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UPMC Health Plan Insurance Coverage for Drug & Alcohol Rehab

On this page, you will learn about UPMC Health Plan coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
If you or a loved one are experiencing a medical emergency, call 9-1-1 immediately.

Provider Overview

Does UPMC Health Plan Insurance Cover Alcohol and Drug Rehab?

In a 2015 survey, about 10% of Americans struggled with drug use and about 75% of them didn’t receive treatment for it.1 These worrying numbers signal the need for comprehensive, widely accessible drug and alcohol treatment.

If you’re a member of UPMC Health Plan, your insurance can cover at least a part of the costs of your addiction treatment. The Affordable Care Act requires all health plans to include coverage for the treatment of mental health disorders, which also applies to substance use disorders. This means that all private insurers, including UPMC Health Plan, have to offer some degree of coverage for drug treatment, making it available to a wider range of struggling individuals.2

How to Check UPMC Health Plan Coverage for Drug Treatment?

To verify the details of your UPMC Health Plan policy and determine what extent of rehabilitation coverage it provides, it’s advisable to contact the company directly. If you take a look at the back of your insurance card, you’ll find a hotline number that you can call to discover more about your benefits.

Your other option is to browse treatment facilities in locations that suit you, narrow down your choice, and phone the ones that you are considering. The helpline run by the American Addiction Centers is a toll-free, confidential service that helps you learn more about addiction treatment and verify your insurance coverage. There you can also find out the details about their intake process and browse the locations of their luxury facilities, which are situated in some of the most beautiful and tranquil areas

What Is UPMC Health Plan Insurance?

UPMC Health Plan is a Pittsburgh-based health care provider and insurance company. With 40 medical facilities, 92,000 employees, 800 facilities, and over 4.1 million in-network members, it’s the biggest health insurance provider in western Pennsylvania.4 It brings members access to high-quality medical care, helpful customer support, and affordable services to protect their health and well-being.5

What Is Included in UPMC Health Plans?

UPMC Health Plan offers multiple types of coverage, including plans for individuals and families, Medicaid/Medical Assistance Plans, and Special Needs Plans.They’re designed to fit a variety of medical and financial demands.6  

UPMC Health Plan is in partnership with a range of rehab centers across its coverage area in Pennsylvania, enabling members to receive top-quality care, including evidence-based help for alcohol and drug addiction. Since members pay less at in-network treatment facilities, this means that their membership allows them to get excellent care at more affordable rates.

What Will UPMC Health Plan Insurance Cover?

UPMC Health Plan provides rehabilitation coverage for drug addiction and mental health. Depending on the member’s plan, they can expect some or all of their treatment expenses to be covered by insurance. Some of the services that may be covered include:7 

  • Drug detox: This is the first stage of treatment, which could last for 3 to 7 days or longer. It includes stabilizing the patient’s condition and eliminating all traces of the drug from their body in the safest and most comfortable way possible.
  • Residential rehab: Inpatient treatment is the most intensive level of care because the patients stay at a residential facility throughout its duration. They’re monitored 24/7 and their needs are consistently addressed.
  • Outpatient rehab: If the patient’s condition is stable and they have a support network outside the facility, they may only visit the center several times a week to receive outpatient treatment, without staying there round the clock.
  • Intensive outpatient rehab: This kind of treatment takes up more hours in a week than classic outpatient rehab. It can be the right fit for patients who have favorable conditions for recovery in their environment but still need high-intensity care.
  • Partial hospitalization: This program takes place every day, for most hours of the day, with patients going home afterward. It’s for those who have very high treatment needs but whose condition is stable enough to remain living at home.

Does UPMC Health Plan Insurance Cover Mental Health Treatment?

Many individuals with drug addiction also have a history of mental health struggles. Mental health disorders and substance abuse can be triggered or made worse by similar risk factors. People may find themselves in a vicious circle of self-medicating with drugs because they’re mentally unwell and then having their mental health deteriorate because of their substance use.8

Since treatment-seekers often have mental health concerns too, they can have the best treatment outcomes if they’re simultaneously treated for both co-occurring conditions and drug addiction. This is why most drug rehab centers assess and treat their patients for co-occurring disorders.9

UPMC Health Plan offers coverage for mental health. This is a requirement placed on health insurers by the Affordable Care Act. However, your coverage is limited by your plan, which means that not all treatment services may be covered. To make sure that your UPMC Health Plan covers your drug rehab, you can call the carrier’s hotline to check.6

How Long Does UPMC Health Plan Insurance Cover Addiction Treatment?

