UnitedHealth Group Rehab Coverage
UnitedHealth addiction coverage benefits are primarily based on Medicare standards for medical necessity for admission. These criteria are somewhat standard with all addiction coverage plans for medical insurance
. This means that a physician needs to diagnose the member with a substance abuse disorder such as dependence and/or addiction and refer them for treatment to agencies providing the following types of care:
can be done in an inpatient or outpatient setting and appears to be based on the same definition of medical necessity. Determining factors will be types of drug being abused, length of time and frequency of use, and how medically impacted the member will be to stop using the substance.
Benefits for inpatient detoxification
are approved for two to three days when medically necessary, with time up to five days available. Extensions of this time frame are available if needed as determined by a physician. This is an unlimited benefit and does not have a cap on how many detoxifications may be performed during any time period of benefit.
is limited only to the need for referral for medical necessity and does not have a cap on days for service approval.
Detox services that are not allowable are for use of methadone
, although other drugs for aversion therapy are allowable. Intervention for lifestyle and to remove member from situation are not.
is covered and is allowable for up to 190 days per lifetime benefits for members who meet criteria for need of inpatient services (in a psychiatric hospital setting).
Those services provided in an inpatient setting for treatment are outside that limit and are allowable if criteria for necessity are met. These criteria are primarily the recognized need for medically supervised treatment services. There is no cap for these services, as long as approved and medical necessity is ongoing.
services have no limit to benefits. As long as medical necessity is proven and authorized, benefits will continue to be provided. Both group and individual counseling services are eligible for coverage, as deemed appropriate by primary treatment coordinator and authorizing agent for insurance products. The services not covered are Methadone treatment, meals, transportation and other ancillary expenses.
Copay amounts are based on specific plan materials and must be determined at the time of medical intervention for referral to treatment. As will all insurance products, it is crucial for the member to understand and request all authorization information from the physician and/or agency performing intake for treatment services. This will allow the member to be empowered to choose their own best course of treatment options and receive maximum benefits available at a minimal cost out of pocket.
If you would like assistance locating a specific drug and alcohol rehab in your area, contact The Good Drugs Guide at the phone number listed above today.