Does United Healthcare (UHC) Insurance Provide Coverage for Opioid Rehab?

Last updated on June 13, 2022

As one of the largest private healthcare insurance companies, United Healthcare (UHC) is required by law to provide the same level of coverage for behavioral health services (including substance abuse and mental health disorder treatment) as they do for other health issues.¹

This is guaranteed by laws called the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act. These laws ensure that all state-regulated health plans provide coverage for SUDs (including opioid addiction), as well as any accompanying mental health issues. The benefits and coverage that United Healthcare (UHC) plans provide must be equal to those provided for general medical and surgical services.²

United Healthcare (UHC) offers a variety of insurance plans and programs to fit each individual’s needs, and they also provide programs for Medicare and Medicaid beneficiaries. Finding an appropriate in-network rehab center for yourself or a loved one shouldn’t present too much of a challenge since UHC delivers nationwide coverage through contracts with more than 1.3 million primary care physicians, specialists, as well as 6,500 hospitals, labs, and other healthcare facilities across the U.S.³

What Parts of Opioid Addiction Treatment Does United Healthcare (UHC) Insurance Cover?

When it comes to opioid rehab, and addiction treatment in general, you can count on United Healthcare (UHC) to provide nationwide coverage for all rehab-related services that are determined to be appropriate, medically necessary, evidence-based, and FDA-approved. This includes:⁴

Screenings and evaluation for substance abuse (including opioid abuse), as well as any co-occurring mental or physical health issues, and appropriate, medically necessary interventions.
Medically monitored detoxification process, and administering medication to mitigate highly unpleasant and, in some cases, even life-threatening opioid withdrawal symptoms.
Inpatient or residential opioid addiction programs, both short and long-term.
Outpatient and intensive outpatient programs, depending on the severity of the addiction.
Behavioral therapies and services that aim to get to the underlying cause of one’s opioid addiction and address any potential co-occurring mental health issues. They focus on patients’ behavior patterns and lifestyle habits to treat their opioid abuse.⁵
Treatment for co-occurring disorders is also covered by United Healthcare (UHC) health plans since mental health issues typically go hand in hand with substance abuse and need to be addressed simultaneously to achieve lasting recovery and prevent relapse.

As an ACA-compliant, nationwide health insurance provider, United Healthcare (UHC) offers healthcare plans divided into several ‘metallic’ categories: Bronze, Silver, and Gold. The difference between them is how your health plan and you split the cost of healthcare services you receive. These are Marketplace plans, meaning that people buy them on their own, as opposed to those they get through an employer or a government program (like Medicare or Medicaid).⁶

It’s also possible to qualify for financial help, (under the American Rescue Plan Act of 2021), and get coverage with lower premiums. This usually depends on your income and household size. These subsidies can reduce your share of the cost to help you pay for the needed services. Alternatively, you can look into state-funded rehab centers, that provide free or low-cost addiction treatment.⁶

Since most of the substance abuse treatment facilities are operated by private organizations (about 90%), they accept all major providers’ health insurance, including United Healthcare (UHC) rehab coverage.⁷

Are There Elements of Opioid Treatment That the United Healthcare (UHC) Won’t Cover?

Since opioid addiction rehab, and different types of substance abuse treatment in general, involve tailoring the recovery program to each patient’s individual needs, some elements of treatment that could be highly beneficial for certain individuals might not be considered medically necessary and therefore not covered by most health plans. These services may include:⁸

Diverse types of non-medical amenities, like high-end hotel-like accommodation with swimming pools, spas, gyms, etc.
Holistic approach services like yoga, mindfulness exercises, and tai chi.
Recreation programs or nature/wilderness therapy.
Particular dietary preferences, professional chefs, or food delivery.
Private treatment services like massages or personal training.
Various alternative therapies like hypnotherapy, acupuncture, energy healing, or Chinese herbal remedies.

How Much Does United Healthcare (UHC) Covered Opioid Rehab Cost?

The cost of opioid addiction treatment will depend on various factors since individual characteristics of each patient are taken into consideration when designing the appropriate treatment program. The most important criterion that determines the necessary level of care is usually the severity of addiction, but other factors also affect the overall cost of treatment:^{9, 10}

The number and type of services available to the patient.
The Intensity of services and level of care.
Duration of treatment in both outpatient and residential settings.
The type and range of amenities offered at specific rehab centers.

