UMR Rehab Coverage

Addiction Treatment Services Covered By UMR

Addiction is a chronic illness that doesn’t just impact the body; it triggers mental health disorders and affects nearly every dynamic in your life. Whether it’s your relationships to overall mental health, or even your finances, no area of your life is immune to the damage of drug and alcohol addiction.

For most who struggle with alcohol addiction or other forms of substance abuse, finding the right drug and alcohol rehab is the first step toward success. Taking this step for most individuals looking for addiction treatment is contingent on the type of insurance coverage available to them.

If you’re a recipient of UMR Health Insurance through your employer, you have access to some level of coverage for drug and alcohol rehab. Most UMR plans cover addiction treatment services, including detox, inpatient treatment, and several outpatient programs.

However, UMR operates differently from a standard insurance company, so it’s essential to understand exactly how your benefits work.

This guide by Icarus Behavioral Health in Idaho walks you through what UMR is, what types of drug and alcohol rehab services are covered, and important points to be aware of when planning addiction treatment.

What Is UMR?

UMR stands for United Medical Resources. UMR Health Insurance is a third-party administrator (TPA), meaning it doesn’t offer insurance plans directly but instead manages health benefits for self-funded employer groups.

UMR Health Insurance is under the umbrella of UnitedHealthCare, arguably the largest insurance company in the United States. If your employer uses UMR insurance coverage, they design the coverage benefits while UMR handles claims processing, provider network access, and customer service.

As part of the Affordable Care Act, UMR offers policies for overall health insurance coverage, and due to the Mental Health Parity Act behavioral health and addiction treatment are required to be covered, though to greatly varying degrees among policies.

Unfortunately, this structure can confuse working with an insurance company. However, it’s important to remember that regardless of the specifics, your UMR insurance coverage does include services for addiction treatment.

Does UMR Cover Addiction Treatment?

In most cases, UMR plans provide coverage for various care levels in drug and alcohol rehab facilities. That said, because every employer-sponsored plan is unique, the specific services, length of stay, and out-of-pocket costs will vary.

The types of treatment UMR insurance might cover include:

Insurance coverage for drug and alcohol rehab is usually based on mental health necessity, meaning that a doctor or clinician must determine that the outpatient or inpatient treatment is essential for your health.

UMR insurance coverage, like any other insurance company, has to cover mental health or drug rehab in some form. At Icarus Behavioral Health in Idaho, services are available to recipients of UMR health insurance coverage, including the following:

Medical Detox

Medical detox is usually the first step in inpatient drug rehab, though at this time Icarus in Idaho does not offer this level of care. Individuals suffering from opioid, benzodiazepine, or alcohol addiction generally require detox as a starting point, regardless of the next care level.

During this stage of alcohol and drug rehab, your UMR health insurance company may cover:

  • 24/7 nursing care to monitor for seizures or withdrawals
  • Support medications to help during the detox process

Detox is generally one stage of drug rehab that requires a preauthorization form from your treatment provider at the drug rehab you select.

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Residential or Inpatient Rehab

Residential Rehab at Icarus in Idaho

After clients complete the detox portion of drug treatment, many opt for inpatient rehab as the next step. Clients commit to a 30, 60, or 90-day stay during inpatient rehab. Attending drug or alcohol rehab treatment includes daily meetings with counselors in a one-on-one setting, group meetings, and holistic treatment options.

Your UMR insurance rehab coverage provides funding for:

  • Living arrangements (room and board, meals, etc.)
  • Daily therapy and psychiatrist sessions
  • Medication management
  • Education on relapse and triggers

The amount of rehab coverage you receive depends on your specific UMR insurance plan. There could be limits on the number of days you’re permitted to attend. Additional rehab coverage might require a prior authorization form from a medical professional at Icarus Behavioral Health in Idaho.

Partial Hospitalization Programs (PHP)

PHPs are covered by your UMR insurance plan and offer full-day treatment while allowing you to return home in the evening. These programs are ideal for those who need intensive treatment but can’t commit to extended stays. In addition, clients who struggle with mental health challenges and require dual diagnosis care make ideal candidates for our PHP program.

