United Healthcare Insurance Coverage

United Healthcare Group is the largest provider of health insurance in the United States. As such, the company offers health insurance to some 49.5 million people. That’s good news if you’re looking for rehab coverage for substance abuse, as United Healthcare offers a very large network of rehab clinics and hospitals. However, there’s still a lot to research and learn about your coverage and your plan before you should go to rehab.

For example, United Healthcare offers vastly different coverage depending on your plan. That’s also true if you have United Healthcare through your employer, which means you’ll have to check your insurance coverage with your employer.

Does UHC Insurance Cover Substance Use Disorders?

Yes, United Healthcare offers coverage for substance use disorders and treatment. Every insurance provider in the United States does. That’s because it’s required under the Affordable Care Act.

In addition, as one of the largest insurance providers in the country, you’re very likely to have your insurance accepted by most clinics and rehab providers. United Healthcare also has one of the largest networks of PPOs on the market.

What Types of Rehab and Treatment Does United Healthcare Insurance Cover?

UHC offers support for most rehab and treatment options.

These include:

However, it’s important to keep in mind that your actual treatment will depend on the rehab center you go to. If you want dual diagnosis treatment, you’ll need a treatment center that provides it. And, if that center is in UHC’s network, they will offer coverage.

What Are Your Costs with UHC?

UHC divides its plans by provider and by scale. So, you can get a PPO (Preferred Provider Organization), a Health Maintenance Organization (HMO, a Point of Service (POS) or an Exclusive Provider Organization (EPO), each of those are divided into tiers. Therefore, those points will affect the following costs:

• Bronze – $9,100 deductible with a matching out of pocket limit. However, you won’t pay anything else. You cannot go to an out of network provider.
• Silver – UFC’s silver plan has a $2,000 deductible with a $9,100 out of pocket limit. You’ll also pay a $20 per visit copay for outpatient services and a $750 copay for inpatient services. Out of network providers are not covered. In addition, you may pay more without a referral. 
• Gold – UFC’s Gold plan has no deductible. You’ll also pay $5,000 out of pocket for in-network providers. Otherwise, costs are the same as the silver plan.
• Platinum – The Platinum plan does not have a deductible. In addition, you’ll pay a maximum of $3,000 out of pocket for in-network providers. There are no costs with an IHCP provider. However, you can expect a $500 per admission at a non-IHCP provider with a reference. Out of network providers are not covered.

Essentially, your actual coverage can vary a lot. In addition, coverage will vary further based on the specific type of your plan.

Can You go to Out of Network Providers?

UHC allows out of network providers depending on the type of plan. For example, if you have an EPO, you cannot go out of network. On the other hand, most other plans will allow you to do so. However, you will pay extra costs.

In most cases, UHC does not support out of network providers. In other cases, you may be able to waive some costs by attending a specific type of provider with a referral. However, you’re always better off attending an in-network provider. However, with over 760 treatment centers accepting United Healthcare, that should be relatively easy. And, with almost 300,000 behavioral health providers, UHC offers plenty of coverage for counseling, therapy, and aftercare as well.

Getting Started with Rehab with UHC Insurance

United Healthcare is one of the largest insurance providers in the United States. In fact, it lists that over 29,000 people have used its insurance policies to attend rehab between 2020 and 2023. UHC has an extremely large network, that makes it relatively easy to move forward with the provider.

Here, you’ll want to:

• Go to your doctor and get a referral, this ensures you get maximum coverage, although not all plans will need it
• Choose an in-network provider to go to. You can do this with your doctor or with the help of your rehab counselor
• Check what your plan covers and how much it covers so you understand your total out of pocket costs
• Request prior authorization for treatment, either through your doctor or through the UHC dashboard

From there, you can go to treatment and get coverage for your substance use disorder treatment, just like you would for any other medical service or treatment. UHC will follow up on your claim in the same fashion as for anything else.

Keep in mind that if you have UHC treatment through your employer, you’ll have to use their terminal. However, the employer is not legally allowed to know what you’re getting medical treatment for, so prior authorization always goes through UHC and not through your employer.

United Healthcare Group is one of the largest insurance providers in the United States. It’s also one of the options with the largest network. That’s good, because they rarely offer coverage for out of network clinics. However, with over 760 treatment centers in network, you’ll still have plenty of options to get the treatment you want.

Stairway Resource Center is an in-network provider for United Healthcare Insurance. If you or a loved one is seeking help for drug or alcohol abuse, contact us at Stairway Resource Center today. At Stairway Resource Center we provide a 60 to 90-day outpatient program that takes place in an engaging and supportive community setting. We offer dual diagnosis treatment and daily group and individual therapy for our clients, in addition to fun community-based events and activities.