Factors That Influence the Cost of Inpatient Opioid Rehab

If a team of substance abuse specialists determines that the severity of your opioid addiction, as well as your personal characteristics and lifestyle, warrant a live-in treatment, you will be offered an inpatient (also called residential) treatment program. These programs can significantly vary in length, depending on each patient’s needs, and this is one of the main factors that will determine the cost of treatment.¹⁰

All programs usually start with medically monitored detoxification that can last up to a week, depending on the severity of the withdrawal symptoms. After that, patients can move on to short-term or long-term recovery programs. Short-term ones usually last for about a month (28-30 days), while long-term inpatient programs can last from 2-3 months up to a year, in the most severe cases.¹⁰

Non-hospital residential treatment is available in about 23% of all US rehab facilities, and aside from the length of the program, the included services and amenities will also influence the overall cost.¹¹

Factors That Influence the Cost of Outpatient Opioid Rehab

Outpatient treatment is the most common type of substance abuse treatment since it’s generally less expensive and more widely available. As many as 82% of US rehab facilities offer this type of treatment program.¹¹ It can also vary in length and the number of services that patients receive, so this will be the main price-determining factor.¹²

This type of treatment is best suited for people with stable home life and a reliable support system of friends and family, as well as those who are unable to take time off from professional or personal responsibilities. For those with more severe forms of opioid addiction, intensive outpatient programs are available, and since they involve more hours of treatment, they’re also more expensive.¹²

Factors That Influence the Cost of Opioid Partial Hospitalization Programs (PHP)

Partial hospitalization programs provide a higher level of care and more intensive therapy programs than outpatient ones. The patient spends more time at the treatment facility (usually a minimum of 20 hours per week, for several months), but they live at home, so this type of opioid abuse treatment is not as expensive as inpatient treatment.¹⁰

Factors That Influence the Cost of Medication-Assisted Treatment (MAT)

Medication-assisted treatment is a particularly important part of opioid detox and subsequent addiction treatment. Pharmacotherapy is used to mitigate the unpleasant symptoms of withdrawal, and after detox, it’s used to help maintain sobriety and lower the chances of relapse. However, MAT treatment is not enough on its own. Opioid addiction recovery should also include various types of counseling and behavioral therapy.¹³

The cost of MAT will depend on its duration and the tier of prescribed medication. Generic medications are usually fully or mostly covered by health insurance plans, while more expensive ones might not be. Depending on the type of health plan you have, sometimes you need to pay a determined amount out-of-pocket or a percentage of the cost. The most common medication used for opioid addiction includes buprenorphine, methadone, and naltrexone.^{13, 14}

The Cost of Opioid Rehab Is Lower Than the Cost of Opioid Addiction

Aside from the stigma that is still associated with opioid addiction and the need to go to rehab, even in modern society, one of the main reasons for not getting the necessary help for opioid abuse is the seemingly cost-prohibitive nature of high-quality treatment programs. However, a lot of research has been done on the cost-effectiveness of rehab in comparison to active addiction.^{15, 16}

This was proven to be true regarding both the cost to society, as well as the individual. People who don’t get appropriate help and guidance to recover from opioid addiction are likely to suffer even greater costs that include:¹⁷

The cost of active substance abuse disorder, meaning the cost of drugs themselves.
The cost created by lost income, usually due to diminished work productivity or losing a job.
The cost of various health problems that may result from prolonged opioid use, including the danger of injury, overdose, and death.¹⁸ These costs also include emergency room visits and mental health treatment services, since co-occurring disorders among opioid-addicted individuals aren’t uncommon.
Costs related to arrests for various criminal activities, violence, child endangerment, or domestic violence.

What Length of Opioid Rehab Does United Healthcare Provide Coverage for?

Like all ACA-compliant healthcare insurers, UHC is required by law to provide coverage for appropriate, medically necessary, evidence-based, and FDA-approved treatment.¹⁹ Since each patient battling opioid addiction has their own unique needs, a team of addiction specialists will determine the best course of action on a case-to-case basis.²⁰

Longer treatment times have been proven to be more effective in achieving lasting sobriety and reducing the chance of relapse. They provide the patient with enough time to profoundly commit to their program and address any potential underlying mental health conditions. More than 50% of patients in addiction treatment get diagnosed with co-occurring substance abuse and mental health disorder.^{7, 10}

Personally tailored programs might include certain approaches and services that could be highly beneficial for the patient but don’t satisfy the medical necessity criterion. When this happens patients can investigate alternative payment options to cover the part of the cost that is not covered by their healthcare plan. Since there’s a wide selection of policies and different tiers of coverage, the covered length of treatment will depend on the type of plan you have.^{10, 19}

Each patient can get information about the coverage their plan provides by going through their insurance contract or by reaching out to United Healthcare for the most accurate information about their benefits and substance abuse coverage.

