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Does UMR Insurance Cover Drug & Alcohol Treatment?

UMR Drug & Alcohol Rehab Coverage

If you’ve made the decision to seek out rehab, insurance is an important part of ensuring that your drug rehab remains affordable and achievable. If your employer provides UMR Insurance as part of healthcare coverage, you probably want to know if it offers drug and alcohol treatment coverage. If you have UMR, chances are, you’ll have a large portion of your health costs covered by your employee insurance.

With the help of our experts at Asana Recovery, we can guide you through UMR’s drug and alcohol treatment offerings to help you get the most out of your health insurance when you look for treatment.

What is UMR ?


While many people receive UMR through their workplace, it is not an insurance policy. Instead, it is a third-party administrator, known as a Third Party Administrator (TPA). Here, a TPA ensures your claims are paid correctly and that healthcare costs are kept to a minimum.

Essentially, this means UMR does not help you pay for rehab. In fact, any portion of your healthcare costs not covered by your employer and insurance will be paid by you.

However, UMR will help you to ensure you are paying a fair rate, that your insurance pays your claim, and that everything is handled without you having to intervene, so you can focus on recovery.

In addition, UMR is a UnitedHealthcare company, which is an insurance provider. However, the TPA covers and helps with insurance policies from most providers – meaning that if your employer offers UMR coverage, UMR will help with your drug or alcohol treatment. 

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Does UMR Cover Drug and Alcohol Treatment?

UMR’s provider network includes a diverse range of behavioral health services including inpatient treatment and outpatient treatment. The Patient Protection and Affordable Care Act, commonly known as the ACA or Obamacare, mandates that all insurance providers must cover at least a portion of drug and alcohol treatment. Therefore, it doesn’t matter which insurance provider you have in addition to UMR, your drug and alcohol treatment is required to be included in the plan.

UMR officially supports:

Inpatient and residential rehabilitation
Outpatient and intensive outpatient treatment
Partial hospitalization treatment

However, the scope and extent of treatment varies per provider. This means that while UMR offers support for both inpatient and outpatient drug and alcohol rehab, your provider may not. On the other hand, UMR will work to ensure that you get the maximum amount of coverage available from your provider for the type of treatment you choose to seek out.

Most insurance providers offer better coverage for outpatient care. Therefore, if you’re on a budget, looking into outpatient treatment may be in your best interest. You can call Asana Recovery to discuss your specific insurance provider with us to see how much of treatment they will cover.

UMR Policy Coverage for Substance Abuse

UMR covers behavioral and mental healthcare including substance abuse treatment. Here, UMR substance abuse rehab policies extend to cover inpatient and outpatient for the recommended duration of treatment, as confirmed by your healthcare provider. This means that your provider will cover the full amount agreed for the full duration of treatment, whether your treatment is 30 days or 6 months.

If you’d like to see more about UMR policy, log in via the portal here.

However, coverage varies significantly per plan and per option. For example, if you choose the UMR Tier Two Choice Plus Network and got to a preferred network provider you can expect:

$100 deductible
$4,000 out of pocket expenses (the most you could possibly pay out of pocket yourself for your drug treatment)
$20 office fee per visit for outpatient services
5% coinsurance after $100 copayment for outpatient services
5% coinsurance after $100 copayment for inpatient services

If you look for the same services from an out of network provider, you’ll likely have a 50% coinsurance policy. However, these rates are for the state of Arizona and may not apply everywhere.

UMR Mental Health

UMR offers significant mental health coverage including behavioral treatment like cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR). With over 3,000 health care providers in the UMR network, you have access to a significant number of mental healthcare providers in the network. In addition, you may have access to out of network providers as well.

While UMR doesn’t require pre-approval for behavioral health treatment, your insurance provider may. Make sure you check with your provider before moving forward with treatment.

UMR PPO: Can You Use an Out of Network Provider?

UMR is a preferred provider organization, also known as PPO. This means that the organization operates with a network of pre-approved hospitals, doctors, pharmacies, and care providers. This offers numerous advantages to users in that you can often go to treatment without a referral, the network includes a large range of providers and clinics, and services through a preferred provider are often up to 30% discounted over going to the same facility without UMR membership.

However, UMR also offers full coverage for an out of network provider. However, UMR does have specific requirements for this:

  • The out of network provider must submit an actual bill charged, which you can then forward to UMR.
  • The rate must be reasonable and in-line with standard rates for drug and alcohol treatment in that region. E.g., you won’t be able to attend a luxury treatment facility without prior approval unless they’re already part of UMR’s network.

At the same time, it’s also important to check with your insurance provider to see if they offer the same coverage. UMR insurance is not traditional insurance, so you’ll have to check both. In addition, UMR Out of Network Coverage is not always available with every UMR plan. Check your plan to be sure. Normally you need a Tier 3 plan to have out of network coverage.

Does UMR Cover Medication Assisted Programs?

UMR covers generic and brand name medication providing it is approved by the FDA. In practice, this means you will get coverage for any medication assisted program provided by a licensed treatment facility and recommended by a doctor. This includes coverage for both short and long-term prescriptions. 

UMR Methadone

If your doctor recommends a methadone maintenance program, UMR will ensure that your insurance policy covers it to the full extent listed in the policy.

UMR Suboxone

Like Methadone, UMR offers Suboxone treatment providing it is recommended by your doctor and provided by a licensed drug treatment facility. Here, Suboxone is not treated any differently than any other prescription medication, meaning that it will fall under coverage.

What if UMR Doesn’t Provide Enough Coverage for Drug Treatment?

If your insurance provider and UMR are not providing enough coverage for your chosen drug and alcohol treatment provider, the best alternative may be to look for another rehab center. However, you may also look into:

Payment plans, most treatment providers offer payment plans to make treatment more accessible
Medical loan services
Local grants and medical support for seeking rehab and addiction treatment
Medical discount services (E.g., choosing an in-network provider which will offer a discount)

If you’re unsure if UMR or your insurance plan cover the drug treatment center you’re looking into, contact them to ask. Most insurance providers maintain a list of covered treatment centers. However, most will offer at least partial coverage for most treatment centers.

Getting Help

Asana Recovery works with and accepts UMR insurance for our drug and alcohol treatment programs. If you’d like to learn more or would like to see how your UMR policy works with our treatment plans, contact us at (949) 763-3440 to learn more about available treatment plans, insurance coverage, and coverage options. Our team of experienced addiction experts is available to help now.

Our goal is to help you to get affordable and accessible mental and physical healthcare to treat substance use disorder and that starts with good advice and helping you to understand what your insurance policies offer.

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