Insurance Coverage for Addiction Treatment
When it comes to insurance, there are many factors at work during the process of providing a recipient with coverage. In some cases, there are multiple parties involved on the chain from insurer to recipient, and the language involved with insurance coverage for life events like the need for addiction treatment can be confusing for some.
If you’re a recipient of UMR Insurance Benefits and struggling with a substance abuse disorder, you’re eligible to receive coverage for drug and alcohol rehab at many different organizations nationwide. Icarus Behavioral Health in Nevada is at the top of such facilities, and we work daily to simplify the process through which our clients navigate the experience with any given health insurance provider.
In this article, we clarify some of the most pertinent information regarding substance abuse treatment, mental health services, and other behavioral health benefits for those covered under UMR Insurance.
If you have questions regarding coverage for alcohol and drug rehab, inpatient rehab, or any other form of substance abuse treatment, read this until the end to satisfy any concerns you have about any UMR health insurance and finding help now with Icarus!
The Basics of UMR Insurance Regarding Drug and Alcohol Rehab
UMR insurance company is a third-party administrator (TPA) for the larger entity United Healthcare and a large collection of organizations that use them to provide coverage for employees. The simplest example of this dynamic would be to compare UMR to a secretary or office administrator for the United Healthcare Insurance Company, only on a much larger scale. UMR’s job entails processing claims, managing recipients’ benefits packages for employers, and facilitating payment of services.
UMR Insurance is what’s known as a Preferred Provider Organization (PPO) insurance plan. A PPO health insurance plan contracts with various medical organizations, such as doctor’s offices, hospitals, and addiction treatment facilities, to maintain a network of what’s referred to as participating providers. However, PPO plans allow clients to seek treatment at facilities out-of-network, usually for additional costs and copays.
The Benefits of Using a PPO Plan
One of the major benefits of a PPO health insurance plan is the fact that you’re generally not required to obtain a referral for any specialized forms of treatment like drug and alcohol rehab. Despite the fact that monthly premiums and out-of-pocket expenses tend to be slightly higher than HMO health insurance plans, most recipients willingly endure this increase to enjoy the flexibility of selecting their own treatment provider without the hassle of obtaining a referral.
That said, if you choose an addiction treatment provider that’s in-network for UMR, like Icarus Behavioral Health Nevada, you usually automatically receive the following benefits:
- The ability to see specialists with no referrals
- Receive treatment at a discounted rate
- Less paperwork and hassle during each visit
- Usually, their network is so vast your chosen provider is likely a member
This covers the basic framework of all medical care – but what about drug and alcohol treatment specifically? You might be unsure of what level of substance abuse care to receive, so it’s important that you’re confident in the fact that the options you’re considering are indeed covered.
What Levels of Substance Abuse Care does UMR Insurance Coverage Provide Benefits For?
When you’re contemplating entering drug rehab, nothing is guaranteed from the onset. Many clients attend drug rehab or alcohol treatment in an inpatient rehab setting, only to discover they require additional treatment services.
Nobody wants to feel that they’re limited in what their insurance policy will cover, especially when it comes to something as crucial as drug and alcohol addiction treatment. UMR insurance benefits regularly provide coverage for the following:
During inpatient drug rehab, clients undergo a plethora of drug treatment or alcohol treatment-related therapy. Options for visits generally include 30, 60, or 90-day residencies at a live-in facility like Icarus Behavioral Health. During inpatient drug rehab, clients receive a personalized treatment plan catered specifically to their situation, outlining the framework of mental health and drug and alcohol treatment.
Clients normally meet with counselors several times throughout the day to cover drug and alcohol-related topics and mental health challenges. Clients also have the opportunity to participate in multiple forms of group therapy sessions, and even involve their families in their treatment plan.
One of the main advantages of outpatient rehabilitation is that it allows people to live in their own homes, and their lives continue as usual while they’re recovering. This type of treatment is often used for those with mild addiction. It can also be used for those who have completed inpatient alcohol and drug rehab and want to build on what they learned during their residency at the facility.
Who Should Choose an Outpatient Drug Rehab?
Despite the varying levels of intensity, both types of treatment can help individuals successfully recover. Outpatient drug treatment is normally ideal for:
- Clients with an addiction of medium severity who have already experienced medical detox and the withdrawal process
- A strong support system
- Reliable means of transportation to their sessions each week
- The responsibility and drive to see their treatment through until the end
- Low risk of relapse or those whose drug of choice DOES NOT include a physical withdrawal
- Clients who want to gradually decrease their drug treatment experience by taking baby steps
Intensive Outpatient Programs or IOPs for Substance Abuse Treatment
For clients who don’t require 24-hour supervision or medical detox, intensive outpatient treatment is an ideal option. However, the ideal client must maintain a higher level of commitment and involves regular contact with a treatment professional.
It’s also an ideal option for those who want another step between inpatient and standard outpatient. Compared to other types of outpatient programs, intensive outpatient programs are more cost-effective as you’re getting more treatment time for your money.
Even though the length of an intensive outpatient program varies, many of them last for up to 16 weeks before a person moves to standard outpatient or aftercare services. Intensive outpatient care can help people manage their school, work, and family obligations while allowing them to focus on their recovery. The most critical aspect as with standard outpatient is the existence of a drug-free environment while a client transitions back into a normal setting.
Partial Hospitalization Program or PHP
Individuals entering a Partial Hospitalization Program (PHP) generally require the same level of intensity of treatment as those in a residential setting. However, certain roadblocks may stop them from staying overnight in an alcohol rehab treatment or drug rehab center.
During a PHP treatment program, clients normally receive six-to-eight hours of therapy per day, generally starting in the morning. They’re able to return home in the mid-to-late afternoon and usually stay home over the weekend.
So what about specific amounts of coverage? How much will a drug addiction treatment program cost with a UMR insurance policy?
What are the Typical Cost of Services With UMR Coverage?
The following list outlines the cost of specific services for those with UMR coverage under the Premier Plan:
- If a client attends an outpatient rehab program, the copayment is usually $40. The coinsurance rate is 5% after a $100 copayment is met.
- Inpatient treatment is also 5% after a $100 copayment is recorded.
- If you use an out-of-network provider for either one, the coinsurance rate is 50%, meaning UMR covers half of your treatment.
Use Icarus in Nevada and Your UMR Insurance for Recovery
With the right treatment plan and expert team to deploy the plan, your odds of successful recovery are incredibly high. Add a quality insurance organization to the mix and you’ve got a recipe for a stress-free experience and long-term recovery.
If you or someone you know carries a UMR policy and is interested in receiving treatment in or around Nevada, contact the admissions department at Icarus Behavioral Health today.