In general, longer treatment times produce more favorable results than shorter stays. However, every patient has their own unique needs that have to be evaluated and subsequently addressed with a suitable duration and intensity of treatment. Thirty days in recovery may be effective for some individuals while others may require 60 days in rehab or programs that go on for 90 days or more.7 

Since there are multiple policies and tiers, your insurance may or may not cover the cost of your program in full. This is determined by the details of your plan, which you can check if you call your insurance carrier or your rehab center to inquire.6

What to Do if My UPMC Health Plan Does Not Cover Drug Treatment?

While there are different tiers of UPMC Health Plan Insurance benefits, all health insurance plans offer substance abuse treatment coverage. However, it may not cover the full price of treatment. In that case, there are different possibilities for financing it, including:10

  • Free or low-cost treatment programs funded by the government.
  • Fundraising.
  • Scholarships.
  • Loans.
  • Borrowing money from loved ones.

Do I Choose In-Network UPMC Health Plan Rehab or an Out-of-Network Facility?

UPMC Health Plan Insurance has a network of providers, including top-rated rehab centers. As a member, you’re required to pay less for the services of these in-network facilities. If your preferred facility isn’t on your carrier’s mental health provider list, you will have to pay more out-of-pocket. To determine whether a center works with your insurer, contact either of them and ask.11

How to Read Your Insurance Provider Card
  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
  1. National Institutes of Health. (2015). 10 Percent of US Adults Have Drug Use Disorder at Some Point in Their Lives.
  2. U.S. Department of Health & Human Services. (2019). Does the Affordable Care Act Cover Individuals With Mental Health Problems?
  3. Mental Health & Substance Abuse Coverage.
  4. UPMC. The UPMC Story.
  5. UPMC Health Plan. Benefits of Choosing UPMC Health Plan.
  6. UPMC Health Plan. Plans & Services.
  7. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
  8. U.S. Department of Health & Human Services. Does the Affordable Care Act Cover Individuals With Mental Health Problems?
  9. National Institute of Mental Health. Substance Use and Co-Occurring Mental Health Disorders
  10. (2019). Paying for Treatment.
  11. UPMC Health Plan. Buying Insurance.
  12. UPMC for You. Enrolling in UPMC for You Medical Assistance Plans.
  13. Substance Abuse and Mental Health Services Administration. (2022). Medication-Assisted Treatment (MAT)
  14. Substance Abuse and Mental Health Services Administration. (2022). Buprenorphine.

Check Your Policy Coverage

With the form below you can quickly and privately check your insurance benefits to see if you're covered for addiction treatment services. We’ll be able to tell you if your policy is in-network at an American Addiction Centers location.
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Frequently asked questions

What to Do if UPMC Health Plan Doesn’t Cover the Full Cost of Treatment?
It’s possible for your UPMC Health Plan to only provide partial coverage for drug treatment. If your plan offers limited coverage only, you will be required to pay for the rest yourself. In this case, you can still access effective treatment using options like crowdfunding and bank loans. There is also the possibility of finding other funding opportunities or government-funded rehab facilities with low-cost or free-of-charge services.10
Does UPMC Health Plan Provide Medicaid and Medicare?
UPMC Health Plan Insurance offers a Medicaid/Medical Assistance Plan for eligible individuals in Pennsylvania, called UPMC for You. These benefits are approved by the Pennsylvania Insurance Department and the Pennsylvania Department of Health. You can find out if you meet the requirements for this health managed care plan by contacting the Department of Human Services.12
Can I Use My UPMC Health Plan for Medication-Assisted Treatment?
Medication-assisted treatment (MAT) is used in the treatment of opioid addiction. People addicted to heroin or prescription pain medications typically experience unpleasant withdrawal symptoms and cravings when they stop using the drug. In addition to behavioral therapies, MAT includes medications that normalize brain chemistry and reduce cravings.13 UPMC Health Plan is in-network with a range of rehab centers and provides coverage for different drug treatment programs, such as treatment that couples can enter together and rehab plans specifically designed for women. It may cover medication-assisted treatment in part or in full. However, this depends on the specifics of your plan, which you can check by contacting the company.6
Can UPMC Health Plan Be Used for Suboxone Treatment?
Suboxone is typically used as part of opioid addiction treatment. It reduces the symptoms of physical dependence on opioids, such as cravings and uncomfortable withdrawal symptoms. Your UPMC Health Plan Insurance will likely cover some degree of suboxone treatment costs. However, you need to call their hotline to have a confidential conversation and check what your exact plan includes.14

Guides for other health insurance providers

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  • You may receive treatment at one of our facilities at a reduced rate.
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