United Behavioral Health Drug and Alcohol Coverage

Addiction is a hard enough to beat, dealing with withdrawals and negative psychological effects. What makes it worse is that rehab and detox services are expensive. Financing rehabilitation was difficult before, until the Affordable Healthcare Act. Now, insurance companies are now adding rehab services as part of their coverage.

United Behavioral Health (UHB) is among the largest healthcare insurance companies in the US. Depending on your plan, UHB can fully or partially cover your rehab, under certain conditions.

The first condition must be that the program is pre-approved. Second, the program must have a proper outline, with clear goals and all personnel accounted for. Third, the program must have constant monitoring by professionals.

How do I start?

If you’re already a member, you need to check with UHB accredited physicians. After the physicians make a diagnosis, you can then be referred to an Addiction Specialist. Since rehab affects each person differently, your addiction specialist will decide which program will fit you best.

Inpatient vs Outpatient

There are several factors that determine whether you’ll be opted into inpatient or outpatient care.

For outpatient care to be considered, you need to meet the following criteria:

• Your daily activities don’t undermine your treatment.
• You don’t have physical or mental conditions that can cause complications.
• You have a low risk of using a new substance.
• There are no inpatient facilities close to your area.

Inpatient care is considered for more severe cases. Inpatient treatments are generally more expensive. As the name goes, you’re required to be admitted to a hospital, or in residential treatments, have you live inside a rehab facility.

• Inpatient treatments are considered if any of the conditions are met:
• You have physical and mental complications due to the addiction.
• You have a condition that could be undermined by regular treatment.
• Your household has high risks of exposing you to drugs and alcohol.
• There are no outpatient facilities in your area.

Coverage Details

After the preliminary conditions are met, UHB will then consider coverage if the program for rehab is an “Active Treatment.” A treatment can be considered active if it has the following:

• Treatment has a definite and substantial diagnosis
• The program’s short and long term goals are outlined
• Your physician has enough evidence to justify rehabilitation as the treatment

UHB will only cover a maximum of 190 days per person, per lifetime. This means all your total inpatient days must not exceed 190. Once it reaches that amount, you need to speak to UHB’s addiction support to negotiate continued coverage.

For outpatient treatment, UHB has other criteria to be considered.

First is that the program must be recommended by a practitioner of similar line. This means an outpatient treatment for behavioral disorder and alcoholism, must be recommended by a psychiatrist or an addiction specialist.

Second, the treatment’s outline must have a significant effect on the patient. The program’s outline should show clear expectations and goals, ones that apply to you.

Third, the outpatient program must be supervised by an appropriate physician. Counselors must have proper credentials for UHB to consider coverage.

Dr. Vikram Tarugu MD

Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.