UMR Drug And Alcohol Rehab Insurance Coverage

UMR is a third-party company, or TPA, that your employer hires to ensure that your claims on a healthcare policy are handled correctly. It is not an insurance provider; however, it is a UnitedHealthcare company and works with your insurance policy to help you focus on health and addiction recovery goals.

Since UMR is classified as a third-party administrator of your insurance and is not an insurance provider, it does not directly provide coverage for alcohol and drug treatment in Massachusetts.

Although it does not provide coverage, the company does work with UnitedHealthcare insurance companies and assists with the process of filing claims on the insurance provided by your employer.

Your insurance policy when you have UMR services is provided by your employer. Generally, your employer offers a few policy options that offer coverage for addiction services.

Keep in mind that the details of any policy may vary and UMR helps with the claims process to ensure that paperwork is filed correctly and individuals are able to get the most out of their coverage.

When you are unsure about your coverage when navigating UMR or your insurance provider’s resources, Spring Hill Recovery Center can help you clarify the details of your policy as it relates to drug and alcohol rehab.

UMR Insurance Coverage For Massachusetts Drug Rehab Programs

The amount of coverage you have for Massachusetts drug rehab through an insurance provider who works with UMR depends on the policy you select. Your employer may offer a few different policies through a company like UnitedHealthcare that allows you to choose different levels of coverage based on your specific concerns and goals.

While specifics may vary by employer policy options and the plan you chose for your needs, an insurance company will usually cover between 60 and 80 percent of in-network provider services. The coverage for out-of-network services may differ based on your situation and the type of policy you choose.

Keep in mind that you may need to pay a deductible before your insurance policy applies to your treatment. Deductible amounts may vary significantly, so you will want to look at the details of your specific plan to determine the amount required before coverage starts.

Using UMR Services For Addiction Treatment

Addiction treatment is an important part of the recovery process. It is worth the expense due to the support and assistance it provides to an addicted individual. Although the costs are worth the potential outcome of long-term recovery, it can seem expensive without insurance coverage.

UMR is not an insurance carrier, so it does not offer specific coverage for a substance use disorder. It works with your insurance provider to ensure that your insurance claims are handled correctly and your coverage applies to appropriate situations.

Working with UMR helps you clarify the details of your policy and ensures that you are not over-paying for drug and alcohol treatments that your current policy covers when you seek treatment for substance abuse.

Do You Need To Stay In-Network When Using UMR?

When it comes to treatment providers for substance use disorders, the details about when you must stay in-network and when you can seek out-of-network treatment may vary. Since UMR works with a variety of insurance policies and employer plans, the details about when it allows out-of-network treatment differs for each individual or group.

Generally, an insurance provider offers PPO and HMO policies. When your policy is an HMO plan, you may not be able to seek out-of-network treatment for your health concerns.

In most HMO policies, you are required to stay in the network, even when you are seeking specialized substance abuse treatment. Some exceptions may apply in specific situations; however, the details about exceptions vary by policy.

A PPO policy may allow you to seek treatment from in-network and out-of-network providers. Keep in mind that an out-of-network treatment facility or provider may charge more for treatment services.

Your policy may not provide the same level of coverage, so you can expect slightly higher out-of-pocket costs. Details about the potential costs vary by policy and plan.

What Out-Of-Pocket Costs Can You Expect For Rehab In Massachusetts?

The out-of-pocket costs for rehab in Massachusetts differ based on your policy. An insurance company that works with UMR may set different standards for out-of-pocket expenses based on the type of policies your employer offers and the specific plan you select.

You can expect three primary types of expenses when working with your insurance provider. You may have a deductible, copayments, and coinsurance. If you are looking at a treatment that is not covered by your policy, then you may also have additional costs for drug and alcohol treatment from the additional treatments.

A deductible is an amount you pay before insurance covers any costs for treatments. The exact amount differs based on your policy. For example, you may have a deductible of $500 or $1,000 per year. That means you pay the stated amount before your treatment is covered, and then the insurance starts covering costs up to the stated percentage.

The copay is the amount you pay at the time of service. It usually applies to outpatient services and is a fixed amount. For example, you may pay $25 or $30 at the time of your treatment.

Coinsurance payments refer to the percentage you pay after the insurance covers your treatment. Depending on the policy you have, it may range from 20 to 40 percent of the total costs of treatment. In the case of working with an out-of-network provider, you may have a higher coinsurance rate when compared to in-network providers.

Finding A Rehab Center That Works With UMR

Rehab centers that accept insurance policies that are administered by UMR differ based on the policies your employer offers. If you are unsure about whether your policy covers a specific rehab center, then you can reach out to UMR or contact Spring Hill Recovery Center to learn more details about your specific policy.

