Optum Rehab Coverage
Optum, a UnitedHealth Group (UHG) company, is not a health insurance provider. Optum is a UHG-specific physician, specialist, and member advocate consortium. As part of UnitedHealth Group, Optum United Health Behavioral Solutions (OUHBS) connects members with UnitedHealthcare insurance to mental health services, hospitalization, and other substance abuse treatment options.
Optum/UnitedHealthcare members in need of mental or behavioral health services receive community outreach and an assigned Behavioral Health Advocate to help connect them with the care they require.
If you or a loved one need to find an insurance plan or need help understanding your health insurance benefits, reach out to our team at Zinnia Health by calling (855) 430-9439. We are in-network with UnitedHealthcare. our helpline is completely free, and we’re available 24 hours a day.
Does Optum Insurance Cover Alcohol Rehab?
Optum does not, but UnitedHealthcare does.
The Affordable Care Act established certain essential benefits for insured individuals, and alcohol rehab, substance abuse treatment, and mental health services are considered essential care services.
Health insurance carriers (such as state-funded Medicaid programs and Marketplace insurance providers) are required to cover at least a portion of the costs associated with rehab for substance abuse, alcohol abuse, substance use disorder, and offer other addiction treatment coverage as necessary.
Alcohol addiction sometimes requires detox (or detoxification) before entering residential treatment or beginning an intensive outpatient treatment program, in which case you may need to consider things like per-visit copays. There may also be a limit on the number of visits per policy period.
Your policy details your coverage, deductible, co-insurance, and any other out-of-pocket expenses you might experience. Call the phone number listed on the back of your insurance card to speak with a UnitedHealthcare benefits representative.
But remember: Optum is not healthcare insurance. Optum health insurance plans do not exist. Instead, Optum is a network of advocates, physicians, and specialists. Optum is a resource to help you find the right drug rehab aligned with evidence-based methods, such as medication-assisted treatment, cognitive behavioral therapy sessions for mental health issues, and sober living homes for post-treatment, faster and easier than you might on your own.
Optum cannot cover drugs required during your treatment, but UnitedHealthcare may. The Optum network can provide referrals and put you in touch with other resources in your community that you may not realize are available and try to help you keep your out-of-pocket costs as low as possible.
However, Optum’s sister company, UnitedHealthcare, provides health insurance coverage for mental health, substance use, and rehab treatment centers. For instance, if you purchase your UnitedHealthcare plan through the Marketplace, this carrier offers four distinct levels of coverage. The coverage level of your plan determines what your plan covers.
Note: Optum’s Provider Express website provides Clinical Criteria, Policy, Guideline, and Manual information that can help you understand the Optum approach to mental health, co-occurring disorders, dual diagnosis, and other treatment services.
Does Optum Insurance Cover Substance Abuse Treatment?
Optum is not health insurance, so it does not cover the costs of any treatment. Depending on your specific policy and plan, your UnitedHealthcare insurance might cover all or a portion of necessary drug abuse treatment, inpatient residential care, and/or outpatient rehab services.
Optum is contracted with UnitedHealthcare under the UnitedHealth Group umbrella. While Optum isn’t health insurance, and there is no Optum HMO, there are primary care physicians, specialists, and treatment facilities within Optum’s network that provide substance use disorder treatment and alcohol treatment options.
UnitedHealthcare (UHC) insurance offers multiple types of insurance for individuals and families. For instance, if a person misses the Marketplace’s Open Enrollment period, UnitedHealthcare’s Short-Term Insurance policies might be a solution.
However, these policies are not within the scope of the Affordable Care Act, meaning they may provide very little coverage for drug or alcohol rehab, if they cover any portion at all. Rather than choose a short-term policy, many people opt for UnitedHealthcare’s Individual & Family ACA Marketplace plans (which are expressly part of the Affordable Care Act).
Actual coverage amounts vary according to the level of care needed and other variables unique to each individual. For instance, this Coverage Summary outlines in detail the alcohol and substance abuse detox and rehab coverage for an individual with a UnitedHealthcare Medicare Advantage policy.
Does Optum Cover Mental Health Treatment?
Optum is not health insurance, so it doesn’t cover the costs of any healthcare services. Depending on your specific UnitedHealthcare policy and plan, all or a portion of necessary substance abuse treatment and rehab care may be covered.
Optum also doesn’t offer insurance coverage for mental health treatment, but its network of member physicians provides mental and behavioral health services. UnitedHealthcare policies may or may not offer mental health treatment coverage—however, if you purchase your UnitedHealthcare plan through the Marketplace, mental health services are covered under all Marketplace plans.
