Using UHC Insurance with Optum for Drug & Alcohol Rehab

Optum—a clinical healthcare service that serves over 127 million customers—coordinates treatment with United Healthcare insurance and other major insurers.¹ Optum and UHC contract with many providers and facilities, including those that provide addiction treatment. This article will explore how UHC/Optum cover behavioral health treatment.

Does Optum/UHC Cover Addiction Treatment?

Optum and United Heatlhcare with one another to comply with federal parity guidelines, which mandate that coverage for addiction treatment and mental health services in a given plan are equal to the coverage provided for medical and surgical needs.²

The extent of your insurance coverage for addiction treatment will depend on your specific policy. Your coverage will depend on whether you stay in your plan’s network or go out of it. Staying in your network will generally result in much greater coverage levels than were you to go outside of it. You can verify your coverage now with our short and simple .

Which Types of Substance Abuse Treatment Does UHC with Optum Offer?

With your UHC/Optum coverage, you may be able to access many forms of evidence-based treatment for substance use disorder (SUD), such as:

• Medical detox.
• Inpatient treatment.
• Outpatient rehab care.
• Transitional housing.

There are many addiction treatment resources in the New England area accept UHC/Optum plans. For example, AdCare facilities—located in Rhode Island and Massachusetts—are within the UHC/Optum care network and offer a full continuum of care spanning from medical detox and inpatient rehab to outpatient therapy.

How Much Does Addiction Treatment Cost with United Healthcare/Optum?

The out-of-pocket costs of addiction treatment depend on several factors including, but not limited to:

• The type of treatment (inpatient vs. outpatient, etc.).
• Whether insurance was used, and the coverage provided by the specific plan.
• The treatment facility.

Usually, patients will have to meet their deductible—an amount that must be paid out-of-pocket each year before coverage begins.³

After the deductible is reached, patients will likely be charged either a co-insurance percentage of the entire cost of treatment, or co-payments at each point of service.

• A co-insurance percentage is a percentage of treatment costs someone would have to pay out-of-pocket.⁴ For example, if the co-insurance rate is 20% for an inpatient stay, the insurer would cover the remaining 80% of the cost of that service.
• A co-payment is a fixed dollar amount that is paid when services are rendered (e.g., attending an outpatient counseling session).⁵

Each insurance plan should have an out-of-pocket maximum, which is a dollar amount that, once reached, means the insurance provider will cover 100% of the remaining costs of eligible health services for the rest of the plan year.⁶

Information regarding the specifics of these terms and how they would apply to addiction and mental health treatment can be found in the summary of benefits and coverage (SBC) on each given insurance plan.⁷

To find more complete information on how much addiction treatment costs with your insurer, call the number on the back of your insurance card to speak to a representative.

How to Pay for Rehab with UHC and Optum

Optum is not an insurance company; however, they do contract with United Healthcare to provide coverage for many health services, including addiction treatment.

UHC/Optum coverage is accepted at AdCare Treatment Centers. Prospective patients can check their coverage at AdCare using the confidential online form below. Doing so requires:

• An email address.
• The name of the insurer.
• The insurance policy number.

Once you have decided on using your UHC/Optum coverage to enter addiction treatment, program staff may need to obtain prior authorization from your insurance company or primary care provider (PCP) before they formally start the rehab admissions process.⁸ Admissions navigators at AdCare are standing by 24/7 at to answer questions and assist with this process.

Benefits of Using UHC Insurance with Optum for Rehab

Using UHC insurance with Optum enables people that are insured to get addiction treatment that they might otherwise have difficulty affording. While there are ways to pay for rehab without insurance, using health insurance simplifies the process, allows for more options, and makes it considerably cheaper.

There are 6 states in the New England area are New Hampshire, Connecticut, Vermont, Maine, Massachusetts, and Rhode Island. Addiction is a devastating and widespread issue, but the problem is particularly grim in New England:

• At 9.8%, Vermont has the second-highest rate of residents that drink heavily in the country.⁹
• According to data compiled in 2018, every state in New England except for Vermont is ranked among the top 10 worst states in terms of opioid-involved overdoses per capita (Vermont is 11^th).¹⁰
• In 2019, Massachusetts was among the top 5 states for reports of fentanyl.¹¹

If you struggle with addiction, you’re not alone, and it’s not too late to get help. Please reach out to an admissions navigator at to discuss your options for treatment today.