Does Optum Health Insurance Cover Drug and Alcohol Rehab Programs?
If you’re looking for drug and alcohol rehab and have OptumHealth as your insurance provider, you may be wondering about insurance coverage for you or your loved one’s treatment. OptumHealth is a health insurance company that serves over 19 million members across the United States.1 With more than 53,000 doctors and 1,450 neighborhood clinics, OptumHealth is dedicated to helping people live healthier lives—including those who live with substance use disorder.1
Optum Health Insurance Plans
OptumHealth is available in the following states:2
- New Jersey
- New Mexico
- New York
If you’re ready to enter treatment for drug or alcohol addiction, rehab centers can check your coverage for you to determine what is covered by your OptumHealth plan. Call the rehab center with your insurance information, and the admissions specialist can check your coverage for you while you’re on the phone. Alternatively, you can call the number on the back of your insurance card to speak with an OptumHealth customer service agent who can help you learn more about the details of your plan and what is covered for drug and alcohol addiction treatment.
What Types of Addiction Treatment Is Covered by Optum Insurance?
OptumHealth provides insurance coverage for the treatment of mental health conditions including substance use disorder. Depending on the state you live in and the type of policy you have, OptumHealth will work with different treatment centers to provide services for people seeking rehab for drug and alcohol addiction. A variety of levels of care may be covered by your policy plan. The amount covered generally depends on your policy.
Addiction treatment services that OptumHealth insurance policies may cover include:3,4
- Medically assisted detox
- Inpatient treatment
- Counseling/therapy—for individuals, families, and group therapy
- Medication-assisted treatment
- Dual-diagnosis treatment programs
- Outpatient detox
- Partial hospitalization programs (PHPs)
- Outpatient treatment
The most widely-used drug and alcohol treatment services that may be covered by OptumHealth include:3,4
OptumHealth For Medical detox: Treating addiction to some drugs and alcohol requires a complex withdrawal process that requires medical supervision to keep you safe and healthy. Medications administered by medical professionals are often used during the withdrawal process to help you safely detox from the substance(s). This is known as medication-assisted detox. OptumHealth plans may cover medical detox when it is deemed medically necessary. If you believe you may benefit from medical detox, you may need to get pre-authorization before insurance coverage is provided. Medical detox can take place in inpatient and outpatient rehab settings.
OptumHealth For Inpatient/residential rehab: Inpatient rehab involves living on-site at a rehab treatment facility for a set number of days—typically between 15 and 90, though the length of stay depends on your needs and the inpatient treatment center you are attending. Patients attend individual counseling sessions and group therapy to get to the root of addiction, understand triggers and reasons for using substances, and learn healthy coping mechanisms and lifestyles to get and stay sober. With pre-authorization, many OptumHealth plans offer coverage for inpatient rehab treatment. Getting prior authorization often requires a referral from your primary care physician to prove inpatient rehab is necessary. Policies that require prior authorization vary between states and plans. Some OptumHealth policies may not cover all costs for inpatient treatment. Depending on your plan, you may need to meet a deductible before insurance coverage kicks in. Some policies also require copayments. Some plans may offer full coverage for a specified number of days per year.
OptumHealth For Outpatient rehab: Outpatient treatment is ideal for those who have completed inpatient treatment and prefer ongoing support and treatment. Outpatient treatment programs allow you to live and sleep at home and attend treatment during the day. Day programs—such as partial hospitalization programs and intensive outpatient programs—are recommended for people who need significant support but cannot or do not want to enter inpatient rehab. Depending on the outpatient treatment program, you may be required to attend sessions from 3 to 10 hours a day, from 2 to 7 days a week. Your OptumHealth plan may cover the cost of outpatient treatment, though in some cases a deductible may need to be met before coverage kicks in, and some policies require copayments. Working with an in-network provider can reduce or eliminate any out-of-pocket costs you may otherwise incur. If working with an out-of-network provider, you may be able to submit a claim to OptumHealth to request insurance coverage for treatment.
OptumHealth For Partial hospitalization programs (PHPs): Partial hospitalization programs allow you to live at home while you get treatment, and your days are spent at the treatment facility. This is sometimes referred to as “day treatment” and is optimal for those who know they can stay sober at home during the evenings/nights and are able to commit to attending treatment during the day.
OptumHealth For Intensive outpatient (IOP): Intensive outpatient programs involve attending treatment 3-5 evenings a week. You can live at home and work during the day but must attend treatment in the evening. These programs are best for people who have either completed inpatient rehab or do not yet require that level of care.
OptumHealth For Drug and alcohol counseling: Each person who goes through treatment—whether inpatient or outpatient—attends counseling sessions, both alone and in group settings. Some insurance policies also offer coverage for family counseling. Counseling can help identify reasons and triggers that contribute to substance use disorder and can give you the knowledge and life skills needed to prevent relapse in the future.
Knowing what your OptumHealth plan covers can help you avoid unexpected costs while you or your loved one are receiving treatment. This provides much-needed peace of mind so you can focus on what matters most: getting sober and staying in recovery. For more information on OptumHealth insurance plans and to check what your plan covers, you can call the number on the back of your insurance card to speak with an OptumHealth customer service agent. Alternatively, you can call one of our admissions specialists at . They can check your insurance benefits for you while you’re on the phone.
Does Optum Health Insurance Cover Inpatient Mental Health Treatment?
Many people who struggle with drug and alcohol abuse also have mental health disorders, including anxiety, depression, PTSD, and mood disorders. These are known as co-occurring disorders or dual diagnoses. According to the 2016 National Survey on Drug Use and Health, more than 8 million adults aged 18 or older had mental illness and substance use disorder.5
To optimize treatment results, it’s imperative to treat any mental health conditions while treating substance use disorder. The conditions often impact one another and treating one but not the other is generally not as effective. Most rehab centers treat mental health conditions along with addiction.
