Cornerstone

Understanding UMR Drug Treatment Coverage

Learn about using your UMR insurance policy to cover substance abuse treatment

or

Alcohol and Drug Treatment Coverage with UMR

When you or a loved one is facing the challenges of addiction, finding the right treatment and understanding your insurance coverage can be overwhelming.

UMR is a third-party administrator (TPA) that partners with healthcare companies like UnitedHealthcare to provide members with access to a wide range of mental health and substance abuse treatment options, including drug and alcohol rehab.1

In this guide, we’ll explore the details of UMR drug treatment coverage, including network coverage, claims approval, types of plans, deductibles, and hardships so that you can make informed decisions about your care.

By the end of this guide, you’ll better understand how to navigate your UMR coverage and take the first steps toward recovery.

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Addictions we treat at Cornerstone

UMR drug treatment coverage

When considering addiction treatment, it’s important to understand the advantages and disadvantages of choosing an in-network provider with your UMR policy. In-network treatment centers have a contractual agreement with UMR and its partners, like UnitedHealthcare, which often means lower out-of-pocket costs for you. These providers have negotiated rates with the insurance company, resulting in reduced copays, coinsurance, and deductibles. In-network providers have met UMR’s quality standards, ensuring that you receive appropriate care. However, the downside is that you may need more options when selecting a specific treatment center or location. Researching and confirming that the in-network facility offers care and services that align with your needs is crucial.

Information about UMR Plan Types

UMR’s HMO plans typically require you to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists when necessary. In most cases, HMO plans only cover treatment from in-network providers, except in emergencies. While HMO plans often have lower monthly premiums and out-of-pocket costs, they offer less flexibility regarding provider choice.

UMR has three options for PPO: Bronze2, Gold3, and Platinum4.

PPO plans offered by UMR provide more flexibility than HMO plans. You can generally receive care from both in-network and out-of-network providers, although choosing an in-network provider usually results in lower out-of-pocket costs. With a PPO plan, you don’t need to select a PCP or obtain referrals to see specialists.

UMR’s EPO plans combine features of HMO and PPO plans. Like HMOs, EPO plans typically don’t cover out-of-network care except in emergencies. However, like PPOs, you usually don’t need to choose a PCP or get referrals for specialist care. EPO plans often have lower monthly premiums compared to PPO plans.

UMR’s POS plans blend aspects of HMO and PPO plans. You’ll need to select a PCP who coordinates your care, but you can see out-of-network providers if you’re willing to pay higher out-of-pocket costs. Seeing in-network providers or obtaining a referral from your PCP generally results in lower costs.

UMR’s HDHP plans feature lower monthly premiums but higher deductibles than other plan types.5 These plans can be paired with a health savings account (HSA) to help cover out-of-pocket expenses.6

Once you meet your deductible, your plan starts sharing the cost of covered services.

UMR also offers managed care plans for Medicaid and Medicare beneficiaries. These plans are designed to coordinate care and provide additional benefits beyond what’s typically covered by standard Medicaid and Medicare programs. Eligibility and coverage details vary by state and plan type.

Understanding Policy Terminology

A deductible is the amount you pay for covered healthcare services before your UMR insurance plan starts to pay. For example, if your plan has a $1,000 deductible, you must pay the first $1,000 of covered services yourself. Once you’ve met your deductible, your insurance will share the cost of covered services according to your plan’s co-insurance or co-payment requirements. It’s important to note that some plans may have separate deductibles for in-network and out-of-network care, and not all services may be subject to the deductible.

UMR Approval Process for Treatment

Before beginning addiction treatment, the first step is to verify your UMR insurance coverage. The treatment center you choose will contact UMR to confirm your active policy and determine the specifics of your coverage, such as deductibles, co-payments, and co-insurance. They will also inquire about any prior authorization requirements for the services you need. Once your coverage is verified, the treatment center will inform you of any out-of-pocket expenses you may be responsible for, helping you understand what amount you will have to pay (if any) to get treatment. To streamline this process, you can provide your insurance information to the treatment center in advance.

