UMR is a subsidiary of United Healthcare Insurance. As a third-party administrator (TPA) of United Healthcare, UMR can offer insurance coverage for rehab and aftercare for addiction treatment. Learn more about how to use your UMR insurance at our drug and alcohol rehab located in Crystal Lake, Illinois.
Understanding Your Coverage With UMR Insurance
Does UMR Insurance Cover Drug and Alcohol Rehab?
What Drug and Alcohol Rehab Services Are Covered by UMR Insurance?
Inpatient rehab, also known as residential treatment, requires individuals to stay at a treatment facility for a predetermined period, typically ranging from 30 to 90 days, though longer programs are also available. This highly structured environment provides 24/7 medical supervision and therapeutic support, making it ideal for individuals with severe addiction or co-occurring mental health disorders.
Unlike inpatient rehab, outpatient treatment allows individuals to receive care while maintaining their daily responsibilities, such as work, school, or family obligations. These programs vary in intensity and can range from a few hours per week to several hours per day, depending on the individual’s needs.
There are different levels of outpatient care, including:
- Partial Hospitalization Program (PHP): Sometimes called “day treatment,” PHPs offer intensive therapy and medical supervision during the day while allowing individuals to return home in the evenings.
- Intensive Outpatient Program (IOP): These programs provide structured therapy sessions multiple times a week but offer more flexibility than PHPs. They are ideal for individuals who require strong support but do not need round-the-clock care.
- Outpatient Treatment: This is the least intensive form of outpatient care, typically involving one or two therapy sessions per week. It is best suited for individuals who have already completed a higher level of care and need ongoing support.
Detoxification, or detox, is often the first step in addiction treatment. This medically supervised process helps individuals safely withdraw from substances while managing withdrawal symptoms. Medical detox is particularly crucial for substances such as alcohol, opioids, and benzodiazepines, as withdrawal from these drugs can be dangerous or even life-threatening without medical oversight.
Behavioral therapy plays a fundamental role in addiction treatment by helping individuals understand and change the thought patterns that contribute to substance abuse. Some of the most common evidence-based therapies used in rehab include:
- Cognitive-Behavioral Therapy (CBT) – CBT helps individuals recognize negative thought patterns and develop healthier coping mechanisms. It is particularly effective for treating both addiction and co-occurring mental health disorders such as anxiety and depression.
- Dialectical Behavior Therapy (DBT) – A specialized form of CBT, DBT teaches emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. It is often used for individuals who struggle with self-destructive behaviors, including substance abuse.
- Motivational Interviewing (MI) – This approach helps individuals resolve ambivalence about quitting drugs or alcohol by enhancing their intrinsic motivation for change.
Medication-assisted treatment (MAT) combines FDA-approved medications with counseling and behavioral therapy to support individuals recovering from opioid or alcohol addiction. MAT is especially useful for reducing cravings, preventing withdrawal symptoms, and lowering the risk of relapse. Common medications used in MAT include:
- Suboxone (buprenorphine/naloxone) – Helps reduce opioid cravings and withdrawal symptoms without producing the same high as full opioids.
- Methadone – A long-acting opioid agonist that prevents withdrawal symptoms and reduces cravings, typically administered in regulated clinics.
- Vivitrol (naltrexone) – A non-addictive medication that blocks the euphoric effects of opioids or alcohol, discouraging relapse.
MAT is a highly effective treatment approach that can significantly improve long-term recovery outcomes when combined with therapy and support services.
Recovery does not end when a rehab program is completed. Aftercare programs provide ongoing support to help individuals maintain their sobriety and prevent relapse. These programs include a variety of resources and services, such as:
- Sober Living Homes – These structured, substance-free living environments help individuals transition back into society while providing peer support.
- Ongoing Counseling and Therapy – Continued therapy sessions, either individual or group-based, help individuals address lingering challenges and strengthen coping skills.
- 12-Step Programs and Support Groups – Programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) offer peer support, mentorship, and accountability.
