UPMC Health Plan Insurance Coverage for Drug & Alcohol Rehab

Does UPMC Health Plan insurance cover Alcohol and Drug Rehab?

In 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) found that an estimated 14.8 million Americans struggled with alcohol use disorder, and 8.1 million Americans had at least one illicit drug use disorder.^{1, p. 37-38}

If you’re someone who struggles with substance use, you know that you could face long-term legal and health consequences unless you get the treatment you need to break free. If you have UPMC Health Plan insurance, you might wonder if your coverage can help you pay for rehab.

The good news is it can. Treatment centers can check your insurance plan to see what level of coverage you could get if you attended their programs. You can contact American Addiction Centers (AAC) by phone or through chat, and our admissions navigators can verify your insurance in just a few minutes over the phone. You can also call the phone number on the back of your insurance card to find out what to expect when you use your UPMC Health Plan behavioral health benefits.

UPMC covers 3.9 million members located throughout Pennsylvania, West Virginia, Maryland, and parts of Ohio.^{2, our company} This guide will help you understand how to use your UPMC Health Plan care options to get the help you need to live substance-free.

What is UPMC Health Plan Insurance?

The UPMC Health Plan is owned by the University of Pittsburgh Medical Center and focuses on providing high-quality health care to its 3.9 million members.^{2, our company} The company offers a wide range of insurance plans, from individual and family options, employer-provided coverage, Medicare plans, and is also a Medicaid provider in Pennsylvania.^{2, our company}

The provider network includes over 140 hospitals and 29,000 medical providers throughout the company’s service area, which includes Pennsylvania, Ohio, West Virginia, and Maryland.^{2, our company}

UPMC Health Plan

UPMC offers a full range of individual and group health insurance plans. Individuals and families can get coverage through the Health Insurance Marketplace or directly through the company.^{3, individuals and families} UPMC is also a provider of Medicaid and Medical Assistance plans in Pennsylvania, as well as plans for those who are dually eligible for Medicare and Medicaid.^{3, Medicaid, Community Healthchoices} Employers that want to offer coverage to their employees can use UPMC to offer comprehensive care at an affordable price.^{4, Why choose UPMC}

Can you rely on your UPMC Health Plan coverage to cover the substance use treatment you need? Yes, you can, thanks to the Affordable Care Act (ACA). The ACA requires all long-term health insurance plans to cover 10 essential health benefits, and one of them is mental health and substance use treatment.^{5, fifth bullet} That means that your UPMC plan will pay at least some of the cost of rehab.

The specific level of coverage will depend on your individual plan, which is why it’s important to verify your insurance before you commit to a treatment program.

What will UPMC Health Plan insurance cover?

What kind of treatment does UPMC Health Plan insurance coverage help pay for? Generally, insurance providers focus on medically-necessary treatment that uses proven methods. The first step is to work with your doctor to create a treatment plan. Your doctor will ask about your substance use, what substances are involved, and more.

From there, your doctor will create a plan to help you break free from substance use.

Some of the most common treatment options include:^6,7

• Inpatient/Residental Rehab: Individuals who go through inpatient treatment can live at the facility full time while getting help for their substance use. The staff will provide support and guidance to teach you new habits and coping skills like managing triggers or temptations, as well as teaching healthy habits that help you live life substance-free over the long term.
• Outpatient rehab: Outpatient treatment can involve a variety of different interventions, such as counseling and therapy. These programs are typically less intensive than residential treatment offered at the rehab center. Outpatient care can include medication management for those who need it. This type of treatment allows patients to live at home while developing new habits and mindsets about substance use.
• Intensive Outpatient Programs (IOP): You receive more in-depth treatment in an IOP than you would during a regular outpatient program, but you still live at home. Experts work with you to design a personal program that will help you create the habits and relationships to keep you substance-free.
• Partial Hospitalization Programs (PHP): A partial hospitalization program for substance use treatment is a great option for people who are unable to commit to a full-time inpatient program but need more intensive care than what outpatient treatment can offer. Patients in a partial hospitalization program typically attend the program 5 days a week for several hours per day and then return home in the evening.

Unfortunately, many people start a rehab program but then stop before they finish, which increases the chance that they will use again.^{8, fifth bullet} To give yourself the best chance of success, be sure to see the program through to completion.

Does UPMC Health Plan Insurance Cover Mental Health Treatment Facilities?

Mental health and substance use are both issues that have a lot of stigma around them, but the truth is they are more common than many think. In fact, 50% of those who struggle with substance use also have a mental health diagnosis, which is known as a co-occurring disorder.^{9, second paragraph}

What’s important is to use your UPMC Health Plan mental health coverage to get the right kind of help. Studies have shown that mental health and substance use should be treated together rather than addressing only one or the other.^{10, first paragraph}

The good news is that your insurance will cover both as part of the ACA requirement to cover essential health benefits.^{5, fifth bullet} Also, many treatment programs offer treatment for co-occurring disorders as part of their program.

How Long Does UPMC Health Plan Insurance Cover Rehab?

Each plan will have its own rules, and your doctor’s treatment plan recommendation will also impact the type and length of treatment your UPMC Health Plan rehab coverage will pay for. However, there are scientific recommendations as well. Studies show that most people need at least 90 days to significantly change their substance use habits.^{8, fifth bullet} That means longer programs are often better, especially if you commit to attending the entire treatment and making it through to graduation.

Curious what your plan will cover? You can call the phone number on the back of your insurance card or contact AAC over the phone or online. We’re happy to help.

What if my UPMC Health Plan policy does not cover rehab?

You might find that your UPMC Health Plan rehabilitation coverage doesn’t cover the full cost of the treatment program you’re interested in. Or, you might decide you’d like a type of treatment or program that the insurance doesn’t cover at all.

Don’t let that hold you back from getting the evidence-based care you need. Substance use leads to long-term health and legal problems, and it’s important to take action to break free as soon as possible. Fortunately, there are a variety of ways to pay for rehab. For example, the treatment program might offer scholarships, or you might be able to set up a payment plan. Some people also get a personal loan or borrow money from family and friends for rehab.

There’s no doubt that after successfully completing treatment, you’ll be in a much better place emotionally, financially, and healthwise. This will help you get back on your feet and manage your financial options more effectively.

The key is to get the treatment you need right away. You deserve to live a happier, healthier life.

UPMC Health Plan In-Network vs. Out of Network Rehab Centers

You might have heard that there are some UPMC Health Plan providers that are “in-network” and others that are not. What does that mean? Insurance companies create contracts with medical providers, who agree to treat plan members at a lower cost.^{11, What’s a provider network?} This helps patients and the insurance company save money, and plan members pay less out-of-pocket when they use these providers.^{11, Why do some plans cover…}

However, this also means that plan members get a smaller level of coverage—or, often, no coverage at all—if they use providers that are not in the insurance plan’s network.^{11, Why do some plans cover…} That’s why it’s important to verify your insurance and ensure that your insurance will apply to the treatment program you’re interested in.

Check UPMC Health Plan Insurance Coverage for Rehab

If you have UPMC Health Plan insurance coverage, you can use it to help you pay some or all of the cost of rehab. However, you’ll need to verify your coverage before you commit to a program, so you know what to expect financially.

You deserve a life free of substance use. You’ll be happier, healthier, and so glad you took this step. If you’re ready to get started, contact us today.