Does UMR Cover the Cost of Alcohol or Drug Rehab?

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July 27, 2021 by
Does UMR Cover the Cost of Alcohol or Drug Rehab?

What Benefits Does UMR Offer For Treating Alcohol & Drug Rehab?

United Medical Resources (UMR) is a healthcare company that is part of the UnitedHealth Group. It’s one of the country’s largest third-party administrators (TPA) that provides support to its members seeking healthcare solutions through their insurance provider.

UMR’s 5 million members have custom-designed plans that provide them with cost-saving solutions and innovative services. The organization doesn’t directly provide healthcare services to its subscribers, but it helps negotiate benefits between members and their insurance companies.

If you or a loved one are struggling with addiction, call WhiteSands Alcohol and Drug Rehab today at 877.969.1993 to learn how we can help.

Within UMR’s third-party network, more than 3,000 healthcare providers are listed on the network. UMR works with each provider to widen the variety of alcohol and drug rehab resources available to their clients.

Every healthcare insurance policy is different, so your benefits may or may not include coverage for treating alcohol and drug rehab. We can help review your specific plan and contact your insurance representatives for you to better determine your benefits.

In general, however, most UMR-affiliated plans do offer various levels of coverage for inpatient and outpatient substance use disorder treatment and co-occurring mental health disorder services.

Does UMR Cover the Cost of Addiction?

UMR works with insurance companies to help you get the most coverage for your addiction-related costs. A number of variables, such as the specific insurance company you’re with, the plan you have, the state in which you live, and which type of addiction treatment you need will affect your potential out-of-pocket costs.

There is a chance that your insurance coverage for addiction treatment will be denied. In that case, we strongly suggest that you appeal that decision, especially if your substance use disorder has been deemed to be medically necessary or if you suffer from a dual diagnosis of addiction and a mental health condition.

If your insurance coverage via UMR doesn’t fully pay for your treatment plan, you can look into various payment plans offered by most rehab facilities. There are also many medical discount services, medically-based lines of credit, and charity-funded grants, if necessary. Savings and help from family members are also other options. But, of course, your UMR insurance provider is your first line of payment to thoroughly explore addiction treatment before looking into other avenues.

How To Verify Your UMR Insurance Benefits For Addiction Coverage

Finding the right rehab treatment for your needs can be hard enough to navigate, and finding the funds to pay for addiction treatment can become even more difficult once you’ve settled on the best type of treatment for your needs.

Our counselors at White Sands can help you get the information you need so you can begin on your recovery path sooner rather than later. You can also call your representatives at UMR, which is a third-party administrator. They’ll help you get the information you need about your specific rehab treatment and insurance coverage verification.

Does UMR Cover the Cost of Attending Rehab for Spouses or Children?

If you are covered by UMR for Alcohol and Drug Rehab, your spouse and children can be added to the plan as well. For more information on spouse and child coverage, call one of our WhiteSands representatives.

Tiers of UMR and Benefits of Each Package?

Although UMR is not your health insurance company per se, it is the company that ensures your claims are paid in a timely manner. This makes UMR a great resource for you when you need more information about the costs of rehab and what your benefits will entail.

UMR, the United Healthcare Company, should provide you with coverage at different levels, depending on your plan, for all different types of substance use disorder treatments.

Your UMR coverage will depend on the individual policy you have. You may be covered for inpatient treatment first if you can take the time off from work and other responsibilities to live away from home as you participate in rehab treatment full-time. Your plan may then cover a transition to an outpatient program as a follow-up plan for recovery.

Either way, it’s important that you understand the differences between the plans and what your policy states about your treatment benefits.

Does UMR Cover the Cost of Inpatient Rehab?

UMR understands that both inpatient and outpatient treatment are good options for addiction rehab, depending upon your condition and other variables. For alcohol and drug addiction, however, inpatient rehab is generally preferable for achieving a successful, long-lasting recovery from substance use disorders.

The more than 3,000 insurance companies that are listed in the UMR network cover inpatient rehab at some level, particularly if it’s determined that you medically require it. UMR will do its best to ensure your rehab stay is mostly covered.

You will more than likely be covered by the cost of inpatient rehab if the treatment center you want to work with is affiliated with a UMR-network insurance plan.

Does UMR Cover Substance Abuse & Mental Health Residential Stays?

UMR and its providers recognize the Mental Health Parity and Addiction Equity Act of 2008, which provides specialized treatment for alcohol and drug rehab, including mental health services as an offered requirement. Individuals with a dual diagnosis of substance use disorder and a co-existing mental health disorder can expect to receive some coverage for both conditions while in rehab treatment.

Does UMR Pay For Outpatient Rehab?

Outpatient rehab is typically covered with UMR-related insurance plans, although inpatient treatment centers are usually more available in-network than outpatient rehab treatment facilities with UMR.

How Long Will UMR Cover the Rehab Stay For?

Although UMR doesn’t need to delineate a set length of stay for the rehab treatment, the organization recognizes that rehab treatment is private and depends on each individual’s unique condition.

UMR encourages insurance companies to work closely with their members and their healthcare providers on determining the length of rehab stay for each patient’s individual needs for recovery.

