Substance Abuse Treatment Covered by UnitedHealthcare in Pennsylvania

Maybe. Generally, the more severe the person’s addiction is, the more likely an insurance company will pay. The determining factor in getting coverage is if the insurance provider believes you need it. Insurance companies have a team of medical professionals that review all claims submitted. If they disagree that the person needs drug rehab, they don’t pay. All this being said, you must ensure the facility you want to attend accepts your insurance.

The easiest way to know if your policy is accepted is to call the treatment facility and give them your insurance information. They will be able to let you know if your insurance is accepted and verify your benefits to provide you with an idea of how much coverage you will get. Another way is to ask your insurance provider for a list of treatment facilities they work with. Doing so can save a lot of wasted phone calls to facilities that don’t accept your policy.

Yes. Between the Mental Health Parity and Addiction Equity Act and the Affordable Care Act of 2010, all insurance providers must offer some form of substance abuse treatment coverage. The level of coverage varies between insurance providers and policies. Generally, more expensive private health insurance policies cover at a higher rate. It’s important to note that treatment facilities may limit the type of policies they accept. Even if your insurance plan has coverage, it may not be taken at the drug rehab you want to attend.

Technically, there’s no reason someone can’t purchase a policy specifically to cover their addiction treatment. What makes it challenging is private health insurance companies have developed tactics to prevent people from quickly purchasing a policy to avoid a significant expense like addiction treatment and then dropping the policy afterward. To prevent this financial loss, they only allow people to but policies during a certain period of the year, known as “open enrollment.” Open enrollment can be a window as small as a few weeks out of the year, forcing people to wait until that time to get coverage. Other policies have “blackout periods” where major services like substance abuse treatment aren’t yet covered. Blackout periods usually last for one year, meaning the person must pay to keep the policy active for twelve continuous months before it will pay for any portion of an addiction treatment service.

Medicaid is free health insurance subsidized by each state and offered to qualified residents. To obtain Medicaid coverage, a person must demonstrate financial hardship that prevents them from getting private health insurance. Private health insurance is not free. It is purchased by individuals from insurance companies or may be provided through employment.

The questions from Addicted.org’s “Ask a Professional” are answered by Michael Leach, CCMA. If you need further clarification on any of the questions above or have any other questions you can contact him directly at [email protected].