How to Pay for Drug Rehab With UPMC Insurance

UPMC is headquartered in Pittsburgh, Pennsylvania and serves more than 3.4 million members in Pennsylvania, Ohio, West Virginia, and Maryland.1 Group health insurance, Medicare, employee assistance, worker’s compensation, and behavioral health are just a few of the many health care services provided by UPMC.

UPMC Health Plan provides its members with partial or full coverage for substance abuse and mental health treatment. Confirm your health benefits and learn more about your treatment options at American Addiction Centers.

Which Addictions Treatment Does UPMC Covers?

UPMC covers treatments for most major addiction types and co-occurring disorders. A co-occurring disorder is the coexistence of both a substance use disorder and a mental health disorder such as depression, PTSD, or schizophrenia.

Roughly half of all people with a substance use disorder also suffer from a mental illness, while the opposite is also true.2 The effects of drugs and alcohol can often lead to the development of a co-occurring mental health issue, while those who suffer from mental health disorders may use drugs and alcohol as a way to self-medicate their symptoms. Many drug rehab centers treat both conditions at the same time to help patients experience a complete recovery.

Addiction types that may be covered by UPMC include:

  • Alcohol.
  • Heroin.
  • Cocaine.
  • Methamphetamine.
  • Marijuana.
  • Prescription drugs (opioids, stimulants, benzodiazepines).
  • Inhalants.
  • Hallucinogens.

Which Types of Addiction Treatment Are Covered?

UPMC covers a wide range of treatments for addiction and mental health. Factors that may be taken into consideration when determining the right treatment program are the type of substance being used, your medical history, and whether you also have a mental health disorder.

Types of care that may be covered by UPMC include the following:

Medical Detox

Detox helps you manage unpleasant withdrawal symptoms. Medical detox is the first stage of addiction treatment and occurs before therapy and counseling in standard rehab programs. With certain types of substance dependence, medications may be used to manage your symptoms and decrease the risk of complications.

Inpatient and Residential Rehab

Many of these programs offer 24-hour medical care, support, and monitoring, as well as counseling and a range of therapies in a structured setting. Inpatient and residential rehab programs focus on helping patients adapt to a healthier lifestyle without drugs and alcohol. Patients live at the facility for the duration of their treatment programs and receive services such as daily meals and housing.

 UPMC covers a wide range of treatments for addiction and mental health.

Partial Hospitalization

Partial hospitalization programs, or PHPs, offer many of the same therapies as inpatient and residential programs but allow patients to live at home or in sober-living facilities while visiting the rehab center daily for treatment. These programs can meet up to 5 days a week for between 4 and 6 hours per day.

Intensive Outpatient Rehab

Intensive outpatient programs, or IOPs, meet less frequently than PHPs for up to 3 hours per day. These programs offer a high level of support for people and allow them to continue work, school, and family responsibilities.

Standard Outpatient Rehab

Standard outpatient programs are the most flexible treatment programs and are often able to be scheduled around the person’s personal life. These programs meet at least once per week and provide ongoing support in the form of 12-step support groups, group counseling, and family therapy.

UPMC may cover the following rehab program services:

  • Assessments
  • Exams
  • Lab tests
  • Medications
  • Therapy
  • Costs for inpatient or residential stays, including meals

Assessments are normally provided before people start their recovery programs to determine the appropriate level of care.

Your health plan with UPMC may only cover a certain number of days or visits of treatment per calendar year regardless of whether you receive inpatient or outpatient care. Most treatment centers will perform a free insurance benefits check so you will know about the type of coverage you’ll receive.

How Much Will I Pay Out of Pocket?

People at group psychotherapy session indoorsThe amount you pay out of pocket for addiction treatment will depend on your health plan and its deductibles, co-pays, and coinsurance.

A deductible is the amount you pay for covered services before UPMC begins to provide coverage. For example, if your health plan has a $1,700 deductible, that is the amount you must pay out of pocket before UPMC begins payment. A co-pay is a fixed amount you pay for a covered service (some plans require it before or after you meet the deductible), and coinsurance is a fixed percentage you pay for a covered service. Your co-pay and coinsurance rates will likely be higher if you receive treatment from an out-of-network provider.

Most substance abuse and mental health treatments must be preauthorized for you to receive coverage from UPMC. Preauthorization is when your health insurer determines that a certain medical treatment or service is medically necessary for your recovery.

UPMC requires preauthorization for the following addiction and mental health services:3 

  • Medical detox
  • Medically monitored inpatient and residential rehab
  • Partial hospitalization treatment
  • Intensive outpatient treatment
  • Psychological and neuropsychological testing
  • Electroconvulsive therapy

Behavioral health emergencies do not require preauthorization from UPMC. A behavioral health emergency is when care is required immediately for life-threatening emergencies, such as when drug and alcohol use leads to violence or suicidal thoughts, or when a person is suffering from alcohol poisoning or a drug overdose.3

What if My Provider Is Out of Network?

It is best to choose an in-network provider to benefit from lower treatment costs.

Out-of-network providers do not have contracts with UPMC in which they have agreed to offer services at predetermined rates. If you choose a treatment center that is out of network, you may be required to pay a large portion of the treatment cost or the entire cost.

Whenever possible, it is best to choose an in-network provider to benefit from lower treatment costs. If you are interested in receiving treatment from an out-of-network provider, ask the provider about other available payment options and payment plans like sliding scale fees that can make treatment more affordable for you or your loved one.

Other UPMC Programs and Services

UPMC offers other programs and services that can benefit those who are struggling with addiction and mental illness. Beating the Blues US™, LifeSolutions, and UPMC’s Behavioral Health Management Program are all services that have the common goal of helping UPMC members maintain good mental health and experience strong, supportive recoveries.4

Beating the Blues US™ is an online tool that aims to improve your mood and well-being on stressful days or when you’re dealing with serious life problems. UPMC’s LifeSolutions service provides 24/7 support and online access to resources that help you find a healthy work-life balance. UPMC’s Behavioral Health Management Program teaches you how to use available treatment resources to best manage mental health conditions such as depression, anxiety, and ADHD so you can stay safe and become healthier.

How Do I Get Started?

Your first step toward getting addiction treatment is to verify your insurance benefits with American Addiction Centers. Our admissions navigators are available 24/7 to check your insurance benefits and help you choose the best rehab facility and treatment program based on your health plan, coverage, and individual circumstances.

There are several ways to verify your insurance benefits. You can call 888-966-8152 to speak to an admissions navigator or use the live chat feature on our website to chat with a navigator. Alternatively, you may also fill out our free insurance verification form to learn more about your benefits and get a response instantly before speaking to an admissions navigator.

Your information will always be kept safe, secure, and confidential. American Addiction Centers is dedicated to helping people experience safe and fulfilling recoveries from addiction.

Sources

  1. UPMC Health Plan. (n.a.). Our company.
  2. National Institute on Drug Abuse. (2018). Comorbidity: Substance use disorders and other mental illnesses.
  3. UPMC Health Plan. (2009). Behavioral health.
  4. UPMC Health Plan. (n.a.). Programs and services to improve and manage behavioral health.
Last Updated on July 9, 2020
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Dan Wagener
Dan Wagener is a Senior Web Content Editor at American Addiction Centers.
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