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Optum Insurance for Drug and Alcohol Rehab

More than 21 million adults find themselves in the crippling grips of addiction. Even less of those that find themselves suffering from addiction will seek treatment. But, since you're here reading our post, we've assumed that you're seeking treatment.
One of the most critical aspects of treatment is figuring out if your treatment will be covered. Or if a portion of your treatment will be covered by your insurance company. In this guide, you'll find information about the coverage offered by Optum insurance rehab.
By the time you've finished reading, you're going to have all the information you need to move forward with and begin your recovery journey.

Addiction can happen to anyone from young teens to adults but it can be treated. No matter who you are, there can be a lot of uncertainties about whether or not you can get the proper treatment. At Dr. Paul By the Sea, we accept Optum Insurance to help you or your loved one fight their addiction and live a healthier life. Don’t let your addiction take control of you and get the help you need today.

About Optum Insurance and Coverage

Optum Care, a subsidiary of UnitedHealth Group, operates across all of the United States, from California to Florida with over 70 million members. With over 53,000 physicians, Optum is dedicated to working with you and your circumstances to provide the best level of care. Optum specializes in a variety of mental health and addiction treatments for its members and works with the Mental Health Parity Act. If you are experiencing addiction or a mental health disorder Optum Care will cover the majority of your addiction and mental health treatment. Although there may be a co-pay, all insurance plans must have addiction treatment available to you under the Affordable Care Act.

What's Your Plan?

Before we can answer the question, will insurance cover rehab? We've first thought about the type of insurance plan you've signed up for. There are a few different plans that are offered by Optum that you should be aware of.
Below we're going to detail the two insurance plan options provided by Optum and what each has to offer.


When it comes to this insurance plan, you'll have to choose from a specific network of treatment facilities and doctors. You're not able to choose your own provider. But this is beneficial because it can take the challenge of finding a provider on your own, which can be challenging at times.

When you've got this plan, we recommend selecting one of the doctors that the insurance plan features on its list to ensure you get the most coverage. If you choose a facility or care provider outside of the network, less of your treatment will be covered, and you'll end up paying more out of pocket.


Optum HMO

When you've chosen the Optum HMO plan, you've got the freedom to select your own treatment facility and care provider. Once you've chosen your provider, they will then help you to select more specialized providers. Providers that fall within the HMO network for you to choose from.

Much like with the PPO, if you choose to use a provider outside of the HMO network, you'll receive less treatment coverage. And in most cases, they won't cover even a small percentage of your treatment.

When it comes to your insurance plans, you've got to ensure you're choosing a facility and provider in-network. This is because the cost of treatment can be expensive depending on the type of program you enter (inpatient vs. outpatient).


What Am I Responsible For?

Before your insurance plan begins to pay for your treatment, there are some parts of your bill that you'll be responsible for first. You must ensure that your deductible has been paid completely before the insurance company begins to pay its portion. Also, depending on the insurance plan that you've chosen, you may have a copay that needs to be paid before your insurance kicks in. It's essential to ask what your co-pay is before attending rehab sessions. And you can always call your insurance to ask about your deductible amount that needs to be paid before beginning treatment. Now that you've understood the requirements that you must meet before beginning treatment, we can jump into the services covered. As well as pieces of each treatment plan that you can expect to be covered by your insurance.

Initial Diagnosis

Before you begin the treatment process, you'll undergo a series of tests. Tests to provide answers to specific questions that are essential to your recovery. How long have you been using it? What drugs do you frequently use? What's the severity of your addiction?

These are just a few of the questions that will be answered during the diagnosis phase. Once these questions have been answered, your doctor will then move forward with their recommendation for treatment. Fortunately for you, Optum does cover this process to ensure you're getting the right kind of treatment for recovery success.

Medically-Assisted Detox

Detoxing on your own can be challenging and, in some cases, life-threatening. For this reason, most facilities will have those in need of treatment go through detox under the supervision of medical professionals.

This ensures that if something goes wrong, there will be people available to provide treatment and medication if and when it's necessary. Optum covers the expenses associated with detox. But again you must call the insurance company to verify this before moving forward with treatment. If they don't cover all the expenses, they'll be able to detail for you which parts they cover and the parts that are going to be your responsibility.

Outpatient Treatment Programs

Optum doesn't cover a complete inpatient rehabilitation program. It focuses on providing coverage for outpatient programs. Outpatient programs provide recovering addicts with the flexibility they need to work on their addiction issues. While making a living and paying their bills. In outpatient mental health therapy, people will attend various meetings and therapy sessions throughout the week. You'll be able to create a therapy session that works with your schedule. With outpatient therapy, you've got to make your recovery a priority and attend meetings even when you don't want to.

What you put into rehab is what you'll get out of it. If you choose to seek inpatient rehab, Optum does ask that you first attempt to seek treatment from an outpatient program. Depending on your plan, you will have partial coverage of inpatient treatment.
If your treatment runs longer than the standard amount of days, you may have to pay a portion out of pocket.


Verify Your Insurance Today

Dr. Paul By the Sea offers some of the best mental health treatments in St. Augustine, Fl. We offer high quality, evidence-based drug rehab treatments to help with long term recovery so that you or loved ones remain sober. As a company, we want to make sure rehabilitation is available to you and your loved ones no matter the circumstances. By accepting TRICARE Insurance it allows for veterans, service members, and their families to receive proper treatment for a better life. To see what treatments and programs you are eligible for through TRICARE Rehab Insurance by filling out our insurance verification form today!


Optum Insurance Rehab in St. Augustine

We've gone over the ins and outs of Optum insurance rehab with you; now, all that's left to do is begin searching for your in-network treatment facility. Remember, you must meet your deductible and pay any copays before treatment can begin.

If you're looking for a place to help you throughout your recovery journey, contact Dr. Paul By the Sea. With state-of-the-art facilities, our patients will receive a pristine level of care that will help fight their addiction. It isn’t easy to escape the cycle of addiction but working with us will help you break that cycle. We provide effective, evidence-based solutions that will help you remain sober. We've got the experts and staff on hand to help you take the steps necessary to get your life back.


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