UMR Residential Behavioral Health

UMR is a Third-Party Administrator (TPA) that collaborates with United Healthcare and various other providers to enhance the range of mental health services available to clients, including rehabilitation options for substance abuse. Members are advised to review their plans for specific coverage details.

UMR’s collaboration with UnitedHealthcare enables access to plans that might include various levels of behavioral health care. However, coverage specifics vary per individual policy. Under the Affordable Care Act (ACA), health insurance providers must cover behavioral and mental health treatments comparable to medical and surgical procedures, including substance use disorder treatment.²

UMR Covers the following behavioral health programs: 

• Inpatient Treatment: Intensive, structured care where patients reside at the facility to receive comprehensive behavioral health treatment.
• Outpatient Treatment: Allows patients to live at home while attending regular counseling and therapy sessions.
• Intensive Outpatient Program (IOP): Offers more structured and intensive care than standard outpatient treatment, typically involving multiple weekly group and individual therapy sessions.
• Partial Hospitalization Program (PHP): A step down from inpatient treatment, PHP provides intensive day treatment, allowing patients to return home or to a sober living environment in the evenings.

UMR health insurance typically includes coverage for residential treatment for mental health, also known as inpatient care. Still, the extent and conditions of the coverage can vary greatly depending on your specific policy and the plan’s requirements.

• Review Your Policy: Review your benefits booklet or coverage documents. They will usually outline what types of treatment are covered, including residential or inpatient care.
• Pre-authorization: Many plans require pre-authorization for residential treatment, which means your treatment must be deemed medically necessary before you check in.
• Network of Providers: Check if the facility is within UMR’s network of preferred providers, as using an in-network facility typically means more of the costs will be covered.
• Deductibles and Copayments: Even if UMR covers residential treatment, you may still be responsible for deductibles, copayments, or coinsurance.
• Contact UMR Directly: The best way to get a definitive answer is to contact UMR directly. They can provide specific information about your coverage, any necessary pre-authorization, and guidance on how to proceed with your treatment.
• Let Cornerstone Verify Your Benefits: Our admissions team will contact UMR on your behalf and submit an insurance verification form so that you can get the details of your insurance policy and what you can expect to be covered.

Remember that the Affordable Care Act requires most insurers to cover mental health and substance use disorder services at a level comparable to medical and surgical services, but the specifics can differ from one policy to another.

The duration of a residential treatment stay typically covered by UMR health insurance can depend on several factors. Here are some general considerations:

• The level of coverage and the details of your specific UMR plan.
• Medical necessity as determined by a healthcare provider and approved by the insurer.
• Individual progress and reassessment throughout the treatment process.
• Any plan-specific limits on the number of days or the type of residential treatment program.

The timeline for entering a residential treatment facility with UMR coverage can vary based on several factors. These include:

• The process of verifying your insurance benefits and coverage for residential treatment.
• The need for pre-authorization or a referral from a healthcare provider, if required by your UMR plan.
• The availability of beds or space at the residential treatment facility of your choice.
• Any waiting periods that may apply under your UMR policy.

To determine the most accurate timeframe, it’s advisable to check UMR benefits and any necessary pre-authorization steps and contact our admissions team to get in on the intake schedule.