united healthcare

United Healthcare is a modern insurance provider that prides itself on its diversity and innovation. On a national scale, United Healthcare covers 41.6 million people in the United States alone. That includes Medicare and Medicaid as well as “traditional” commercial plans. Excluding the 3.9 million Medicare supplement plans, United Healthcare covers 37.7 million people. DreamLife Recovery is proud to accept many insurance plans, including United Healthcare plans.

 

What Is United Healthcare’s Coinsurance Fee?

Most United Healthcare plans cover 80% of rehabilitation costs after the deductible is met. After the deductible is met there is a 20% coinsurance fee. In other words, after you meet your deductible if you have a medical bill for $100 because of your healthcare insurance you will only pay $20. A 20% coinsurance rate sounds high until you look at how much the plan covers and how little you have to pay compared to the overall cost of any treatment.

 

What is the Most Expensive Drug and Alcohol Rehab Can Get?

There is also a maximum out-of-pocket expenses cap that limits how much a person has to pay for medical treatment a year out-of-pocket. This expense cap only applies to expenses stated under your plan.

 

What are the Basic Insurance Terms?

Here are a few terms that are helpful to know when you are dealing with insurance and insurance plans. These are very basic terms, but they are important to know.

  • Provider:

Any medical entity like a doctor, hospital, or medical clinic that provides a person with health services like mental health care, addiction rehabilitation care, and physical care like x-rays and annual checkups is considered a medical provider

  • Coverage:

When you “buy” your insurance plan you and the insurance company negotiate a coverage amount. That amount of money is the amount that the insurance company agrees to pay you under certain circumstances to “cover” your expenses after the terms of your agreement have been met. In healthcare insurance, the requirement you have to meet is you have to pay your deductible.

  • Deductible:

You “pay down” your deductible every year after you enroll in your insurance program. You pay down your deductible by paying for healthcare services and items that your insurance covers until you “meet your deductible”. When you meet your deductible, your insurance starts to pay for these services and items. Your deductible is agreed upon when you sign up for your healthcare policy.

Deductibles have widely varying amounts. Some deductibles are met after several hundred dollars. There are other deductibles that are met after several thousand dollars. High deductibles are usually part of disaster insurance plans like flood insurance.

  • Out of pocket:

When you pay for any health care service related to your insurance without being reimbursed by your insurance company you are paying out of pocket. Usually out of pocket costs are either for services or items not covered by your insurance, payments made to the deductible, and copays or coinsurances. Usually, copays and coinsurances are not called out of pocket for the sake of clarity. When a provider says that you pay a certain copay or coinsurance for that visit, they are indicating that your insurance is already paying some portion of your treatment. This is usually because your deductible has been met.

  • Copay:

Your copay is the amount of money you owe to your doctor or other service providers after your deductible is met. Usually, copays are much smaller than the regular cost of the service provided.

  • Coinsurance:

Coinsurance has a similar concept as copay, except for the fact that, instead of a fixed dollar amount, coinsurance is a direct reflection of how much you would otherwise pay to the health service provider. Usually, United Healthcare’s coinsurance rate is 20%. This means that after you meet your deductible, United Healthcare will pay for 80% of your costs if you have a certain plan

  • Comprehensive coverage:

Comprehensive coverage only covers certain instances. For example, someone who has comprehensive coverage for their office might have bought coverage in case their business was robbed but if they did not buy coverage in case their computers were hacked and their information was stolen and used they would be paying those costs on their own

  • All-inclusive coverage

All-inclusive coverage is coverage that covers an entire category of a section of insurance. If someone had all-inclusive business insurance the company would pay for damages to the business if it was robbed, its computers hacked, and if its information was otherwise stolen and illegally used the insurance company would pay damages to the company.

  • In-network:

In-network service providers are pre-approved by your health insurance provider. In many plans’ insurance companies will only pay for treatment provided by providers in their network. There are some plans in which companies will cover out-of-network providers, but it is usually more expensive to see even if these providers are covered by your particular plan. United Healthcare covers treatment at DreamLife Recovery

  • Out-of-network:

If a doctor is out-of-network, it does not always mean that it is because they are a bad doctor or have a bad reputation. Some doctors simply do not want to be part of a network. Many insurance providers including United Healthcare have rigorous standards that providers must meet before the company brings them into its network

Now that you know some of the basics, there are some other things to know about insurance.

 

Does the Affordable Care Act Change My Addiction Rehabilitation Coverage?

The Affordable Care Act (ACA) also known as “Obamacare” changed some insurance requirements. It listed 10 essential health benefits. One of the listed benefits was addiction coverage. This means that any coverage plan you purchased on the health exchange should provide you with at least some substance abuse rehabilitation coverage. This applies to people covered by Medicaid as well.

The other essential benefits are:

  • Ambulatory patient services (outpatient services)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

What is Considered an Addiction Disorder?

Addiction is considered a mental health disorder just like depression and anxiety. Many mental health disorders will occur along with, or “co-occur” with addiction. This is called a dual diagnosis. Some of these disorders are:

  • PTSD
  • Depression
  • Anxiety
  • Bipolar

These are by no means the only mental health disorders that can co-occur with addiction. Sometimes addiction occurs because someone suffering from mental illness is either not treated or improperly treated which causes the person to live with extreme suffering.

Sometimes this causes the person to “self-medicate”. Self-medication is when someone turns to misuse of substances like alcohol and opioid painkillers to relieve either physical or mental pain. This self-medication can often have devastating consequences, not only for the person suffering from the addiction but for their loved ones too.

 

What is the Cost of Addiction?

Addiction can cause people to lose their jobs, homes, families, and sometimes even their lives. There are some drugs like Narcan that can bring people who are at the edge of death from an opioid overdose back, but unfortunately, Narcan is not always there. There is not always someone to administer Narcan there to save you. 

Unfortunately, there are no similar medications for any other type of substance. Even if there were, sometimes people are so lost in the pain of addiction brought about by self-medication for mental illness that they become socially isolated. We do not want you to be alone. Your friends want you back, your family needs you back. Even if you think that you have nothing left to provide to the world, you do. And you have so much to get back from it.

 

Do a Lot of People Have Addiction Rehabilitation Coverage? 

According to some sources, 1 out of 10 people who have a substance abuse problem receives treatment. Some of these people might not get the help they need because they are unable to pay for it as they either do not have insurance, do not know that their plan may cover some or all of their rehabilitation costs, or have other insurance problems.

 

Do I Have to be the One that Calls My Insurance Company about My Drug Rehab Coverage?

Here at DreamLife Recovery we will, with your consent, make the phone call to your insurance company. We proudly accept United Healthcare and we know how to work with them so that there are no misunderstandings or errors that could cost you money. Healthcare is expensive, but without rehabilitation, an accidental overdose means that your next expense could be your last. Please do not become part of an ever-growing statistic. There is hope and there is a way to find your right path. We, at DreamLife Recovery, want to help you find that path.

Article Reviewed by Lidice Morales

Lidice MoralesLidice Morales, an honors graduate from the Kaiser University, has made a name for herself as the Director of Nursing at several behavioral health facilities and as the Director of Operations for Detox MD. Now she is the VP of Operations at DreamLife Recovery. She strives for better patient care through constant self-improvement and furthering her education. Her steadfast work ethic and passion in the field has remained the most important aspect of her professional career; showing dedication to not only the acquisition of new knowledge, but also its mastery. Lidice believes that a professional work atmosphere fosters cohesion and malleability amongst herself and her coworkers; thereby increasing both the level of patient care and quality of life.

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