United Behavioral Health Coverage for Substance Abuse Treatment

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People who have substance abuse issues often see detrimental effects in their personal relationships and work life. Detox and rehab can be expensive, so many cases would go untreated if patients were expected to pay for the entire treatment out of pocket. Fortunately, insurance companies understand that helping these individuals get better is important, and coverage can usually be found for those who are ready for substance abuse rehab.

As part of the Unitedhealthcare network, United Behavioral Health is a department that deals specifically with substance abuse and mental health services. Although insurance regulation can change, most policies are now required to provide substance abuse services to qualified members thanks to the Affordable Care Act.

Does United Behavioral Health Cover Drug and Alcohol Detox?

United Behavioral Health (UBH) provides services for those who are having issues that are interfering with their happiness. One of these services is drug and alcohol detox. During the detoxification process, the body is allowed to get rid of the toxic influences of alcohol or drugs. For people with abuse problems, this process can be very unpleasant and sometimes dangerous. As a result, patients need to be in a supervised program that includes proper treatment by trained medical professionals. The experience and time period will vary according to the frequency and type of substance used.

United is a large organization whose members can be found all over the country, and there are many different types of policies. The majority of these policies include services related to substance detoxification, and most members can find a nearby treatment center that will accept United Behavioral Health insurance coverage.

While United Behavioral Health will help cover rehab services, certain criteria must be met. For inpatient detox, a United member must be diagnosed by a doctor, and the specific diagnosis must be Substance-Related Disorder. The coverage for detox or withdrawal treatment must also include intervention or monitoring by a health care professional that occurs more frequently than on an hourly basis.

The UBH network includes a variety of health care professionals who are trained and experienced with treating substance abuse disorders. As part of the detox and rehab services, members may come in contact with substance abuse counselors, psychiatric nurses, psychiatrists, psychologists, and/or social workers throughout their period of care. Most rehab centers will offer psychiatric evaluations, group and individual therapy, and medication management.

Quick Stats:

Rates of Heroin use have increased by over 200% over the last 15 years.

United Behavioral Health Coverage Options for Substance Abuse Treatment

Once detox is complete, rehabilitation needs to continue in order for the individual to confront his or her addictions. This substance abuse treatment includes a variety of behavioral therapeutic interventions such as therapy sessions and ways to maintain sobriety. Patients are educated about identifying triggers and high-risk situations, and they also learn about relapse prevention skills.

Because everyone’s insurance policy is different, it is important to contact United Healthcare directly to find out exactly what your particular policy will cover in regard to substance abuse. In most cases, UBH must grant the member authorization in order for coverage to kick in. Many treatment centers can verify your insurance benefits for you if you would prefer.

When you contact UBH for authorization, the mental health care professional will also help you find a substance abuse professional and treatment center in your area. Depending on your specific needs, you will be linked up with the ones that are the most qualified to help you out. Finding one that is in your network will also cut down on out-of-pocket expenses.

Because coverage varies widely according to the state you live in and the individual policy you have, you should always contact United directly or ask the rehab center to check on specific coverage details. Some plans include substance abuse as a standard coverage, while in other plans it is an additional coverage option. The amount of coverage you have largely comes down to your specific plan.

Group Plans

If you have a group plan through your employer, substance abuse treatment is covered to some extent. For businesses that have 50 or more employees, the Mental Health Parity and Addiction Equity Act of 2008 requires that substance abuse treatment be covered and affordable, specifically in regard to permitted number of visits and out-of-pocket costs.

Family and Individual Insurance Plans

Even if you do not have health insurance through an employer, there is a good chance that you are covered for substance abuse treatment. Family and individual plans found on the HealthCare.gov website are required by the Affordable Care Act to cover essential health benefits, which include mental health and substance abuse disorders. The amount of coverage, however, varies according to the specific plan.

Deductibles and Copays

Every insurance plan, whether it is employer-provided or not, has an individual/family deductible and copay or co-insurance, and these will determine how much each member will end up paying for treatment. The deductible can vary widely from a couple hundred to thousands of dollars, and this must be met by the member before UBH will start paying for treatment.

Once the deductible has been paid, patients may be responsible to pay co-pays for each visit/day or a percentage of the total care. Depending on your specific plan, you may have to pay anywhere from 10 to 40 percent of your total medical expenses. This information can be found by calling a United representative, by logging into your account online, or by reading your policy documents.

