Does Optum Health Insurance Cover Addiction Treatment?

Does Optum Health Insurance Cover Addiction Treatment?

For individuals covered through an Optum health insurance policy, drug or alcohol treatment is widely available. In most cases, it will either be partially or fully covered by one’s Optum health plan. It is worth noting, however, that the extent and nature of addiction coverage depends in large part on the specific health insurance plan. Other factors that can influence coverage include one’s state of residence, the rehab center in question, and the copays and deductibles associated with one’s plan.

For people suffering from addiction, it is crucial to get outside help. Addiction cannot be managed through personal will power alone. Rehab programs can help people develop the coping tools they need to avoid relapse, address underlying issues, and begin rebuilding new lives in sobriety. Fortunately, in-network outpatient rehabs like NuView Treatment Center have strong relationships with Optum and are available at almost no cost to Optum policyholders.

Optum Health Insurance

Optum is a healthcare company founded in 2011. It operates in over 150 countries and ensures millions of people throughout the United States. Optum is technically part of UnitedHealthcare. As a subsidiary of Unitedhealthcare, Optum has numerous relationships with other medical groups and insurance programs. As a result, it has an extensive network of high quality service providers. Individuals who are insured through any of Optum’s insurance plans find it easy to access high quality local behavioral and mental health services, including addiction treatment.

Optum and Addiction Treatment

Optum offers health insurance plans in over a dozen US states. These include: Arizona, Colorado, California, Connecticut, Indiana, Florida, Massachusetts, New Jersey, Nevada, Ohio, New York, Texas, and Utah. These states all have legislation that requires insurance companies like Optum to offer coverage for addiction treatment and mental health services.

Many employer-based health plans offer insurance through Optum. For employees or family members covered by an employer-based Optum plan, some degree of addiction treatment coverage is to be expected. In fact, companies with over 50 employees are legally required to offer the same degree of substance abuse treatment coverage as they do for physical health problems.

For people who are not covered by an employer, Optum’s family and individual plans often have different coverage levels. While all plans offer substance abuse treatment, the exact services that Optum is willing to pay for can depend upon the specific plan.

Treatment Services Covered by Optum

In most cases, recovering from a drug or alcohol addiction requires long term treatment. People who successfully recover frequently make use of a wide variety of treatment modalities. With that in mind, Optum offers coverage for a number of different programs and services. These include but are not limited to:

  • Medical detox centers
  • Inpatient rehabs
  • Outpatient rehabs
  • Drug testing and drug screenings
  • Dual diagnosis treatment
  • Medication-assisted treatment (MAT)
  • Individual and group therapy
  • Family counseling
  • Prescription medications

Some Optum health insurance plans require policyholders to obtain a health assessment or get a referral from their primary care physician before they are covered for the above-listed services. Other Optum health plans allow people with diagnosed substance use disorders to take part in these services without authorization, as long as they use an in-network facility. The out-of-pocket expenses associated with addiction treatment also depend upon the specific health plan. Most frequently, these out-of-pocket expenses come in the form of copays, which are fees that policyholders are required to pay before their insurance kicks in.

Types of Optum Plans

The benefits and coverage levels that Optum offers are generally determined by an individual’s state of residence. Certain states cover community center classes, urgent care services, specialty care, advanced care, surgeries, and primary care. Other states only cover a portion of these services, while others cover entirely different ones, such as pharmacy costs, palliative care, and hospitalizations. While an individual’s state of residence determines what Optum plans are available to them, ultimately the main factor is whether they have an HMO or PPO plan.

Both PPOs and HMOs cover basic services like dental, medical, and vision care. However, they are distinct in terms of the benefits they offer. If you have an Optum health insurance plan, it is crucial to understand which type of plan you are paying for. NuView Treatment Center can help verify which type of insurance plan you have, and we can also research what benefits you are entitled to under your Optum plan.

Optum HMO plans generally have lower out-of-pocket expenses. In most cases, Optum HMO policyholders have almost no copays whatsoever. On the other hand, policyholders generally need to obtain referrals to see specialists, including addiction counselors and outpatient rehabs. Services are also often required to be obtained from in-network providers. Out-of-network facilities and services are generally not covered at all by Optum HMO plans. Optum representatives can assist policyholders in finding providers within their extensive network of high quality treatment centers.

Optum PPO plans are associated with somewhat higher out-of-pocket expenses, including copays and coinsurance. Nonetheless, policyholders benefit because they are not required to obtain referrals when they need to see a specialist. They are also allowed to see any provider or attend any treatment center they wish, including rehabs outside of Optum’s network. While out-of-network coverage with PPO plans is better than HMO plans, the coverage is still somewhat less than people receive when they see in-network providers.

Outpatient Addiction Treatment with Optum

Optum healthcare plans have wide coverage for outpatient addiction rehabs. Outpatient rehabs are generally regarded as just as effective as inpatient treatment programs. They have the added advantage, however, of being flexible for clients. With no residency requirement, outpatient rehabs allow clients to live at home with their families or social support system while receiving regular evidence-based treatment at a facility. This makes it easy for clients to go to work, support their families, and remain steadfast with their life commitments.

