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UMR Insurance Coverage for Drug & Alcohol Rehab or Detox Centers Near Me

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UMR, which is a wholly owned subsidiary of UnitedHealthcare (UHC), is a part of the UnitedHealth Group.1 However, it is not an insurance company, and as such does not provide coverage for any services on its own.1 Instead, UMR is a third-party administrator (TPA) that exists to help self-funded employer health plans manage their claims process.1

TPAs like UMR exist to help ensure that your health care claims are paid correctly according to your UnitedHealthcare plan’s benefits and coverage.1 Depending on your plan because UMR can help provide proprietary care management and wellness programs, your employer-sponsored UHC plan may use UMR to provide behavioral health care case management.1

To find out what may be covered under your health plan, call the number on the back of your UnitedHealthcare insurance card. You can also work with American Addiction Centers (AAC) to verify your benefits coverage by calling the confidential helpline today.

What will UMR insurance cover?

  • In this section, discuss at a high level how the insurance provider may cover some or all of the cost of the following:
  • Inpatient/residential rehab
  • Outpatient rehab/therapy
  • Intensive outpatient programs (IOP)
  • Partial hospitalization programs (PHP)

Does UMR Cover Mental Health Care treatment facilities?

In the United States, almost all health plans are mandated by the Affordable Care Act (ACA), a federal health care reform law, to provide coverage in some capacity for mental health care services.2 That means that your UnitedHealthcare health insurance plan that is associated with UMR generally must provide some level of coverage for mental health care services such as substance use disorder treatment (e.g., rehab), behavioral health services, and inpatient mental and behavioral health services.2

As a reminder, because UMR isn’t an insurance policy, but rather a TPA, it specifically doesn’t provide coverage for any health care service itself.

The ACA mandate makes it possible for many to use their UHC insurance to seek covered care for services such as co-occurring disorder treatment or stand-alone heroin rehab. A co-occurring disorder refers to when someone has both a mental illness and substance use disorder at the same time.3

Those with substance use disorder are twice as likely to develop a mental illness at some point in their lifetime, and vice versa.4 Because the 2 conditions are interconnected, experts recommend getting tandem treatment, where each condition is addressed at the same time, but separately.3 “What should I do?”

To find out whether your UHC plan provides coverage for such services, and whether UMR will help facilitate the claims administration or case management for such services, call the number on the back of your insurance card.

How Long Does UMR Cover Rehab?

UMR, as a TPA for your UHC plan, may be the entity to ensure that coverage for a service, such as rehab, is administered correctly under your UHC health plan’s summary of benefits and coverage. There are a wide variety of UHC plans available, and every plan may treat coverage and duration of coverage for rehab differently. Be sure to call the number on your UHC insurance card to learn more about what is covered under your plan.

While every person’s situation is unique, and some may need to be in treatment for shorter or longer than the average recommended length of treatment, many experts agree that treatment should last at least 90 days to improve the overall outcome.5, bullet 5 The most important thing to remember is that adhering to your unique recovery plan is of the utmost importance and should be thoroughly discussed with your provider.

What if My UMR Policy Does Not Cover Rehab?

While you can’t evaluate whether your UMR policy covers rehab, as your actual health insurance coverage will be administered by UnitedHealthcare, it is possible that UHC may not fully or partially cover the costs associated with rehab.

Consequently, you may be responsible for paying for the costs out-of-pocket. Be sure to ask the rehab center you’re attending whether they offer any financing or scholarship options available to you to help offset these costs. Prioritizing getting treatment right now is critical rather than pushing it down the road.

UMR In-Network vs. Out-of-Network Rehab Centers

UMR may be responsible for checking whether the care you’ve received adheres to the network parameters set forth by your UHC plan. A network refers to the providers who have entered into a contract with your UHC plan to provide care at pre-negotiated costs.6

Staying in-network may help you keep your health care costs low and reduce the odds that you’ll receive a surprise medical bill.7 “Stay in-network” Depending on the plan you have, your coverage may be limited to in-network providers. UMR may be tasked with reviewing your health care costs claims and whether a provider is within your plan’s networks or not, and as such, whether it’s a covered claim.

Check UMR Coverage for Addiction Treatment

Your UHC health plan, which is the health insurance company that UMR works with as a TPA, may provide coverage for various types of addiction treatment.

AAC is here to help you navigate your insurance coverage and find quality, covered rehab facilities. Call the confidential helpline today to speak to a person who can check your benefits right while you’re on the phone.

A trained staff member can help you learn more about your benefits, and also check whether the industry-leading treatment centers from AAC, such as the Desert Hope Treatment Center in Nevada, are covered under your plan. Alternatively, you can enter some basic insurance information in the form below to instantly check your benefits and coverage.