Optum Inpatient Coverage
Optum does not provide inpatient coverage, as it’s not a health insurance company but rather a consortium of healthcare professionals, organizations, and advocates under the UnitedHealth Group umbrella.
UnitedHealthcare, or UHC, also under this parent group, provides varying levels of inpatient treatment coverage. Covered treatment options vary according to type of plan and coverage level. For instance, a short-term policy might pay very little towards an inpatient treatment plan (and that’s if the policy covers inpatient treatment). If inpatient services are covered, it’s only partial coverage and your out-of-pocket expenses would be greater than those of an individual or family policy.
Every policy is different, and coverage depends on multiple variables, not the least of which is where you obtained your policy. UnitedHealthcare offers seven handy tips to help you choose the best coverage for your unique healthcare needs.
Optum Outpatient Coverage
Optum doesn’t provide health insurance coverage for any medical services. UnitedHealthcare, however, covers outpatient services. For instance, Washington state resident policyholders requiring emergency substance abuse, mental health, or behavioral health services:
- Can visit any emergency mental health provider
- Do not require prior authorization
- Receive benefit coverage regardless of where they seek treatment (UnitedHealthcare covers in-network and out-of-network providers for Washington residents)
Most of UnitedHealthcare’s plans cover unlimited primary care visits, but again, you must wait until the date of effective coverage, otherwise your deductible, coinsurance, and other treatment costs could come out of your pocket if you receive any treatment outside your policy’s effective dates of coverage.
If you need assistance finding your insurance coverage information, reach out to a compassionate admissions specialist at Zinnia Health by calling (855) 430-9439. With your permission, we can contact your insurance company on your behalf and find out your exact levels of coverage.
Rehabs That Accept Optum Insurance Near You
As the sister company of Optum, UnitedHealthcare Marketplace plans cover you in all 50 states. Zinnia Health is a proud in-network partner with UnitedHealthcare and Optum’s network of physicians, specialists, and Behavioral Health Advocates.
Zinnia Health treatment facilities offer the highest quality standards for substance abuse treatment, and mental and behavioral health programs.
Zinnia Health is certified compliant with:
Contact our admissions team at (855) 430-9439 for a free verification to see if we accept your insurance. Our convenient Zinnia Health locations include the following.
- Zinnia Health Miami | Miami
- Zinnia Health Singer Island | Singer Island
- Zinnia Health Lake Okeechobee | Lake Okeechobee
- Zinnia Health Deerfield Beach | Deerfield Beach
How to Check Your Optum Coverage
Call Zinnia Health at (855) 430-9439. With your permission, we can contact Optum’s sister company, UnitedHealthcare, to discover your policy benefits.
Types of Optum Plans That Cover Addiction Treatment
Almost all health insurance plans cover some portion of addiction treatment, but the coverage amount varies depending on the type of plan you have and where you obtained your policy.
For instance, Optum’s sister company, UnitedHealthcare, offers state-funded and Marketplace insurance plans (with coverage that meets the stipulations of the Affordable Care Act) and a variety of employer-sponsored healthcare plans.
The employer-sponsored plan tiers may or may not align with the standards set by the ACA, meaning your specific coverage depends on what’s covered under your policy. That said, some UnitedHealthcare employer-sponsored plans may cover substantially more than others, depending on variables unique to you, your deductible, and your plan type.
Frequently Asked Questions
What Length of Stay Will Optum/UnitedHealthcare Cover?
Coverage caps on stays depend on your plan.
How To Pay for Costs Optum and UnitedHealthcare Don’t Cover?
Insurance rarely covers 100% of treatment costs for drug and alcohol abuse or any other type of treatment. If you’re concerned about how you’ll cover out-of-pocket expenses like copays, deductibles, and treatments that healthcare organizations may not cover, the best thing to do is speak to the treatment facility directly. Many offer payment plans, and some can eliminate your out-of-pocket expenses with grants and other programs.
What To Do If Optum Doesn’t Cover Rehab?
UnitedHealthcare covers some of the costs of rehab treatment in most cases, but certain facilities may not be covered, especially those that employ nontraditional techniques. If you have chosen a treatment provider but are worried about the cost of drug or alcohol recovery, speak to the treatment center. They can give you information on grants, payment options, and alternatives to ensure you get the care you need.
Do Rehab Facilities Need To Be In-Network?
The type of health insurance plan you have determines whether an inpatient rehab center must meet an in-network requirement.
If you need emergency mental health or substance abuse treatment, UnitedHealthcare requires no prior authorization and policies cover all services in- or out-of-network.