Guide to Optum Health Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author

Bianka Fisk

About

Clinically Reviewed

Jim Brown, CDCA

About

All of the information on this page has been reviewed and certified by an addiction professional.

Optum works to provide appropriate and cost effective mental health and substance abuse treatment benefits to their members.

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

Thanks to the Affordable Care Act, substance abuse is now classed as a mental health condition, which means health insurance providers must offer forms of coverage for it. Exactly how they cover this treatment, which elements they cover, and for how long, however, will vary depending on not just your insurance carrier but also your personal package.

If you are with United Health Group Inc., our country’s largest health carrier, you will be happy to know that you should receive coverage for addiction treatment. Optum Health is one of the two service providers that United Health Group Inc. holds, and if your policy is with them, regardless of which of their three businesses you are with, you should have some sort of coverage. The three businesses are:

• Optum RX
• Optuminsight
• Optum Health

If you are with Optum Health Insurance and you are in need of drug or alcohol treatment, then it is very important that you have a good understanding of exactly what the company offers in terms of coverage. This is because whatever coverage you will receive will be different from that given by other health insurance companies, and it will also be different than should you need any other medical care.

If you are looking for treatment from a rehab center, you will need to find one that is classed as being “in network”. While you may receive some coverage for out of network providers, it will always be less and this in turn means that you will have greater out of pocket expenses. If you want to keep your costs down, therefore, you will need to find a provider that is affiliated with Optum Health Insurance.

Where Can I Find Who Is in Network?

If you are trying to find out whether your Optum Health Insurance coverage will pay for the rehab facility that you are considering, the best thing to do is to contact them directly. They have friendly customer service representatives ready to take your call and they will be able to run you through your available options. In doing so there is no obligation and is 100 percent confidential. It also does not mean you have to seek treatment, or that your premiums will change in any way.

It would also be wise to check your own policy and retain a copy of it for your records. You should be able to find out all the relevant details on there. Getting to know your policy is always a good idea, as you never know when you may need medical care, so you need to be aware of what it does and does not cover.

Be aware not to confuse your substance abuse benefits with your overall health benefits as they are likely to be very different. Again, should you have any questions, it is best to contact a representative.

What Optum Health Insurance Does Cover

Optum Health Insurance is a respected insurance company, not in the least because they show such compassion and care to their policy holders. They offer some of this country’s most extensive levels of coverage for behavioral health rehabilitation and drug and alcohol treatment. They are so well known and extensive that they have won a number different awards, including:

• The National Association of Peer Specialists National Lifetime Achievement Award
• The United States Psychiatric Rehabilitation Association National Recovery Award

Of particular interest for Optum Health Insurance policy holders who seek help with a drug and alcohol problem is the “treatment decision support” team that the company has put in place. This is a team that has been specifically trained in helping patients to make decisions that are cost effective and evidence based to be effective in terms of helping them get healed.

Where Can I Go with Optum Health Insurance Coverage?

If you have Optum Health Insurance Coverage, then you need to start by building your understanding of what is and is not covered. If you are in a position where you want to get help with a drug and alcohol problem, it is important that you also know what help is out there for you in particular.

It is a known fact that addiction and substance abuse are growing problems not just in this country but all over the world. Unfortunately, the vast majority of people will not seek help for their issues, hoping that they can resolve it themselves. For the vast majority of people who don’t seek help, this is because they believe that they will not be able to afford it. Luckily, if you are covered under Optum Health Insurance, you won’t have too much out of pocket expenses.

Coverage for Both Outpatient & Intensive Care

What Optum does is make sure that they have the most cost effective and most appropriate substance abuse and mental health benefits available to each of their members. This is why they offer coverage for both outpatient treatment as well as intensive care management. Optum does want you to use their in network providers.

Proprietary ALERT System for Detecting Risk Factors

For Optum Health Insurance, it is clear that outpatient care has to be managed properly if it is to be effective. This is why they offer the ALERT system, which is proprietary to them, enabling them to quickly spot and red flag risk factors at the start of treatment. In so doing, they avoid both under- and over-utilization. Additionally, this means that the evidence for the effectiveness of treatment continues to be effective.

They also cover members through intensive care management. In so doing, they avoid people having to be admitted to hospital unnecessarily. Instead, they ensure alternatives are in place that are appropriate and have been proven to give excellent results. If you, as an Optum Health Insurance member, are admitted to hospital, the team of Care Advocates at Optum will get in touch with the facility you are in so as to make sure that only evidence based practice is being used, and, when it comes to your discharge, then the insurance provider will coordinate between your loved ones, treating practitioners, and community services, thereby increasing the chance of full recovery.