Your UMR insurance will cover our PHP drug rehab and mental health treatment if:

  • The client has a recent substance abuse diagnosis
  • Treatment is administered by a licensed facility like Icarus Behavioral Health in Idaho
  • Clinical documentation supports the need for structured support (a referral by a substance use professional)

Intensive Outpatient Programs (IOP)

Intensive Outpatient Programs at Icarus in Idaho

IOP provides more flexibility, with roughly 10-15 hours of therapy each week over a 2 to 3-day period. This program is helpful for recipients of UMR insurance who require a less intensive form of treatment or contend with a less severe case of substance abuse disorder. IOPs can also be helpful as step-down programs that bridge a more intensive form of therapy and a lower care level.

Ideal clients include:

  • Clients transitioning out of inpatient care
  • Users with a more modest level of addiction
  • Clients with a strong support system at home

UMR insurance plans usually cover the following during IOP treatment at Icarus Behavioral in Idaho:

  • Group and individual counseling sessions
  • Life skills education (for returning home and coping with life outside of treatment)
  • Family therapy

Medication Assisted Treatment (MAT)

MAT uses a potential combination of several medications combined with one of our care levels to combat substance use disorders. Ideal UMR insurance recipients include those struggling with benzodiazepines, alcohol, and opioids.

Depending on the recommendations of a professional addiction treatment specialist and physician, your UMR insurance coverage could potentially cover the following medications:

  • Suboxone (buprenorphine/naloxone)
  • Vivitrol (naltrexone)
  • Methadone (only available at federally approved methadone clinics)

If other drug and mental health services have been unsuccessful, your UMR insurance plan is more likely to cover MAT. Why does UMR insurance cover drug treatment plans so thoroughly at Icarus Behavioral in Idaho?

Their primary goal is to get you the most efficient form of drug rehab or mental health services to improve your health. Giving you various options increases the odds of finding the care you’re looking for at Icarus Behavioral Health in Idaho.

Outpatient Therapy and Aftercare

Ongoing therapy plays a significant role in relapse prevention. You must have access to the right aftercare resources to help you prevent relapse and identify and deflect triggers when you encounter them.

Your UMR coverage will pay for one or all of the following programs:

  • Weekly individual sessions with a licensed primary care therapist
  • Group counseling
  • Psychiatric check-ins for co-occurring disorders
  • Telehealth counseling (if your plan permits this)

Outpatient treatment is usually covered under the behavioral health services of your plan and might require a referral.

What UMR Typically Requires for Addiction Treatment Coverage

Several steps are typically required to receive coverage at our treatment center in Idaho, whether for outpatient or inpatient treatment.

Medical Need

A licensed professional must document that treatment is needed for you to overcome your substance abuse challenges.

Referral or Prior Authorization

This is more common for inpatient, detox, and other high-care levels of treatment. Usually, this entails a letter or fax from a licensed substance abuse counselor explaining why a certain level of care is required for you to begin the recovery process.

Documentation

Clinical notes, progress reports, and treatment plans must often be submitted for review. As a third-party administrator, UMR will likely assign a case manager who reviews progress and makes continued care determinations for approval from United HealthCare.

How to Verify Coverage for Rehab Using UMR Insurance

Before beginning treatment, it’s critical to verify your UMR benefits. To do so, contact Icarus Behavioral Health in Idaho. We have a reputable admissions team that can handle the verification.

Common Challenges and How to Overcome Them

Common Challenges for Verify Insurance

Even with insurance coverage, clients can face obstacles. Some of the most common issues include:

  • Denied Claims: Usually due to missing paperwork or lack of authorization
  • Out-of-Network Costs: May require higher co-pays or full payment
  • Treatment Limits: Some plans cap the number of sessions or days available at a treatment center
  • Short Authorizations: Plans may only be approved for 7 to 10 days at a time

Solving these challenges may seem complicated initially, but taking the proper steps will help you gain admittance to the right inpatient or outpatient treatment program. Try the following if you run into any of the issues above:

  • File an appeal with additional clinical documentation
  • Request a peer-to-peer review between your provider and the UMR case manager

Work with an admissions coordinator to resubmit claims or negotiate benefits

Up To 100% of Rehab Costs Covered By UMR

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Icarus in Idaho: Get Help With UMR Rehab Coverage

If you’re in the Idaho area and receive UMR insurance, Icarus Behavioral Health is an organization that delivers top-tier treatment options for minimum out-of-pocket expenses.

Contact a member of our admissions team today, and we’ll help you verify your coverage so you can get started on recovery.

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