Under the Affordable Care Act (ACA), insurance companies are required to provide coverage for mental health care and addiction treatment.5 Both co-occurring disorder treatment and stand-alone rehab for drug and alcohol addiction fall under this mandate.6 OptumHealth provides both physical and behavioral health services, understanding both are vital parts of healthcare. Most OptumHealth plans cover mental health treatment while in rehab to ensure improved quality of life and outcomes.7
How Long Does OptumHealth Cover Drug and Alcohol Rehab Programs?
OptumHealth offers a number of different policies and levels of coverage. Each policy’s coverage varies for different services. The length of time covered for drug and alcohol addiction treatment varies depending on the specific plan you have
Longer treatment times are generally considered most effective. In most cases, a longer stay in rehab leads to fewer instances of relapse and better rates for long-term sobriety. Research shows that a longer duration of treatment (3-6 months) and structured continuing care—including counseling and outpatient treatment programs—are associated with better treatment outcomes for people with substance use disorder.8
If you want to better understand what your OptumHealth plan covers and how long you can stay in treatment with insurance covering the costs, you can log in to the OptumHealth member portal to learn how many days are covered in a calendar year. Alternatively, you can call the number on the back of your insurance card to speak directly with an OptumHealth customer service representative, who can go over the details with you about what is covered and for how long for drug and alcohol treatment.
What if my Optum Health policy does not cover addiction treatment centers?
As an OptumHealth member, at least some of your treatment should be covered by your insurance plan. If your insurance policy does not cover all of your rehab expenses, don’t let that keep you from getting into treatment so you can get on the path to recovery. If you’re ready to enter treatment, it is time to do so. Getting and completing treatment saves lives, and can help you move forward with your life while sober and healthy.
Many drug and alcohol treatment centers throughout the United States—including the NorthEastern region of the country—work with OptumHealth to provide coverage for drug and alcohol addiction. Don’t let lack of coverage get in the way of getting sober and moving on in recovery. There are many options to consider when figuring out how to pay for treatment, including:(These are just ideas and not stated facts — not sure how to source it).
- Crowdfunding (asking family and friends for support)
- Payment plans may be offered by rehab centers so you can pay back your out-of-pocket costs over time
- Scholarships and grants that may be offered by rehab centers
Admissions navigators at your rehab center of choice can discuss your payment options with you. They can verify your insurance for you so you know what to expect when it comes to deductibles, copays, and any other out-of-pocket expenses and help you formulate a plan to cover any of the expenses you are responsible for.
Optum Health In-Network vs. Out of Network Drug Rehab Centers
In-network drug and alcohol treatment centers have an agreement with OptumHealth to offer treatment at a lower rate than other providers. If a facility is out-of-network, it means they do not have an agreement with OptumHealth to offer treatment services at a lower rate.
This generally means you will be responsible for more expenses, and in some cases, may need to pay for all of the treatment costs yourself. The difference in cost in selecting in-network vs out-of-network can be staggering as some insurance companies may not provide any coverage for facilities that are not in-network.
OptumHealth insurance is accepted at a number of excellent, high-quality rehab facilities throughout the Northeast region of the United States, so try to work with a rehab center that is in-network whenever possible. Selecting a treatment facility that is in-network with OptumHealth will keep your out-of-pocket costs low. This allows you to focus on what is most important—your sobriety and recovery.
In some cases, OptumHealth may cover some of the costs for treatment at out-of-network treatment facilities. For example, OptumHealth may provide coverage at an out-of-network facility if you live in an area where you cannot access treatment at an in-network facility, or you belong to a certain population (e.g., veteran) and need treatment at a veteran-specific facility. In most cases, this requires more work on your end, including paperwork to get insurance approval.
How to Use Optum Health Insurance Coverage for Addiction Treatment?
It’s important to check your OptumHealth insurance benefits before you make your final decision about which rehab facility you or your loved one will attend. It’s important to understand your financial responsibilities for drug and alcohol addiction treatment, including a deductible that may need to be reached before coverage kicks in, and any copays you are responsible for. There are a few ways to check your coverage:
- Call the number on the back of your insurance card. This will connect you with an OptumHealth customer service representative who can go over the details of your plan with you
- Login to OptumHealth’s member portal on their website to read over the details about your plan and get an understanding of what drug and alcohol treatment services are covered.
- Call an admissions navigator at American Addiction Centers. Reach our helpline at to speak to an admissions specialist who can check your benefits while you’re on the phone.
If you prefer, you can complete the form below to enter your information and see immediately if the center you are considering is in-network with OptumHealth.
American Addiction Centers has a number of drug and alcohol addiction treatment centers in the Northeast United States.
AdCare Rhode Island. Located in New Kingstown, Rhode Island, AdCare has an integrated system of care that offers a nationally recognized hospital facility in Worcester, Massachusetts, an inpatient center in New Kingstown, and a network of outpatient treatment facilities throughout Massachusetts and Rhode Island.
AdCare Hospital. Located in Worcester, Massachusetts, AdCare Hospital offers detox services, residential treatment, outpatient treatment, intensive outpatient services, and behavioral health services.
AdCare Outpatient Facility, North Dartmouth. Located in North Dartmouth, Massachusetts, this facility offers intensive outpatient services, outpatient treatment, and dual diagnosis treatment and care.
AdCare Rhode Island – Greenville. Located in Greenville, Rhode Island, this facility offers detox services, intensive outpatient treatment, behavioral disorder treatment, and outpatient services.