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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.
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.
Optum Health is a prevention-focused organization. This means that it offers coverage for preventive care, addiction treatment, and for aftercare.
Optum Health will cover a portion of your inpatient stay with a residential addiction treatment facility providing the clinic is in Optum’s network. In addition, Optum provides these services itself, which means you may be able to go directly to an Optum clinic to save on costs.
Optum Health covers a percentage of outpatient treatment including intensive outpatient (IOP). However, actual coverage will depend on your plan and whether you’re going to an in-network provider.
If your treatment provider recommends complimentary treatments such as exercise, stress reduction therapy, or similar, Optum will cover it.
Optum supports medication assisted treatment, meaning you can have it covered by your insurance.
Optum will cover doctor-recommended stays in a detox clinic, including medical monitoring.
Optum will cover additional therapy and psychotherapy as part of your plan.
You can get coverage for doctor-referred aftercare including ongoing treatment and sober-home stays.
Essentially, providing you find an in-network provider, Optum will cover nearly any treatment option you might want.
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’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.
Once you know what your insurance provider covers, you can take steps to get coverage. This means:
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.
If you or a loved one is struggling with substance use disorder, getting help means going to treatment and getting therapy. Your insurance provider is required by law to offer coverage. However, Optum’s actual coverage can vary a great deal depending on which clinic you go to. For example, an out-of-network provider will not likely be covered. On the other hand, if you go to an in-network provider, get outpatient care, and have a doctor’s referral, you might get up to 90% coverage depending on your plan. Therefore, you’ll always want to check your employer-negotiated terms as a starting point and check your options from there. Additionally, total costs and deductibles will likely be lower if you choose an Optum facility.
Good luck getting treatment. Hopefully this information on Optum’s coverage helps you find a rehab center that meets your needs.