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UMR Insurance Coverage for Opioid Addiction Treatment Centers

Does UMR Insurance Cover Opioid Rehab?

The United States is facing an opioid epidemic, and it’s getting more serious by the year. From 1999 to 2019 there was an increase of 519.38% in opioid overdose deaths. Apart from synthetic opioids, prescription opioids play a huge role in the epidemic and are responsible for nearly a third of all opioid overdose fatalities. As a result, close to 50,000 people lose their lives to opioids every year and the effects of the raging epidemic are well-known.1

However, what may be less well-known is that addiction to these drugs can be treated – and that treatment can be expensive. Insurance companies such as those working with UMR healthcare plans are now starting to cover some of the cost of rehab for those addicted to opioids, thanks to the Affordable Care Act. However, there are still many questions about how this will work in practice and many people are still wondering “does UMR cover drug rehab”. This article will explore the current state of UMR addiction treatment coverage for opioid rehab and what people can expect going forward.2

More About UMR Insurance Coverage

UMR Insurance is a company that provides third-party insurance services to businesses and individuals in the United States. As such, it does not directly offer insurance coverage for addiction treatment but works with treatment providers across the country, such as addiction treatment providers in Florida, reputable insurance companies in Virginia, and private healthcare companies throughout California to offer the best possible solution for its clients. The company is a part of the United Healthcare group and has a reputation for providing quality services at a fair price.3

UMR is a third-party administrator (TPA) of UnitedHealthcare, meaning that they administer self-funded health insurance plans on behalf of their customers. With over 70 years of experience in the industry and over 5 million members, the company has a reputation for offering custom plan designs, cost-containment solutions, and innovative services.4

Which Treatment Services Are Included in UMR Coverage Nationwide?

The first step in understanding UMR addiction treatment coverage for opioid rehab is to understand what addiction treatment entails. Rehabilitation from addiction is a multi-faceted process that can include detoxification, inpatient or outpatient opioid treatment programs, behavioral therapy, and medication-assisted treatment (MAT).5

Detoxification, or “detox,” is the process of ridding the body of drugs and alcohol. This can be done through a variety of methods, including tapering off the use of the substance slowly.6 

Inpatient opioid treatment generally refers to a stay in a hospital or residential treatment facility, while outpatient opioid treatment refers to receiving care at a clinic or from a doctor. Insurance may cover different aspects of each type of treatment.5

Behavioral therapy involves helping individuals change their patterns of drug use and learn new coping mechanisms. MAT uses medications like buprenorphine and methadone to help alleviate withdrawal symptoms and cravings.6

Finally, coverage may also include treatment for dual diagnosis, if the initial assessment determines a patient may be suffering from co-occurring mental health disorders and both have to be treated simultaneously.5

Can UMR Substance Abuse Providers Deny Coverage for Some Services?

It’s important to note that even if an insurer working with UMR does cover rehab for opioid addiction, there may be limits on what they will pay for. For example, some plans may only cover detoxification or only cover certain types of behavioral therapy.2 

In general, UMR rehab coverage through their network likely won’t cover the following services:5

  • Non-medical amenities: Services like private rooms, concierge services, and other luxury features are usually not covered by insurance.
  • Holistic care services: Services like acupuncture, massage, and nutrition counseling are typically not covered by insurance.
  • Recreation programs: Services like yoga, meditation, and art therapy are often not covered by insurance.
  • Food delivery: Services that deliver meals to your room are not typically covered by insurance.
  • Private treatment services: Same-day admission into treatment, one-on-one therapy sessions with a licensed counselor or therapist, and special couples treatment programs are not usually covered by insurance.
  • Alternative therapies: Treatments like hypnotherapy, EMDR, and somatic experiencing are not typically covered by insurance.

What Are the Expected Costs of Opioid Rehab?

The cost of rehab can vary depending on the intensity of services offered, the duration of treatment, the type of UMR insurance coverage, and amenities. Generally, the more intensive the services, the higher the cost. Treatment can range from a few days to a few months, and amenities may include private rooms, gourmet food, and massage therapy. Some facilities also offer luxury rooms and amenities and family counseling.6

For example, patients in a MAT program may expect to pay an average of $8,800 per year, based on the type of treatment received. Of course, insurance companies under the UMR addiction treatment network may help offset the majority or a part of these costs.7

If you do not have insurance or your insurance does not cover rehab, there are still several financing options available to you. Many addiction treatment centers offer sliding-scale fees based on income, and there are also a number of government-funded programs that can help cover the cost of treatment. Additionally, there are many charitable organizations that provide financial assistance for those struggling to pay for addiction treatment.2

Expected Costs of Inpatient Opioid Treatment

Inpatient opioid treatment can be costly, but it is often necessary for people who are struggling with addiction. The cost of inpatient treatment will vary depending on the facility and the length of the program. Some facilities may offer sliding scale fees, which means that the cost will be based on your income.6