Does UMR Cover Inpatient Rehab Or Residential Treatment?

Coverage for inpatient treatment or residential treatment through UMR-administered policies differs based on the details of your plan. In most cases, a portion of the cost is covered by insurance providers who work with UMR services.

You should keep in mind that the amount of coverage depends on the type of plan you selected through your employer as well as the treatment provider. When you work with an out-of-network provider, you can expect a higher out-of-pocket cost.

Inpatient treatment or residential treatment refers to any drug rehab program that removes an individual from their current environment. You may spend a few weeks to 90 days in the rehab facility.

Insurance providers may set a limit on the duration of treatment in a residential program, but the details of any limitations will vary based on the policy. For example, an insurance carrier may allow you to obtain treatment at an inpatient treatment facility for 30 days. Make sure you are clear on any limitations that apply to your policy.

In some cases, you may also obtain detox services before starting a residential program. Many rehab programs require detox before starting treatment to ensure that an addicted individual has a low risk of health complications from withdrawal symptoms.

Keep in mind that you may need precertification and a referral for inpatient treatment. Your insurance plan may require proof that the treatment is medically necessary before allowing treatment.

Is Medical Detox Covered By UMR?

Policies administered by UMR may offer coverage for medical detox when it is clear that the treatment is necessary. You may need a referral or proof of medical necessity to seek detoxification services. Exact coverage and details for drug and alcohol detox may vary by policy and plan.

Does UMR Cover Outpatient Treatment?

When you or a loved one has a substance use disorder, you may consider outpatient treatment instead of inpatient treatment. An outpatient program offers greater flexibility to your schedule and is a good option for individuals who may have career or family obligations that limit their options for treatment.

In most cases, insurance policies that UMR administers and manages offer coverage for outpatient rehab services. You may have a set copayment for the treatment as well as coinsurance costs that apply to the situation. Some policies may require precertification before you are able to seek outpatient treatment.

Is Partial Hospitalization Treatment Covered By UMR In Massachusetts?

Partial hospitalization programs, or PHPs, may be covered by insurance policies that are administered by UMR. These intensive day programs are optimal for individuals who cannot seek inpatient rehab for any reason and need extra support when starting on recovery goals.

Is Intensive Outpatient Treatment Covered By UMR?

Intensive outpatient programs may be covered by your insurance policy. The details of your policy will help determine the exact requirements for coverage in an intensive outpatient treatment program. In many cases, intensive outpatient care is offered to an addicted individual at the beginning of recovery.

Does UMR Cover Sober Living Costs?

Coverage for sober living facilities may vary based on the program and the details of a policy. Since a sober living facility may be considered transitional treatment when it offers outpatient and other treatment plans, it may be covered in some circumstances. It may also be considered a form of housing, so a policy may not cover the costs.

Is Medication-Assisted Treatment Covered By UMR?

Medication-assisted treatments refer to treatment plans that use certain medications to help support the recovery process.

Since it is an evidence-based approach to treatment, it is often covered by insurance providers administered by UMR. Actual coverage may vary, so you may want to check the details of your policy to clarify.

Is Methadone Covered By UMR Insurance Policies?

Methadone is a medication that may assist with recovery from opioid drugs. It may be covered by your insurance policy when the policy covers medication-assisted treatments.

Some policies may limit the dosage or the method of delivery for the medication, so it’s important to understand any limitations that may apply to your specific insurance policy.

Do Massachusetts UMR Services Cover Suboxone Therapy?

When your insurance policy that is administered by UMR covers medication-assisted treatments, it often covers the cost of suboxone therapy.

Suboxone therapy is often paired with counseling and other treatment programs, so you will want to verify that the full course of therapy is covered and that you do not need precertification to continue your treatment.

Planning Your Substance Abuse Treatment Stay With UMR

When you or a loved one is ready to seek rehab treatment for a substance use disorder, the first step is verifying and confirming your current insurance coverage.

Since UMR is a third-party administrator for the insurance provided by your employer, you can verify your coverage through UMR or your health insurance provider. You can also contact Spring Hill Recovery Center to clarify the details of your policy as it applies to rehab services.

Spring Hill Recovery Center can help with your goals of addiction recovery by assisting with your plans for treatment. For more information about rehab services or to find out more details about your specific insurance policy, contact Spring Hill’s helpline today.

  1. National Institute on Drug Abuse—Types of Treatment Programs
  2. UHC—Summary of Benefits
  3. UnitedHealthcare Community Plan—What's the Difference Between an HMO vs. a PPO Plan?
  4. UMR—Member Booklet, UMR

Written by Spring Hill Recovery Editorial Team

© 2024 Spring Hill Recovery | All Rights Reserved

* This page does not provide medical advice.

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