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UMR Insurance Coverage for Drug and Alcohol Rehab

  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Modified:
  • Reading Time: 8 minutes
  • Reviewed by: Dr. Carl Williams, Ph.D., LCADC
  • Last Update:
  • Reading Time: 8 minutes

Learn more about UMR drug & alcohol rehab coverage.

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UMR Insurance

UMR Insurance covers many addiction treatment services.

Rolling Hills Recovery Center accepts a variety of UMR insurance coverage.

Paying for Treatment

Drug Rehab That Accepts UMR Insurance

If you are insured by UMR coverage, there is an excellent possibility that you will also receive some benefits for treating drug addiction and alcohol use disorder. This is because UMR insurance covers a broader range of conditions than most traditional health insurance plans.

Many facilities for substance abuse treatment are part of the UMR network, though insurance company coverage and admissibility to specific facilities will depend on a range of variables.

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Understanding Insurance

What is UMR Insurance?

Unlike traditional health insurance companies, UMR serves as a Third-Party Administrator (TPA) for United Healthcare, making their policies unique. However, UMR has links with hundreds of caregivers and rehabs that accept HMO and PPO insurance. They will do everything they can to help you get treatment at a price that works for you. If you or someone you know needs help locating UMR-approved substance abuse treatment, please get in touch with our recovery specialists immediately.

UMR is not an insurance company. Thus they do not pay for drug and alcohol rehab services directly, but their provider networks do. UMR now covers various mental health and substance misuse diseases in accordance with the requirements of the ACA (Affordable Care Act). All levels of care for substance abuse are guaranteed to be covered under UMR.

However, the amount covered varies from one state to another, length of stay, the type of facility (out or in-network), and the insurance plan level.

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How Does Insurance Work

Can You Use An Out-of-Network Provider With UMR?

UMR is also a Preferred Provider Organization (PPO). It works with a network of pre-approved doctors, care providers, pharmacies, and hospitals to enable its clients to access the services they seek.

UMR offers the following benefits:

  • Seeing specialists without referrals.

  • The rehab facility of your choice may be already in the provided network.

  • Receiving services at discounted rates, sometimes up to 30% off.

  • Access to an extensive network of providers like hospitals and doctors.

  • You don’t have to fill out lots of forms.

Though UMR gives full coverage for out-of-network providers, it has specific requirements. Firstly, the out-of-network provider must submit a charged bill which you forward to UMR. Then, the rates for treatment must be in-line and reasonable with the standard rates for alcohol and drug treatment in your region of residency.

Please, check with your insurance provider if they offer the same coverage plans. This is because UMR is not a traditional insurance provider. Additionally, not all UMR plans have out-of-network provider coverage. Ensure you check your insurance plan; usually, you require Tier 3 to get out-of-network coverage.

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Specialty Treatment Covered Through UMR Plans

UMR and all its providers recognize the Mental Health Parity and Addictions Equity Act of 2008. This ACT provides coverage for drug and alcohol unique treatments. The coverage depends on individual providers through luxury rehabs who are less likely to receive full coverage.

UMR doesn’t give exclusive rules to providers under them but general guidelines. These guidelines facilitate providing mental health services to member insurance companies and patients.

What To Know About Your UMR Insurance

Our Admissions Experts Will Help You Navigate This Difficult Information.
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Co-Insurance

Typically, co-insurance percentage range from 20% to 40%, and the insurance company clears the rest.

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Deductibles

The amount you pay out-of-pocket for treatment before the health plan starts helping with payments.

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Copayment

Co-pay is a fixed amount you must clear (usually when you receive treatment) for covered treatment services.

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How Long Does Insurance Cover Rehab?

The Length of Drug and Alcohol Treatment UMR Will Cover

Health insurance companies under UMR aren’t supposed to put set limits for drug and alcohol addiction treatments. UMR understands that private treatment depends on the patient and is confidential. Instead, UMR encourages insurance companies to work with consumers to determine the proper treatment length.

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The Out-Of-Pocket Costs Expected From UMR Insurance Coverage

You pay out-of-pocket costs depending on the insurance policy set by your employer. Insurance companies under UMR set different coverage standards depending on the plan you select and the policies offered by your employer. Expect three expenses; deductibles, coinsurance, and copayments.

You also incur extra out-of-pocket costs when looking for a treatment provider not covered in your policy.

Deductibles

A deductible is an amount you pay before the insurance policy covers any treatment costs. The policy you select determines how much a deductible will cost you. For instance, you may choose a deductible of $1500 or $2000 per year. Here, you pay the deductible before the insurance company covers the expenses up to the stated percentage.

Copays

A copay is an amount paid to cover medical treatment and other costs. It is a fixed amount paid during the service and usually targets outpatient services. For instance, you can pay a copay of $45 or $50 when attending outpatient treatment.

Coinsurance

Coinsurance is the percentage you pay once the insurance company has covered your treatment. Depending on the total treatment costs, you may have a 20% to 40% coinsurance. However, out-of-network providers have higher coinsurance rates compared to in-network providers.

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What Does UMR Cover?

UMR Covered Services for Addiction Treatment

According to the Affordable Care ACT (ACA), all insurance providers must provide coverage for mental health treatment and services. While the coverage will differ depending on the tier levels and policies, expect some form of alcohol and drug rehab coverage. The following are some drug treatment programs that UMR may cover:

Inpatient Residential Treatment

Insurance coverage for inpatient rehab through UMR depends on the type of plan you choose. In most cases, UMR services cover a portion of the treatment costs. This amount also depends on your employer’s plan and the treatment provider, like a rehab facility.

Insurance providers set a limit for staying in a residential program. However, the limit details also vary according to the selected policy. Ensure you understand the time limit chosen when applying for the policy. You may also need a referral for inpatient treatment because some insurance plans require proof that residential treatment is medically necessary.

PHP, IOP & Outpatient Treatment

Outpatient, partial hospitalization, and intensive outpatient programs are covered under UMR-administered insurance policies. In most cases, insurance policies under UMR cover outpatient rehab expenses fully. The insurance coverage will depend on the copayment and coinsurance costs that apply to your situation.

Psychotherapy & Aftercare

​UMR-administered policies also cater to some forms of psychotherapies, medicated-assisted treatments, and after-care services. These services may include sober living homes, group support, counseling, and more.

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We are a rehab that takes UMR

The Bottom Line

When treating addicts, entering a personalized treatment plan maintains the highest quality of care, and incorporating different therapy options is essential. 

Before entering a rehab center for addiction treatment, verifying that your insurance will cover all associated costs is essential. You can check with UMR, your health insurance provider, or by contacting us to see if your plan covers the cost of rehabilitation treatments.

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Written By:

Geoffrey Andaria

Geoffrey Andaria mental health writer at rolling hills recovery center
Rolling Hills Recovery Center

Mental Health Writer

About Author:

Geoffrey Andaria is an experienced mental health content writer and editor. With a B.A. in English and Journalism, Geoffrey is highly educated in freelance articles and research. Having taken courses on social work, Geoffrey is adamant about providing valuable and educational information to individuals affected by mental health and the disease of addiction.

Medically Reviewed By:

Dr. Carl Williams Ph.D., LCADC

Carl Williams, medical content reviewer at rolling hills recovery center
Rolling Hills Recovery Center

Expert Contributor

About Reviewer:

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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