Call Us Now To Verify Your Insurance Benefits

Patients come to us from Tampa Rehab Center, Fort Myers Addiction Rehab Center, Orlando Recovery Center, Sarasota, Brandon, Gainesville, Naples Rehab Center, and more. Our admissions team is happy to help you immediately determine and verify your insurance benefits. Call us today to speak with one of our intake coordinators about your coverage with UMR or determine which other providers we accept.

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Frequently Asked Questions

We have the answers you're looking for

UMR covers drug and alcohol rehab as a subsidiary of UnitedHealth Group that administers self-funded employer health plans. When your employer's self-funded plan is administered by UMR, your behavioral health benefits including addiction treatment coverage are determined by your employer's plan design. UMR provides access to the UnitedHealthcare network, which includes a broad range of drug and alcohol treatment facilities. Contacting UMR member services or working with a treatment center that participates in the UHC network is the best way to confirm your specific rehab benefits.

UMR is not exactly the same as UnitedHealthcare, but it is a closely related company. UMR operates as a third-party administrator within UnitedHealth Group and manages self-funded employer health plans, while United Healthcare is the insurance division that issues fully-insured health plans. Members with UMR plans access care through the UnitedHealthcare provider network, which is the same broad network used by UHC plans. The key difference is that with UMR, your employer bears the financial risk for claims rather than the insurance company.

Yes, rehab is typically covered under UMR-administered plans, as the Affordable Care Act and Mental Health Parity and Addiction Equity Act require that substance use disorder treatment be covered comparably to other medical conditions. Since UMR administers your employer's self-funded plan, the specific scope of coverage is set by your employer's plan document rather than a standard insurance policy. Covered services may include detox, inpatient treatment, PHP, IOP, and outpatient counseling, depending on your plan. Verifying your UMR behavioral health benefits before beginning treatment confirms exactly what your employer's plan covers.

What your UMR insurance covers for addiction treatment depends on the specific benefit design your employer has established. Most UMR-administered plans include coverage for medically supervised detox, inpatient rehab, partial hospitalization, intensive outpatient programs, and outpatient therapy when those levels of care are deemed medically necessary. Behavioral health services accessed through UMR typically use the UnitedHealthcare network and may require prior authorization for higher levels of care. Reviewing your Summary Plan Description or contacting UMR member services gives you the most accurate picture of your addiction treatment benefits.

UMR, like UnitedHealthcare, does not set a fixed number of covered days for rehab, as coverage duration is determined by ongoing medical necessity reviews conducted during your treatment stay. At intervals during inpatient or other structured treatment, UMR assesses whether the level of care remains clinically appropriate based on your progress and clinical status. Coverage continues as long as the treatment meets medical necessity criteria. Consistent communication between your treatment team and UMR's utilization management process is essential for maintaining uninterrupted coverage.

UMR typically requires prior authorization for higher levels of addiction care, including inpatient rehab, partial hospitalization programs, and intensive outpatient programs. This authorization process involves a clinical review to confirm that the requested care is medically necessary under your employer's plan terms. Starting treatment without obtaining required prior authorization can result in claim denials. Treatment centers familiar with UMR and the UnitedHealthcare authorization process can initiate and manage prior authorization on your behalf during admissions.

UMR may decline to pay rehab claims for several reasons, including a determination that the service was not medically necessary, that prior authorization was not obtained, that the facility was not in-network, or that the claim was submitted incorrectly or without sufficient clinical documentation. If a claim is denied, you have the right to appeal and should work with your treatment provider to submit supporting clinical records. Self-funded plans administered by UMR are governed by ERISA, which provides specific rights related to benefit disputes and appeals. A treatment center experienced with UMR's claims process can help resolve billing issues efficiently.

UMR-administered plans can provide solid coverage for drug and alcohol rehab, particularly because they utilize the UnitedHealthcare provider network, which includes a large number of in-network treatment facilities. The quality of UMR coverage for rehab ultimately depends on how your employer has designed the benefits within the self-funded plan. Plans with strong behavioral health benefits and broad network access provide meaningful coverage that reduces the financial burden of treatment. Verifying your specific UMR plan benefits before beginning treatment is the most reliable way to assess what coverage is available to you.

You can check your UMR benefits for rehab by calling the member services number on your UMR insurance card or by logging into your UMR member account online to review your behavioral health benefits. Your Summary Plan Description, which your employer is required to provide, also outlines what services are covered and what cost-sharing applies. WhiteSands Treatment admissions staff can contact UMR on your behalf to verify coverage, including covered levels of care, prior authorization requirements, and your expected out-of-pocket costs. Completing this verification before you begin treatment ensures you enter care with a clear understanding of your benefits.

UMR-administered plans generally cover dual diagnosis treatment that addresses both a substance use disorder and a co-occurring mental health condition such as depression, anxiety, or PTSD. Federal mental health parity requirements apply to self-funded employer plans administered by UMR, which means behavioral health and addiction benefits must be provided at parity with physical health benefits. Integrated dual diagnosis care that treats both conditions simultaneously is supported under most UMR plan designs. Confirming your behavioral health benefits with UMR before admission ensures access to the full scope of dual diagnosis services available under your plan.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.

About the Author

is a proud alumni member of WhiteSands Treatment. After living a life of chaos, destruction and constant let downs, Mark was able to make a complete turnaround that sparked a new way of life. He is serious about his recovery along with helping others. At WhiteSands Treatment, we offer support to you in your homes or when you are out living in your daily lives.

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