Should You Choose UHC-Covered Inpatient or Outpatient Drug Rehab Center?

This type of decision should be made according to recommendations you get from the team of addiction specialists that evaluated your case. They will present you with the best and most effective options. However, each person’s life circumstances are different so it’s up to you to choose the type of treatment program you’d be most likely to adhere to and complete.²⁰

The best SUD treatment practice has shown a correlation between longer treatment times and more successful outcomes – lasting sobriety and lowered chance of relapse. The main benefits of inpatient opioid treatment are:^{8, 10}

The appropriate level and high quality of care since patients live at the facility and their progress is being monitored and adjusted accordingly.
A specific treatment ecosystem is created in an inpatient environment, since sharing this experience with others who understand what you’re going through creates a sense of community and mutual support.
Support groups are available in both inpatient and outpatient settings, but inpatient ones allow you to form deeper connections with the other patients and counselors who are there for you every day.
Inpatient treatment also creates a more focused environment, since there are no distractions from the outside world and potential triggers or enabling persons that may be present in your everyday life at home.
The question of accountability is a personal one and is highly dependent on the characteristics of each patient. However, since the progress of residential patients is constantly monitored and evaluated, they’re more likely to stick to the program and complete it.

What Does the Process of Getting United Healthcare Insurance Coverage for Opioid Rehab Look Like?

When you decide to start looking for an appropriate UHC-covered drug rehab, the first thing you need to do is consult your primary care physician. Keep in mind that you need to go to a doctor that is in-network with United Healthcare, so they can direct you further within the network. The process usually consists of the following steps:²¹

Go to your in-network doctor, so they can perform an initial evaluation and take into consideration any physical health issues you might have before referring you further to an addiction specialist.
With the help of specialists, or based on recommendations from other patients, you should be able to find a suitable rehab program.
You need to determine the ability to use the insurance plan you have for the type of treatment and the facility you choose.
United Healthcare will collaborate with the selected rehab center to determine the coverage it can provide for your treatment plan.

All primary care physicians, specialists, labs, and different types of facilities that don’t have contracts with United Healthcare are called out-of-network providers. Some United Healthcare (UHC) health plans may provide out-of-network coverage. This means that they will partially cover the costs of your treatment. However, other plans will not cover any of the costs if you decide to get treatment out-of-network. This is why it’s important to choose a facility that is in-network with United Healthcare.²²

Finding Inpatient Drug Rehab Centers That Accept United Healthcare (UHC) Insurance Nationwide

There are several ways to find high-quality substance abuse treatment centers that accept United Healthcare (UHC) insurance coverage. To get the maximum coverage for your treatment make sure to look for in-network rehab facilities. Reach out to your health insurance provider to get the most accurate information about suitable options within their provider network. This is the easiest way to keep the cost down and have no or minimal out-of-pocket costs.²¹

You can get guidance by calling the United Healthcare (UHC) substance use helpline at 1-855-780-5955. All helpline calls are confidential, and the trained advisors will provide you with the most accurate information, support, and guidance. Hotline representatives will answer all the questions you might have about addiction in general and present you with treatment options.²² They can also help you find substance abuse treatment providers that are in-network with United Healthcare (UHC).⁵

How Can AAC Help You Find Suitable UHC Opioid Addiction Treatment?

Another way to check your coverage is to reach out to trusted substance abuse treatment providers like American Addiction Centers (AAC). This is one of the highest-rated addiction treatment providers in the U.S. AAC is in-network with United Healthcare (UHC), so you can get the best possible coverage with your insurance plan.

To verify your benefits, you can call the AAC helpline and have one of the admission navigators provide you with all the necessary information and verify your insurance while you’re on the phone. They can explain how insurance coverage works or present you with different payment options. Another way to check your benefits is to fill out and submit an online verification of benefits form on the AAC website.

You can also get accurate information about the admissions process, and the admissions navigators will do their best to help you with the same-day admission if you feel the need to start with treatment right away. They can also explain the intake process, including initial evaluation when you arrive at the facility, and tell you what to expect from a drug rehab program.AAC is a nationwide network of addiction treatment facilities that offer a full continuum of care and high-quality rehab programs individualized according to each patient’s specific needs. There are also special treatment programs for certain population groups, like carefully designed programs for veterans, or rehab plans for couples addressing their addiction and relationship issues together.