There are a few things to keep in mind when considering inpatient treatment. First, the cost of the program may be less than the cost of continued drug use. Second, inpatient treatment can provide a safe and supportive environment where you can focus on your recovery. Finally, many UMR substance abuse providers will cover at least part of the cost of inpatient treatment.5

Expected Costs of Outpatient Opioid Treatment

Outpatient opioid treatment can be costly, depending on the type of treatment used. In general, since outpatient treatment does not require patients to stay at the facility for the duration of the program, its costs are significantly lower than the cost of inpatient treatment. Instead, outpatient treatment has patients visit the treatment center for scheduled sessions, and the frequency of these sessions and the duration of the program affect the cost of treatment.6

Expected Costs of Partial Hospitalization Programs for Opioid Use

The cost of partial hospitalization programs for opioid use varies depending on the program. However, most programs fall between inpatient and outpatient treatment in terms of costs and services offered. Typically, PHPs have patients visit the treatment center for up to 5 hours a day, several times a week. As such, they do not include the costs of residing at the treatment center, but still require patients to pay for transportation, which UMR healthcare plans may not cover.8

Expected Costs of Medication-Assisted Treatment for Opioid Use

Medication-assisted treatment is often a necessary step in order to help someone recover from opioid addiction. There are a number of different medications that can be used in medication-assisted treatment, and the cost can vary depending on the particular medication.7 

Typically, the prices range from hundreds of dollars per week to thousands of dollars per month. The cost of medication-assisted treatment can also be a burden for the uninsured or underinsured. However, there are a number of ways to help offset the cost of medication-assisted treatment, including finding an insurance provider through the UMR drug coverage network.7

Are the Opioid Treatment Costs Justified?

The benefits of treatment far outweigh the costs. Treatment is an investment in the future, and it’s one that will pay off for years to come. Opioid treatment can help people get their life back on track and prevent a tragic outcome and it can also be funded through your UMR Opioid coverage. There are many costs associated with opioid addiction apart from the cost of opioids and opioid-related deaths and medical interventions. These include the cost of lost income, criminal justice costs, and healthcare costs.9

The costs of opioid abuse and overdoses impose a significant financial burden on society. According to a 2013 report, the national cost of prescription opioid abuse and related overdoses was close to $80 billion. However, only 3.6 percent of that amount, or close to $3 billion, went towards treatment.7 Additionally, studies have shown that investing as little as $1 in treatment may save up to $7 in criminal justice and law enforcement costs, as well as $4 in medical costs.9

How Long Does UMR Drug Coverage Last?

Most addiction treatment programs last up to 90 days. This is typically enough time for someone to get better and to start rebuilding their life. However, some people may need more time in treatment and some insurance plans will cover this. It is important to speak with your insurance provider to find out what your coverage includes.6

Some people may feel they need more than 90 days of treatment. This is often the case for people who have been struggling with opioids for a long time or who have relapsed multiple times. Longer-term treatment can help people get to the root of their addiction and make lasting changes.6

If you are considering entering treatment, speak with your insurance provider about your coverage. They can help you understand what your options are and how long coverage will last. Treatment can be a vital step in recovery, so it is important to make sure you have the coverage you need. You can reach out to the UMR helpline and they will help connect you with insurance providers who can provide the coverage you need.3

What Is the Difference Between UMR Insurance Inpatient and Outpatient Drug Treatment Programs?

Inpatient drug treatment programs provide around-the-clock care in a controlled environment, while outpatient drug treatment programs allow patients to live at home and attend scheduled treatment sessions. Inpatient drug treatment programs are typically recommended for people with severe addictions, while outpatient drug treatment programs are recommended for people with less severe addictions.6

Inpatient drug treatment programs are typically more expensive than outpatient drug treatment programs, but they offer a higher level of care and supervision. Inpatient drug treatment programs also provide a higher success rate for people who complete the program.6 

How Does UMR Addiction Treatment Nationwide Work?

You should keep in mind a few things when using UMR for addiction treatment. Firstly, UMR is not an insurance company. This means that they do not have their own network of providers that they work with to offer addiction treatment services. However, they do have a large third-party network of over 3,000 health care providers.3,4

The process of finding and using addiction treatment through UMR typically works as follows:2

How to Get Help Through UMR Addiction Treatment Nationwide?

If you’re looking for opioid or opiate addiction treatment programs through UMR healthcare plans, the first step is to call the American Addiction Centers’ alcohol and opioid rehab helpline. One of their admissions navigators will gather some information from you during a completely confidential phone call and then verify your insurance benefits right away. You can also verify your benefits on our website, learn more about the treatment intake process, find alternative private payment options and get all the help you need to get started on your journey to recovery.2

Once the admissions navigators have verified your benefits, they can help you find a treatment center that accepts your chosen insurance from the UMR network. They have numerous treatment programs across the country, including:

If you or a loved one is struggling with an addiction, don’t wait to get help. Call the AAC opioid hotline today to learn more about UMR addiction treatment coverage and how you can find the right treatment center for your needs.

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