- Relapse Prevention Planning – Many treatment centers provide personalized relapse prevention strategies to help individuals identify triggers and develop effective ways to manage them.
Aftercare is a vital component of sustained recovery, offering individuals the long-term support they need to build a stable, substance-free life.
The length of time UMR will cover alcohol addiction treatment depends on the individual’s needs and the terms of the employer’s plan. UMR acknowledges that recovery is a personal process and works with providers to determine the appropriate duration of treatment. While some plans may cover 30, 60, or 90-day programs, others might require pre-authorization or proof of medical necessity for extended stays.
Insurance benefits for luxury or executive rehab facilities may be limited, as these centers often offer high-end amenities that go beyond standard treatment services. Verifying your insurance coverage for rehab is essential before enrolling in a program.
How to Verify Your UMR Insurance Coverage for Drug and Alcohol Rehab?
The first step in reviewing your UMR insurance coverage is to locate your policy documents. These can typically be found online through your UMR account, in a physical booklet, or on your employer’s benefits portal. Once you have access to your policy, focus on the sections related to behavioral health, mental health, substance abuse, or addiction treatment. These areas will provide the most relevant details about your rehab coverage.
As you review your policy, pay attention to several key factors. First, determine the coverage levels for inpatient, outpatient, and partial hospitalization programs. Understanding these distinctions will help you know what to expect in terms of services covered. Additionally, take note of any deductibles and copayments, as these define your out-of-pocket expenses. Some plans have separate deductibles specifically for mental health services, so be sure to check for those details.
Another critical aspect to review is whether your plan requires you to use in-network providers, as out-of-network care is usually much more expensive. Additionally, look for any annual or lifetime limits on mental health or substance abuse treatment. It’s also important to check if prior authorization is required before beginning treatment, as many rehab services require pre-approval.
Be aware of any specific exclusions in your policy that might impact coverage for particular treatments or conditions. If medication-assisted treatment (MAT) is part of your recovery plan, confirm which medications are covered. UMR’s website or member portal may also provide online tools that allow you to easily access and review your plan details.
Once you have reviewed your policy, reaching out to UMR’s customer service can provide direct confirmation of your coverage. Find the appropriate phone number for mental health or behavioral health inquiries, which can typically be located on your insurance card or UMR’s website.
Before making the call, gather your policy number, member ID, and a list of specific questions you need answered. Some important questions to ask include:
- What is my coverage for inpatient and outpatient substance abuse treatment?
- What are my deductible and copayment amounts for these services?
- Do I need prior authorization before entering a rehab program?
- Are there any in-network rehab facilities in my area?
- What is the process for filing a claim for rehab treatment?
- Are there limits on the length of stay or the number of treatment days covered?
- What medications are covered under MAT?
- Can you provide me with a list of in-network providers?
As you speak with a representative, take detailed notes, including the date and time of the call, the representative’s name, and any reference numbers they provide. This documentation can be helpful if any coverage disputes arise later. If possible, request written confirmation of your coverage details via email or mail to have a formal record of the information provided.
A rehab facility can also assist you in verifying your insurance benefits. Choosing a reputable treatment center, such as Northern Illinois Recovery Center (NIRC), can make the process easier since they are experienced in working with UMR insurance.
After selecting a facility, provide them with your UMR policy details. The treatment center’s admissions or insurance verification team will then contact UMR on your behalf to confirm your coverage and clarify any out-of-pocket costs. They will explain the types of treatment covered under your plan, provide cost estimates, and guide you through the process of obtaining prior authorization if necessary.
Many rehab centers also offer assistance with insurance paperwork and claims, helping to ensure that everything is submitted correctly. Additionally, some treatment centers advocate on behalf of patients to maximize their insurance benefits. Utilizing these services can give you peace of mind and allow you to focus on your recovery, knowing that you have a clear understanding of your coverage and financial responsibilities.
NIRC Can Help You Get the Treatment You Need
If you’re struggling with substance abuse, don’t wait. Contact us today to explore your rehab coverage options and begin your journey toward a healthier, sober life.
