers?

If you have 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 those that contract with Optum.

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