Optum health plans cover a wide range of levels of care for outpatient rehabs. Outpatient treatment programs are designed to address the needs of people experiencing addiction at all levels of severity. In most cases, people progress from more acute treatment programs to less acute programs as they develop stronger sobriety. In fact, research shows that making use of multiple levels of care and pursuing formal addiction treatment for longer periods of time is associated with lowered rates of relapse. Outpatient treatment programs covered by Optum, from most acute to least, include:

  • Partial hospitalization programs (PHPs)
  • Intensive outpatient programs (IOPs)
  • Outpatient programs (OPs)
  • Aftercare planning

Outpatient programs within Optum’s network help people recover from substance addiction using a variety of treatment modalities. Clients engage in individual and group therapy to address the underlying issues that may be motivating their substance abuse problems. These issues can range from untreated mental health disorders to interpersonal conflicts. Meanwhile, clients work hard to develop new tools and coping strategies to deal with triggering situations and avoid relapse. Quality outpatient programs within Optum’s network also support clients as they take steps toward developing new and fulfilling lives for themselves in sobriety.

Coverage for outpatient care with Optum depends on an individual’s state of residence and whether they have a PPO or HMO plan.

Optum and the Affordable Care Act

The Affordable Care Act has completely changed the way insurance companies like Optum handle substance use disorder treatment. Perhaps the most important change enacted by the ACA, as it is sometimes known, is that addiction treatment is now considered an “essential health benefit.” As a result, all health insurance companies are obligated to cover addiction treatment for all policyholders.

Addiction can also no longer be used as an excuse to deny someone coverage. In the past, health insurance companies would frequently treat people with addiction as liabilities. They would deny people coverage on the basis that their addiction was a potentially expensive “pre-existing condition.” The Affordable Care Act makes this practice illegal. As such, any individual with addiction, no matter what severity and no matter what substances they use, can have access to high quality health insurance programs through Optum.

Dual Diagnosis Treatment with Optum

Optum recognizes that an enormous percentage of people with addictions are technically dual diagnosis clients. What does dual diagnosis mean? Dual diagnosis is a clinical term that refers to individuals who suffer from substance use disorders alongside one or more additional mental health disorders. Research published by the National Institute on Drug Abuse shows that half of people with addiction have additional mental health conditions, and half of people with mental illness have substance abuse problems.

These two conditions are generally mutually reinforcing, such that it is impossible to successfully treat one without also treating the other. A resurgence of symptoms of depression, for instance, can drive a person to drink even if their addiction treatment program is technically very high quality. Similarly, few people can successfully manage their substance addiction unless they address underlying mental health conditions.

The Affordable Care Act extends to mental health treatment as well as addiction treatment. It makes mental health treatment an essential health benefit, and it also enforces a policy known as parity. Parity means that if a person has to pay a certain copay to see a doctor about a physical health condition, that copay cannot be more for a mental health condition.

Outpatient programs offered in Optum’s network, including NuView Treatment Center, offer a variety of services to help dual diagnosis clients achieve recovery from a variety of conditions. Outpatient programs offer a treatment modality known as integrated treatment, which involves using a comprehensive array of evidence-based therapies to address both conditions simultaneously. They also frequently prescribe medications that help mitigate cravings, reduce symptoms of mental illness, and help people face the challenges of early recovery.

What Does Optum Cover For Me?

It can be difficult and even intimidating navigating the nitty gritty details of one’s health plan. In many cases, the fine text may be difficult to parse. In most cases, your Optum insurance representative’s number is listed on the back of your health insurance card. Optum representatives can help answer questions you have about your coverage levels and what treatment options are available to you.

For those who want to pursue addiction treatment more aggressively and obtain a bit more support, NuView Treatment Center staff members are available to help you navigate the ins and outs of your individual health insurance plan. Contact us at (310) 984-1730, and our staff members can work with you and your insurance representative to determine your coverage levels and get you connected to the rehab services you need.

Addiction Treatment at NuView Treatment Center

NuView Treatment Center, an outpatient rehab center located in Los Angeles’s Westside, offers modern facilities and evidence-based treatment modalities to help people recover from addictions and mental health disorders. We also have a longstanding relationship with Optum insurance, so we are partially or fully covered for most individuals insured through Optum.

Our staff is high trained in the latest evidence-based addiction therapies. We believe that compassion is crucial when treating addiction. We ensure that every client is treated as a human being with a unique story and unique needs. Our staff develop individualized treatment plans for every client, ensuring that their underlying issues are addressed and that they are supported as they work to build new lives for themselves.

For individuals insured through Optum, NuView Treatment Center is in-network — and we are also known as West Los Angeles’ preeminent treatment center. If you are ready to make a change and begin a new way of life, contact NuView Treatment Center today for a free and confidential evaluation.

Reach out to us today.

Send us a message below.