Get Help Paying Your Deductible

File a Hardship With UMR 

If you’re struggling to pay your deductible, you may be able to file a hardship with UMR. A hardship is a situation that prevents you from being able to afford your medical expenses, such as job loss, unexpected expenses, or a severe illness. To file a hardship, you must contact UMR directly and provide documentation of your financial situation. If approved, UMR may reduce your deductible or offer a payment plan to help make your treatment more affordable.

Assistance Programs & Payment Plans 

Many addiction treatment centers offer assistance programs and payment plans to help make treatment more accessible. These programs may include sliding-scale fees based on income, scholarships, or financing options. Some treatment facilities may offer financing options, such as payment plans, to cover the cost of treatment. This may involve taking out a loan or setting up a payment plan with the facility.

Community Resources & Charitable Organizations

Sometimes, community resources and charitable organizations can help you cover your deductible for addiction treatment. These organizations may include local non-profits, faith-based groups, or foundations dedicated to helping individuals access healthcare services. Some organizations may have specific programs to assist with addiction treatment costs, while others may provide more general financial assistance.

FAQs About Using UMR Benefits
to Pay for Alcohol and Drug Treatment

What types of substance abuse treatment does UMR cover?

UMR provides coverage for a variety of substance abuse treatments, catering to different levels of care and patient needs.

This Includes:

  • Detox Services: UMR covers medical detox programs, which are essential for managing withdrawal symptoms safely under medical supervision. This is often the first step in treating substance dependency, ensuring the patient’s safety and comfort during the detoxification process.
  • Inpatient or Residential Treatment: These programs offer 24/7 care in a structured environment, ideal for individuals who require intensive support. They include medical supervision, therapeutic activities, and counseling sessions, and the duration varies from 15 to 90 days, depending on the individual’s needs.
  • Partial Hospitalization Programs (PHP): PHPs provide intensive treatment during the day while allowing patients to return home at night. This option suits those who need structured support but do not require overnight stays.
  • Intensive Outpatient Programs (IOP): IOPs offer flexible treatment options, allowing patients to attend therapy sessions several times a week while maintaining their daily responsibilities, such as work or school.
  • Outpatient Programs: These involve regular therapy sessions and support groups, suitable for individuals with milder addiction issues or those transitioning from more intensive treatment programs.

 

UMR’s comprehensive coverage ensures patients have access to the necessary care at different stages of their recovery.

Do I need a prior authorization for addiction treatment?

Insurance providers and third-party administrators often require pre-authorization for certain healthcare services, such as drug and alcohol rehabilitation.

Pre-authorization, also known as prior authorization, is when the insurer or administrator assesses the medical necessity of a proposed treatment plan and confirms that the coverage aligns with the insurance policy.

This evaluation usually occurs before the treatment begins.

We understand that dealing with insurance requirements and pre-authorizations can be overwhelming.

Fortunately, we offer assistance with submitting these requirements.

Our team of experts can help alleviate some of the burden of treatment and navigating insurance stipulations.

Please submit your insurance verification to get support to begin the process.

How much will I have to pay out-of-pocket for addiction treatment?

Your out-of-pocket costs for addiction treatment will depend on your specific UMR insurance plan.

Factors impacting your costs include deductibles, copayments, coinsurance, and the maximum out-of-pocket.

You can contact UMR or Cornerstone directly to understand your potential out-of-pocket expenses better.

What happens if UMR denies my claim for addiction treatment?

If UMR denies your claim for addiction treatment, Cornerstone will file an appeal on your behalf.

Our experienced team is committed to securing your approval and providing prompt access to treatment.

Verify your insurance with us today so we can start getting you into treatment right away!

CLINICALLY REVIEWED

lionel estrada LISAC headshot clinical director scottsdale

Lionel Estrada, LISAC

CLINICAL DIRECTOR

Lionel, our Clinical Director is a Licensed Independent Substance Abuse Counselor (LISAC) with over 4 years at Cornerstone, specializes in addiction and mental health. Trained in EMDR therapy, he employs a trauma-informed, empathetic approach to address the underlying causes of these issues.

Still have questions about treatment?

Our admissions specialists are here to explain the process, answer any questions you may have, and ensure you’re getting the help you need to live a healthy life free from addiction.

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