What Is Optum Insurance & How Does It Work?

If you are considering rehab for help with a substance use disorder but are worried about how much it is going to cost, you are not alone in this worry. Fortunately, health insurance companies are here to help you pay for some or all of your treatment, doctor’s visits, residential care, medication, and more in many cases.

Optum Insurance is one of the top American insurance companies and has been a subsidiary of UnitedHealth Group since 2011, with a nationwide network of providers including doctors, hospitals, pharmacies, and labs. These in-network providers have agreed to offer services at a fixed fee, part of which is paid for by Optum, as opposed to out-of-network providers who often charge higher fees. Optum may also cover some out-of-network services with pre-approval, but only up to the in-network cost, with the rest paid out of pocket.

Depending on where you live and your health care needs, you can choose between options like a standard plan, a plan with a lower premium that covers a lower percentage of medical/pharmacy bills, or plans with higher premiums that cover more of the cost of treatment, with bi-weekly or monthly payments.

What Are Optum’s Types of Plans?

Optum includes HMOs, PPOs, Original Medicare, Medicare Advantage, and supplemental plans like dental plans, student coverage, short-term insurance, and coverage for self-employed individuals. The Optum care network of doctors, hospitals, pharmacies, and other care varies by state. For example, in California alone, the number of providers includes over 3,700 primary care doctors and 11,000 specialty doctors.

Drug & Alcohol Rehab Facilities That May Accept Optum Insurance

If you are wondering whether a drug and alcohol use disorder treatment program will be covered by your Optum Insurance plan, you can always phone and speak with an Optum representative to ask about a specific rehab center or for recommendations to local treatment centers that are covered, or you can also ask rehab centers directly if they are in-network with Optum.

Muse is an accredited and safe rehab center that may accept your Optum insurance plan, offering comprehensive, effective, and customizable treatment plans that span all levels of care. This means that we use evidence-based therapies and treatments in a whole-patient approach to healing that integrates holistic care with mental health services, scientifically proven methods, community support, and practical life skills.

Our treatment plans lead from detoxing through inpatient and outpatient rehab, with long-term aftercare support and recovery resources supplied as needed. We offer medication-assisted treatment programs, dual diagnosis programs, behavioral therapies, group therapy and process groups, medical detox plans, relapse prevention programs, case management services, and much more to every patient. We aim to help you not only overcome the physical aspects of addiction, but also to heal the roots of substance abuse through therapy, regain your strength and wellness through nutrition and exercise programs, and regain your sense of self and empowerment. You will come to understand yourself in new ways, gain a new perspective on life, and rebuild damaged relationships within your family and your community as you learn new healthy habits within a stable, sober, and inviting environment. We hope to inspire you and give you the chance to set and achieve goals for your future. Please call us today at 866-621-6988 to learn more about how we can help you achieve long-lasting recovery.

Does Optum Insurance Cover Alcohol & Drug Rehab Treatment?

Yes, several acts ensure that your rehab and mental health care will be covered at least partially by your health insurance. These include the Affordable Care Act (ACA), which makes health insurance more affordable to individuals, families, and small business owners while ensuring those with mental health issues have protections when it comes to getting private health insurance. Rehab is considered one of the ten essential health benefits, as is Behavioral Health care. Under most plans, treatments like medical detox programs, interventions, family counseling, and clinic visits will also be covered.

The Mental Health Parity and Addiction Equity Act of 2008 require that insurance companies offer the same level of coverage to substance use disorder treatment and mental health care as they would for other illnesses, diseases, or injuries. This means that insurance companies cannot charge more to cover rehab than they would for a hospital visit.

How to Check Your Optum Insurance Coverage

If you are considering rehab but want to do your due diligence to make sure your treatment will be covered, there are a few different routes you can take. The first option is to phone Optum to ask about the types of treatment they will cover, or you can log onto their website to review your insurance documents to look over the terms of your insurance plan on your own.

For many, it may be easier to speak with the rehab center of your choice directly, because they will have in-depth knowledge regarding treatment for substance use disorders, and how each insurance company works in that regard. Sometimes insurance papers are difficult to understand, or you may not know how copays or deductibles work.

If you are feeling like you need help with understanding your insurance and want to know more about how it works with Muse treatment plans, you can always call us at 866-336-9037 and our team will do all we can to make it easier for you. We may be able to give you an idea of what your out-of-pocket expenses will be, or we can guide you in figuring out what your insurance policy will and will not cover. There are no stupid questions, and we are happy to help you in any way we can.

What Does Optum Insurance Cover?

Optum Insurance will cover physical health care coverage, prescription medications, and senior care, working with groups like surgical care teams, urgent care, primary care, and specialty medicine. When it comes to addiction treatment, Optum Insurance will cover many different forms of rehabilitation programming and may cover treatments like behavioral therapy, dual diagnosis treatments, prescription medications, psychotherapy, family therapy, educational services, medication-assisted treatments (MAT), medical inpatient detox, inpatient or outpatient rehab programs, and even aftercare programming in some cases.

