Optum Health Insurance Coverage

Optum Health Insurance is a subsidiary of United Health Group, and as such is one of the largest providers in the United States. While the group only provides employer-provided healthcare, it covers millions of patients across the United States. In fact, Optum used to be Apple Health Care. Today, it provides a mix of direct care and prevention as well as health coverage via old plans.

However, Optum is not upfront about what they cover or why. In fact, that normally has to do with the terms negotiated by your employer and what plan you’re on. Therefore, you’ll have to check with your employer to see how much coverage you get and what your options are.

Does Optum Health Insurance Cover Drug and Alcohol Treatment?

Yes. Optum Health Insurance covers partial reimbursement for all medical health problems you receive treatment for when it is in network and referred by a doctor.  In addition, all health insurance providers are required by law to offer at least partial coverage for rehab and addiction treatment under the Affordable Care Act (ACA) or Obamacare. This means that no matter what your plan is, you will receive some coverage. However, that can vary significantly depending on where and how you go.

What Types of Drug and Alcohol Rehab Does Optum Health Cover?

Optum Health is a prevention-focused organization. This means that it offers coverage for preventive care, addiction treatment, and for aftercare.

Normally this means:

Essentially, providing you find an in-network provider, Optum will cover nearly any treatment option you might want.

What Do You Pay with Optum Health Insurance?

Your Optum Health Insurance plans will entirely depend on your employer’s plan and what you’ve opted into. This means there’s no way to determine what you are paying or what is covered without logging into your HR portal. Here, chances are, you can simply check coverage in an email or in an HR portal without talking to anyone.

However, if you can’t find that information, it’s important to keep in mind that you can always ask human resources for a list of deductibles and coverage provided by your plan. Your employer cannot ask you what it is for and they will not be able to see what you’re getting treatment for.

You will want to know:

You’ll also want to know who you can call for things like preauthorization or if your doctor has to submit that for you. In most cases, everything you need should be available on a single fact sheet or in a single portal or in your contract with Optum, which may be Apple if you have an older contract. Check these details, make sure they are up to date, and then follow through that way.

If you have an employer-provided health plan from Optum, chances are, you can contact them and see what your coverage is. You might also have a copy of the plan. However, as AppleCare joined Optum in 2010, you might have an old AppleCare contract. In this case, you’ll want to verify your coverage with your employer and request a copy of your new contract.

How to Start Addiction Treatment with Optum Health?

Once you know what your insurance provider covers, you can take steps to get coverage. This means:

• Finding a rehab clinic and confirming that they accept Optum Insurance
• Confirming that your rehab clinic is in network for Optum
• Getting a referral from your doctor
• Having your doctor request pre-authorization

From there, everything else will be covered, just like if you attend any other medical treatment. However, it is important to keep in mind that deductibles for inpatient care are normally quite a bit higher, which might mean that you pay a significant amount of out-of-pocket costs. If you have an Optum HSA to match, you will most likely be able to draw from that savings account as well.

You’ll always need the doctor’s referral. However, you’ll never have to tell your employer, you’ll never need your employer’s sign-off or approval, and they should never ask what you’re getting medical treatment for.