The University of Pittsburgh Medical Center (UPMC) provides health insurance to more than 4.5 million people throughout Pennsylvania, New York, West Virginia, Maryland, and Ohio. In addition to providing health coverage, UPMC also has more than 60 affiliated health clinics in Western Pennsylvania and Ohio alone. Since UPMC manages both insurance products and healthcare facilities, it offers a wide range of services to help people struggling with addiction. UPMC even 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 UPMC insurance plan.

How UPMC Treats Addiction

UPMC dedicates an entire section of its official website to behavioral health and offers various online resources related to substance abuse. If you’re located within close proximity to a UPMC clinic, you can even call the carrier’s hotline to schedule an appointment to be assessed for detox and withdrawal management. Depending on the results of your assessment, you may be guided to a UPMC facility or a third-party clinic like Prosperity Haven for treatment.

Given the fact that UPMC operates as both an insurer and a healthcare provider, it’s important to recognize the distinction between what UPMC covers and the kind of addiction treatment it offers. Currently, you can seek out treatment from a UPMC facility for all of the following addictions:

• Alcohol
• Marijuana
• Opiates
• Sedatives
• Cocaine
• Stimulants
• Hallucinogens
• Gambling
• Tobacco

Through a UPMC clinic or UPMC-affiliated clinic, you can access dual diagnosis inpatient treatment, preventative care, recovery education, and outpatient treatment. However, just because you have UPMC insurance does not mean that you will automatically get coverage at a UPMC clinic or UPMC-affiliated clinic.

Does UPMC Cover Rehab in Ohio?

While UPMC is headquartered in Pennsylvania and most of its clinics reside in Pennsylvania, it does extend coverage to eligible residents in Ohio. Additionally, it covers drug and alcohol rehabilitation at more than 60 clinics in the region, including Prosperity Haven (located in Chardon, Ohio). To ensure that you can get coverage for your substance abuse treatment, you should speak to your doctor and reach out to UPMC to discuss your options.

Like most insurance carriers, UPMC will only cover rehab if it is deemed medically necessary by a healthcare professional. Keep in mind that, while UPMC offers Medicare Advantage plans, most rehab clinics only accept non-Medicare health insurance. So, if you want rehab to be covered b your UPMC insurance, you’ll need to ensure that you have an individual or family policy that is not associated with Medicare.

It’s also important to note that the degree of coverage you can get through UPMC will vary based on the type of plan you have. In most cases, if UPMC will cover your treatment, you will still need to pay your plan’s premiums, meet your deductible for the current benefit period, pay any applicable copays, and also pay for a portion of the cost of rehab (coinsurance).

Does My Health Insurance Only Cover Certain Rehab Facilities?

Yes, UPMC health insurance only covers certain rehab facilities located in Ohio, Pennsylvania, New York, West Virginia, and Maryland. However, just because UPMC operates dozens of clinics throughout the Midwest and Northeast does not mean that your UPMC insurance will only cover treatment at these facilities. In fact, UPMC insurance often covers rehab treatment at non-UPMC rehab clinics or UPMC affiliate clinics.

In either case, your coverage will depend on the type of plan you have with UPMC. Currently, UPMC offers two types of EPO plans, as well as HMO and PPO plans. HMOs and PPOs tend to be the most common plan types and are offered to more people. However, it’s still important to understand how your rehab coverage could differ with each type of insurance.

If you have a UPMC EPO Partner Network plan, you will be limited to a small number of UPMC healthcare providers in your area. You will have some coverage for non-UPMC providers, but not very many, and the coverage will be very limited. Alternatively, if you have a UPMC EPO Select Network plan, you will have access to all of the same coverage, but you will be eligible for treatment at a larger number of non-UPMC facilities.

With a UPMC HMO plan, you will have coverage within a network of UPMC and non-UPMC providers. However, you will be required to have a primary care physician and to get a referral before seeing a specialist. If you want to get rehab outside of your network, this type of plan will not cover the cost. Lastly, a PPO plan from UPMC offers the largest network and the most versatility, as you can get coverage from a larger number of UPMC and non-UPMC clinics, as well as partial coverage at out-of-network providers.

In short, your UPMC health insurance will primarily offer coverage at UPMC facilities and a small number of non-UPMC facilities in Ohio, but the amount of coverage you can get and the number of facilities you can choose from will depend on the structure of your plan.

Prosperity Haven – Quality Substance Abuse Treatment in Ohio

Do you have a private health insurance plan with UPMC? Are you looking for a way to recover from alcohol or drug addiction? Finally, do you want to find a quality, private rehab in Ohio that accepts UPMC health insurance? If so, Prosperity Haven is the answer.

At Prosperity Haven, we put your comfort and long-term goals first. We will work with you to develop a recovery plan that meets your needs, and then introduce you to a wide range of effective treatments. This way, you can learn the skills you need to get sober and stay sober for good.

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