UMR is a third-party administrator (TPA) of UnitedHealthcare and the largest TPA in the nation, serving upwards of 5 million Americans across the country. If you have a UMR health insurance policy and you’re actively seeking drug or alcohol rehab, you’re probably curious about the degree of coverage you can actually get. Fortunately, UMR partners with various private rehab clinics throughout the state of Ohio — including Prosperity Haven — to ensure that you can access the recovery care you need.

In the sections below, we will examine the kind of drug and alcohol rehab available to Ohio residents with a UMR insurance plan.

How UMR Treats Addiction

Since UMR processes claims and benefits for UnitedHealthcare plans, UMR insurance treats substance abuse in the same way that UnitedHealthcare does. More specifically, neither UMR nor UnitedHealthcare offers any special programs or resources for people struggling with addiction. While this may sound disheartening, it is not a reason to change your insurance.

Just because you won’t be able to access special resources for substance abuse treatment doesn’t mean that coverage for rehab is out of reach with a UMR plan. In fact, UMR and UnitedHealthcare offer the same degree of coverage as many other major insurance carriers. If you have a diagnosed substance use disorder or your primary care physician has determined that drug or alcohol rehab would be the best course of action for you, UMR will likely cover a substantial portion of the cost.

Naturally, like most medical treatments, rehab is not 100% covered by a UMR insurance plan. You will still need to pay any applicable premiums, deductibles, and copays, plus a percentage of the cost of rehab (often known as a “coinsurance”). You can always reach out to UMR for more information on the degree of rehab coverage you can expect with your particular plan.

Does UMR Cover Rehab in Ohio?

Generally speaking, UMR can and does cover rehab in Ohio. But again, whether or not you can get coverage will depend on the nature of your substance abuse and the documentation you can provide from your primary care physician or a licensed specialist. Without proof that you actually need rehab to recover from your addiction, UMR will not be able to cover any of the costs. Thankfully, if your doctor has determined that rehab is medically necessary to treat your condition, you can work together with UMR and Prosperity Haven to get covered substance abuse treatment.

It’s also important to consider the out-of-pocket costs you can anticipate when entering rehab with a UMR health insurance plan, regardless of the clinic you choose. Premiums and deductibles can vary based on your location, your health, and the type of plan you have through UMR. If you have a high deductible or you haven’t had any covered medical expenses for the year, you may have to pay a substantial amount out-of-pocket to meet your deductible and start getting coverage for your rehab treatment.

It’s also important to remember that Medicare Advantage or Medicaid plans provided through UMR will not cover treatment at private rehabilitation clinics. So, it’s best to contact your insurance carrier before committing to any rehab provider in Ohio.

Does My Health Insurance Only Cover Certain Rehab Facilities?

Most UMR plans in Ohio are HMO, PPO, or HMO-POS. HMO plans only offer coverage for clinics and providers within a predetermined network. If you want to get treatment at a rehab clinic outside of your network, an HMO plan will not cover the cost. Alternatively, if you have a PPO or HMO-POS plan, you may have a larger network than you would with a standard HMO plan. Moreover, PPO and HMO-POS plans with UMR typically provide a reduced amount of coverage for out-of-network care.

In short, your UMR health insurance will likely only cover rehab at certain facilities, but the amount of coverage you can get and the number of facilities you can choose from will depend on the type of plan you have.

Prosperity Haven – Quality Substance Abuse Treatment in Ohio

Does UMR manage your health plan, benefits, and claims? Do you want to access drug or alcohol rehab without spending a fortune? Finally, are you looking for a high-quality rehab clinic that accepts UMR health insurance? If so, Prosperity Haven is the answer.

At Prosperity Haven, we offer everything you need to overcome your addiction and begin the path toward lifelong sobriety. Our trained staff are available to make you feel comfortable as you recover, while also helping to teach you the skills and coping mechanisms you need to avoid relapse. Plus, Prosperity Haven makes your privacy a top priority, ensuring that you can recover in an environment that is both peaceful and discreet.

Don’t let addiction run your life any longer. Reach out to Prosperity Haven today to learn more.