Does UPMC Cover Drug Rehab in Pennsylvania?

Does UPMC Cover Drug Rehab?

Does UPMC Cover Drug Rehab in Pennsylvania?

The UPMC Insurance Services Division provides coverage to individuals and families in Pennsylvania via several partner organizations, including UPMC Health Plan, UPMC WorkPartners, LifeSolutions Employee Assistance Program, UPMC for You, and Community Care Behavioral Health. The types of health care that are covered under your UPMC policy may vary depending upon the type of policy that you have and which partner organization provided that policy.

Most UPMC insurance plans do provide some level of coverage for behavioral healthcare, which may include therapy and other forms of care for issues related to substance abuse and addiction. However, identifying the specific types of drug rehab and related care that your UPMC policy covers will require a close examination of the details in that policy.

To confirm what drug rehab services are covered by your UPMC policy, please feel free to contact White Deer Run at your convenience. As a Pennsylvania-based network of treatment centers, White Deer Run has considerable expertise working with individuals and families who are insured through UPMC, and the staff member with whom you will speak can help you to identify and access all benefits related to drug rehab that are provided via your UPMC plan.

Types of Rehab Covered

What Types of Drug Rehab Does UPMC Cover?

As noted in the previous section, coverage for drug rehabilitation services and related behavioral healthcare treatment may vary depending upon the type of UPMC policy that you have, and which UPMC partner organization provided that policy. The information in this section contains examples of the types of drug rehab services that may be covered, depending upon those factors.

Policyholders who are covered by a UPMC commercial plan as well as those who are covered by a UPMC for Life or UPMC for Kids plan may be eligible to have the following types of drug rehab and related forms of care funded by UPMC:

  • Inpatient detoxification
  • Inpatient mental health treatment
  • Inpatient substance abuse rehabilitation
  • Partial hospitalization programming (IOP) for mental health disorders and/or substance abuse and addiction
  • Intensive outpatient programming (IOP) for mental health disorders and/or substance abuse and addiction
  • Traditional outpatient behavioral health treatment for mental health and/or substance abuse and addiction

Such services must be authorized by UPMC prior to starting care in order to be covered by the individual’s policy, and limitations on the amount that UPMC will pay or the length of time that UPMC will approve for the policyholder to remain in treatment can vary from policy to policy.

To determine what services at White Deer Run are covered under your UPMC policy, please have your insurance card or other relevant information with you when you contact us. We will be happy to work with you to ensure that you have access to all benefits to which you are entitled and that you receive the best possible care.

How Much is Covered?

How Much of the Cost of Drug Rehab is Covered by UPMC?

In addition to determining which types of services your UPMC policy will cover, getting a full understanding of the financial aspect of care at White Deer Run will also involve identifying the co-pays, payment limitations, and length of stay restrictions that may be present in your UPMC policy. For example, even if your UPMC policy covers one form of treatment, such as inpatient rehabilitation or partial hospitalization, that does not mean that UPMC will pay for all services within that level of care, or that your insurer will continue to pay for services for an extended period of time.

Benefits at each level of care may vary from policy to policy, and may also be contingent upon pre-authorization or the receipt of continued updates throughout your time in treatment. UPMC policies typically require certification prior to starting drug rehab or another form of mental or behavioral healthcare, along with ongoing reviews by a UPMC case manager to confirm that a policyholder’s needs and progress align with his or her policy requirements and mandate continued coverage.

The process of getting certification and continuing to secure insurance coverage for drug rehab, behavioral healthcare, or any other services is known as utilization review. At White Deer Run, we have professionals on our team who have significant experience with the utilization review process, and as such are prepared to advocate on your behalf and help you get the care that you need.

What Happens If UPMC Doesn't Cover All My Needs?

What Can I Do If UPMC Doesn’t Cover All of My Drug Rehab Needs?

It is not uncommon for individuals who have insurance through UPMC or another provider to be required to pay for part of their treatment, even when receiving approved forms of care for drug rehab or a related mental or behavioral health issue. For example, your UPMC policy may include a deductible or a co-pay, which means that you may need to pay up to a certain amount before UPMC coverage begins, or you may be responsible for a percentage of costs incurred for certain types of treatment.

Before we can identify what your financial obligation will be, we will work with you to determine the type and level of care that you need, and then we will confirm the details of your UPMC policy. Once all of this information has been collected, we will identify any financial requirements that may fall outside the scope of what UPMC will authorize for payment.

At White Deer Run we realize that many people allow financial concerns to prevent them from seeking or accessing the treatment services that they need, and we sincerely hope that you will not allow such worries to stop you from pursuing treatment. We are dedicated to working with all who contact us to find treatment opportunities that meet their financial situations, and history has shown us that many people who contact us are pleasantly surprised by our ability to guide them through the financial aspects of treatment and help them get the care that they need.

Confirming My Benefits

How Can I Confirm My UPMC Benefits?

For answers to any insurance-related questions that you may have, including but by no means limited to determining the benefits that are available to you or a family member through your UPMC plan, please do not hesitate to contact White Deer Run at your convenience. A friendly and knowledgeable member of our team is available to speak with you 24 hours a day, seven days a week, and will be happy to provide you with the information that you need.

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