Optum Drug & Alcohol Rehab Coverage in Ohio

Will Optum Pay For Rehab?

Yes, generally, Optum will pay at least a portion of drug or alcohol rehabilitation. Any out-of-pocket costs will depend on the specifics of your Optum policy. You may be responsible for co-pays, co-insurance, and/or a deductible.

Your plan may require that you choose an addiction treatment center that is in-network with Optum in order to receive coverage. Some Optum customers may find that addiction treatment is 100% covered by their plan when they choose an in-network facility.

Thanks to the Affordable Care Act, addiction treatment is considered an essential health benefit, meaning insurers must offer coverage. However, which services are covered will depend on the severity of your substance use disorder. Optum does have some agency to identify which level of care is medically indicated and therefore covered by your plan.

Optum Networks in Ohio

Optum has two primary networks in Ohio:

American Health Network: This network offers over 70 offices across Indiana and Ohio that include primary care doctors, specialists, and addiction treatment centers. 

Unity Health Network: Specific to Northeast Ohio, Unity Health Network offers over 100 providers and 30 offices across five counties.

Types of Optum Plans

Like other insurers, Optum has various plans that can affect your treatment options and out-of-pocket costs. Regardless of your plan, choosing a facility that is in-network with Optum will bring the lowest out-of-pocket costs. Popular Optum plans include:

HMO – Optum HMO plans have a defined network, which means you must choose an addiction treatment center that is in-network with Optum. 

EPO – Similar to HMO, EPO plans only cover certain doctors and hospitals. However, the network is usually larger than HMO networks.

HDHP – High deductible plans require that you spend more money out-of-pocket before insurance coverage starts paying for covered services. Plans with at least a $1,400 deductible are considered high deductible. This usually means you will be required to cover at least $1,400 toward your addiction treatment cost, while Optum covers the rest. Though this can sound like a lot, 30-day addiction treatment can cost tens of thousands of dollars total without insurance.

POS – Optum POS plans allow you to choose a rehab that is either in or out of network, though you may require a referral or pre-authorization. Out-of-network facilities will bring higher out-of-pocket costs.

PPO – Optum PPO plans offer the greatest flexibility when it comes to choosing addiction treatment. PPO plans offer coverage for out-of-network centers, however, in-network providers will have the least out-of-pocket costs.

Optum Medical Detox Coverage

At OARC, we boast a comprehensive medical detox center that includes 24-hour nursing care. Detox is often the first step in addiction treatment and the highest level of care. Detox is designed to treat drug or alcohol withdrawal symptoms with medications and talk therapy.

When medically appropriate, Optum offers coverage for inpatient medical detox. Because detox is designed to treat chemical dependency, not all substance use disorders require detoxification. Optum will typically cover:

• Alcohol Detox
• Benzo Detox
• Prescription Opioid and Heroin Detox
• Fentanyl Detox
• Sedative Detox

Because OARC is in-network with Optum, we’re able to keep out-of-pocket costs to a minimum for our clients. Learn more about our medical detox center in Columbus, Ohio.

Optum Inpatient Rehab Coverage

Residential rehab, also known as inpatient, is an intensive level of care lasting 30-45 days. In residential treatment, clients address the psychological component of addiction and other factors that contribute to substance abuse. Residential treatment includes individual counseling, group therapy, education, relapse prevention, coping skills, life skills, and aftercare planning.

For those who qualify, residential rehab may be completely covered by your Optum plan. Residential treatment is considered the gold standard of addiction treatment.

Learn more about our residential rehab center in Columbus, OH.

Optum Outpatient Rehab Coverage

Optum also offers benefits for outpatient addiction services. This can include partial hospitalization (PHP), intensive outpatient (IOP), outpatient counseling, and MAT programs.

At OARC, we offer:

PHP: PHP is like an in-between of residential and intensive outpatient. Clients attend treatment during the day, and then return home at night.

IOP: IOP is a level of aftercare. Most of our clients first complete residential treatment before starting IOP. Treatment consists of 3-hour sessions three days per week, allowing clients to transition back into work, school, and/or their home life.

Counseling: After IOP, some clients choose to continue counseling sessions with their primary therapist on a custom cadence. Many choose to continue counseling for their first year of recovery.

Optum Mental Health Rehab Coverage

Optum also offers coverage for mental health treatment. At Ohio Addiction Recovery Center, we are a dual-diagnosis rehab, which means we also treat any co-occurring mental health conditions. Our clients can expect to meet with psychiatric healthcare providers that are in-network with their Optum plan.

Understanding Your Optum Plan

Understanding insurance coverage and addiction treatment costs can be confusing. At OARC, we’re proud to offer clarity and transparency to those who reach out for help. Confidential and at no obligation, we’re always available to verify insurance benefits and help you understand any costs associated with treatment. You can reach our insurance experts at 800-481-8457 who can check the exact benefits of your policy.

• Sources
  1. Optum – Find Care in Ohio
  2. Optum – How Do I Choose Health Insurance?