United Healthcare Insurance Coverage for Drug and Alcohol Rehab

Before your UHC coverage begins to pay out, you may need to reach the deductible and copayment threshold. The deductible is the maximum sum of medical expenses you must pay out of pocket each year before your health insurance starts to pay for treatments. 

The payment of a copayment, which is a type of co-insurance, is typically necessary to maintain coverage under health insurance policies. Your UHC plan may require paying a specific copay (for example, $40) for accessing a covered medical service after reaching your health plan’s deductible. It refers to the part of a service cost that the insured must pay out of pocket.

The cost of treatment sessions often runs from $15 to $50; in best-case scenarios, they may be entirely covered. Thus you wouldn’t have to pay anything beforehand. In worst-case scenarios, you will be required to pay the entire session price, typically from $80 to $200 for each session. A typical UHC reimbursement plan works as follows: 

After you’ve met your deductible, your therapy appointments with an in-network therapist from UHC will cost you $15 to $50 for each session. Your copay is between $15 and $50. 

The following scenarios that fall under the umbrella of “In-network Outpatient Mental Health” may be relevant to your case:

Copayment of $15 after a deductible of $5,000.

If you spend over $5,000 on healthcare this year, each treatment session will only cost $15.

Copayment of $15 after a deductible of $1,000.

If you spend over $1,000 on healthcare this year, each treatment session will cost $15.

The co-payment is $15, and there is no associated deductible.

No matter how high your deductibles go, you will only have to pay $15 out of pocket for each treatment session you attend.

If you have a PPO plan and see a therapist, not in UHC’s network, expect to pay anywhere from $50 to $100 per session (20% to 50% of the total price your therapist costs).

After the deductible has been met, PPO plans often pay for treatments received from providers outside the PPO’s network. In the “Out-of-Network” OMH (Outpatient Mental Health) section of your Summary of Benefits, you may notice the following illustrations:

After meeting a $5,000 deductible, each session with the therapist costs $100 plus 20 percent coinsurance.

Your plan reimburses $80 for each session once you’ve spent $5,000 on healthcare this year, bringing your net cost per session to $20.

20 percent coinsurance, after attaining a $1,000 deductible, the therapy costs $150 per session.

Your plan reimburses you for $120 of your therapy price for each claim once you’ve spent $1,000 on healthcare this year, bringing your effective treatment cost down to $24 per session.

If you have a UHC EPO or HMO Plan and you see a mental health professional, not in UHC’s network, your plan will likely not cover the cost of your sessions. If your plan does not cover therapy, you will be responsible for paying the entire price of each session upfront. Look for a psychotherapist who provides a sliding scale or reduced session rates depending on financial necessity if the treatment expense prevents you from getting help.