Your plan will determine the therapies and treatments that will be paid for, and the percentage that will be covered. It is always a good idea to review your insurance coverage before entering rehab.

Does Optum Insurance Cover Mental Health & Substance Abuse Treatment?

Yes, Optum will cover a wide variety of behavioral health care and mental wellness treatments. Many people who have a substance use disorder also have a co-occurring mental health disorder, like depression, anxiety, PTSD, schizophrenia, or bipolar disorder, and for a full recovery to be possible these issues must be treated at the same time in a dual diagnosis treatment plan.

Mental health and addiction are often deeply intertwined, so healing the underlying causes of addiction through integrated therapies, treatments, groups, and practical resource provision will give each individual the best possible chance at achieving a full recovery. Your exact level of mental health coverage will depend on your state, your insurance plan and the type of care your doctor recommends.

Outside of substance abuse treatment, Optum also covers a full network of therapists and other mental health care workers. To find an in-network provider in your community, you can visit Optum’s website or call a representative who will be happy to help you.

Does Optum Insurance Cover Inpatient Drug & Alcohol Rehab?

Yes, if your doctor determines that staying inside a treatment facility for inpatient rehab is the best course of action for you, then your Optum Insurance plan must cover the associated costs. Although each insurance plan is unique, inpatient medical detox, along with up to six weeks of inpatient care will often be covered.

Optum recognizes that inpatient rehab can make a huge difference in the initial stages of recovery. Because it is a residential program that includes room and board, inpatient rehab is the most costly treatment, but it can be the most beneficial to individuals with severe addiction, co-occurring mental health issues, or anyone who does not have a stable or supportive home to return to after medical detox.

Does Optum Insurance Cover Intensive Outpatient Alcohol & Drug Rehab?

Yes, Optum Insurance will usually cover between four to twelve weeks of an intensive outpatient program (IOP). This type of program is a good option for a person who is experiencing a less severe addiction, and/or a person who has obligations that they cannot set aside to attend full days of treatment. IOPs offer up to twenty hours (three to five days a week) of therapy sessions, groups, medical appointments, and other support and care, on a flexible basis that will work around a work or school schedule.

Does Optum Insurance Cover Partial Hospitalization?

Yes, your Optum insurance may pay for a partial hospitalization program (PHP) in some states, if it is deemed necessary by your treatment team. PHPs are day programs, offering full days of treatment five to seven days a week, allowing the patient to return home in the evenings. It is an excellent bridge between inpatient rehab and an outpatient program and is usually given on a short-term basis.

How Long Will Optum Insurance Cover Alcohol & Drug Rehab?

Your treatment providers at Muse will work with Optum to determine the right program length for your case. Depending on factors like co-occurring conditions, your history of substance abuse, and your current practical needs, your treatment plan will be customized to suit you. Optum will cover treatments that are deemed to be necessary, and cost-effective. Rehab programs often last for 30 to 90 days, and if more time is needed, our team will contact your insurance to see if an extended timeframe can be covered.

Optum Insurance May Offer Treatment Coverage for the Following Addictions:

Along with alcohol addiction, cocaine addiction, and meth addiction, some other addictions your Optum health insurance may cover include:  

• Drug addiction
• Heroin addiction
• Xanax addiction 
• Ativan addiction
• Ambien addiction

What are the Options if Optum Insurance Does Not Cover the Cost of Drug & Alcohol Rehab?

It can feel like a roadblock if your Optum Insurance does not cover the full amount of your drug and alcohol rehab program, but the good news is that you have some options. Your rehab center may be able to offer payment plans or financial aid of some kind, or they may be able to restructure your program to better fit your Optum coverage. You may also be able to take out a loan from a financial institution or a trusted family member to pay the out-of-pocket fees. Addiction is hard on the body, mind, and spirit, so finding a way to pay for treatment as soon as possible is ideal. If you have found yourself questioning whether you can afford treatment, you can always call the customer care team at Muse to discuss your options. We are here to help, and we will work with you to get you the care you need in a customized rehab program.

Verify Your Insurance with Us

To verify your insurance with Muse, all you have to do is give us a call at 866-260-9050. We have caring and knowledgeable staff available now for a confident discussion about your options, and to help remove barriers from your pathway to recovery. Verifying your insurance is an important step because it could cover the costs of things like medication, inpatient rehab, therapy, medical care, and more. Our team can help you figure out what your out-of-pocket costs may be, as well as whether you will have copays or deductibles to meet.

Next Steps with Insurance Coverage for Alcohol & Drug Rehab Treatment with Muse Treatment

The caring, experienced, and highly credentialed staff at Muse are ready to meet you wherever you are in your recovery journey. We provide personalized care that is tailored to meet your unique needs at all levels of care, from the first days of medical detox through residential (inpatient treatment), partial hospitalization programs, intensive outpatient programs, and aftercare. Whether your doctor recommends a long-term inpatient program, a short-term outpatient program, addiction treatment with integrated mental health services, or a medication-assisted treatment plan, we have what you need to achieve long-term recovery. Our team is here to help you now. Please give us a call at 866-336-9037 to learn more.