Specific Treatment

The amount of coverage UBH is responsible for will also depend on the specific treatment the patient receives. Typically, inpatient rehabilitation is more expensive than outpatient rehab. Also, the amount of treatment time will be a factor in cost. The specific treatment facility will also affect the insurance coverage amount.

For inpatient care, United will often cover for a semi-private room, and those who want their own room will be required to pay more. Also, patients who choose a luxury rehab center will likely be expected to pay a higher amount out of pocket than those who choose a more affordable one.

Quick Stats:

Over 60% of all deaths from overdose are attributed to prescription drug abuse.

What Amount of Time Does United Behavioral Health Cover for Treatment?

The process of rehabilitation will vary from one patient to another. The average amount of time for substance abuse programs is 30 days, although there are 60-day, 90-day, and longer-term treatment programs. Treatment professionals will determine the appropriate treatment length by considering factors such as:

• Severity and history of addiction
• Specific substances abused
• Co-occurring mental, medical, or behavioral health conditions
• Mental, physical, spiritual, and emotional needs of the individual

The amount of time that United Behavioral Health will cover depends on your individual benefits. Plans will often have limits in regard to number of inpatient days or number of sessions. Depending on your plan and financial standing, you may want to combine both inpatient and outpatient services to take advantage of your insurance coverage.

For example, you may choose to convert some of your inpatient days to transitional care or intermediate care (intensive outpatient programs or partial hospitalization) to make better use of your coverage. This decision, however, needs to be made at the discretion of your substance abuse designee, who is responsible for coordinating all of your care.

According to UBH, one inpatient day is equivalent to:

• Two day treatment or partial hospitalization sessions
• Five intensive outpatient treatment sessions
• Six outpatient visits
• Ten days of transitional care, which includes transitional living or sober living arrangements

Keep in mind that whether or not your insurance covers all of your treatment, studies have found that the longer one stays in a treatment program there is a better chance of long-term sobriety. Longer programs allow patients to focus on the foundational causes of the addiction and more time to practice the behaviors related to living sober.

Recovering from substance abuse is a lifelong process, and after being released from a rehab treatment program the patient will need to plan for ongoing therapy and support groups to prevent a slide back into addiction. While insurance helps keep the cost of rehab low, it is important to make treatment decisions based off of what you need rather than what your benefits cover.

Quick Stats:

Hydrocodone is directly related to over 100,000 emergency room admissions each year.

Important Questions to Ask

Making the decision to get help for an alcohol or drug treatment program takes guts and is extremely admirable. Just as your addiction changed your life tremendously, seeking treatment will also be a game changer and it is a huge step. It is important that you make the right decisions as to which treatment is the best for your needs.

It is best to conduct thorough research in order to find the appropriate treatment facility. Once you have done that, then you can look into the financial aspects of getting care. Asking a series of questions is imperative for you to get the information you need to make an educated decision.

In regard to your United Behavioral Health insurance policy, some important questions to ask include:

• Does my specific UBH policy cover mental health and substance abuse care?
• Are there United preferred providers in my local area?
• How do I get authorized for substance abuse treatment?
• What is needed to determine a medical necessity for drug and alcohol rehab?
• What is my deductible for treatment?
• What is my copay or coinsurance?
• How many days or how much treatment is covered under my insurance plan?
• What is my estimated out-of-pocket expense based off my individualized treatment plan?
• Is there a lifetime limit to the total number of inpatient services covered?

Besides insurance inquiries, there are additional questions that you should ask your rehab center or medical professional:

• Is inpatient or outpatient treatment the better choice for my needs?

• Can I get time off work for substance abuse rehab?

If you are getting inpatient treatment, and even in some outpatient cases, you will need to take time off of work. There are some options to ease this issue:

• Family and Medical Leave Act- your employer may offer up to 12 weeks of unpaid leave to treat addiction, which is considered to be a medical condition that interferes with your capacity to complete tasks related to work
• Paid Time Off- if you have accrued personal, sick, or vacation days, you can use them to get rehab treatment
• Executive Rehabilitation Centers- there are some executive rehab centers for those who need to continue with heavy work demands

• Can I lose my job if I attend rehab?

There are a number of federal laws that determine it is illegal to fire an employee for seeking substance abuse treatment. There is a better chance that you will be legally fired if you continue abusing drugs or alcohol while on the job.

• Are family members involved in the treatment program? If so, in what ways?

• Does the treatment program address special concerns that someone from a particular religious or culture background might have?