Does UnitedHealthcare Cover Rehab? What Your Plan Pays For

UnitedHealthcare is the largest health insurance carrier in the United States, covering approximately 50 million Americans through employer-sponsored plans, individual marketplace plans, Medicare Advantage, and Medicaid managed care. UnitedHealthcare’s behavioral health services are managed through Optum Behavioral Health, which operates the nation’s largest addiction treatment network with over 2,200 contracted facilities. Under the Affordable Care Act and Mental Health Parity and Addiction Equity Act, all UnitedHealthcare marketplace and employer plans must cover substance use disorder treatment at the same level as other medical conditions.

What Does UnitedHealthcare Cover for Rehab?

UnitedHealthcare covers the full continuum of substance use disorder treatment services when medically necessary:

Covered Services

Medical Detoxification — Medically supervised withdrawal management in hospital-based or freestanding detox facilities. Covered at 60-80% after deductible for in-network facilities. Duration based on medical necessity, typically 3-14 days depending on substance and severity.

Inpatient/Residential Treatment — 24/7 residential treatment programs providing comprehensive addiction care. UnitedHealthcare covers 60-80% after deductible for in-network facilities. Initial authorization typically 7-14 days with concurrent review every 3-7 days for continued stay.

Partial Hospitalization Program (PHP) — Intensive day treatment providing 6+ hours of programming daily, 5-7 days per week. Covered at 70-90% after deductible.

Intensive Outpatient Program (IOP) — Structured outpatient treatment typically 3-5 days per week, 3-4 hours per day. Covered at 70-90% after deductible. Common step-down from residential treatment.

Outpatient Therapy — Individual, group, and family counseling sessions. Covered at 80-90% after deductible, with typical copays of $30-$70 per session depending on plan type.

Medication-Assisted Treatment (MAT) — All FDA-approved medications for substance use disorder:

• Buprenorphine products (Suboxone brand, generic buprenorphine/naloxone, Sublocade injection, Zubsolv)
• Methadone (through certified opioid treatment programs)
• Naltrexone (Vivitrol monthly injection, ReVia daily tablets)
• Acamprosate (Campral) for alcohol use disorder
• Disulfiram (Antabuse) for alcohol use disorder

Coverage: 80-90% after deductible, depending on prescription drug tier. Generic medications typically have significantly lower copays than brand-name options.

UnitedHealthcare Plan Types and Rehab Coverage

UnitedHealthcare Choice Plus (PPO)

Best for: Maximum flexibility with broad nationwide network and out-of-network coverage

Network: Optum’s network of 2,200+ addiction treatment facilities nationwide Out-of-network: Covered at 60-70% (higher than most carriers) Referrals: Not required Typical coverage: 60-80% in-network, 50-70% out-of-network after deductible Average out-of-pocket for 30-day inpatient: $6,000-$22,000

Choice Plus is UnitedHealthcare’s premium PPO offering with the most generous out-of-network benefits in the industry.

UnitedHealthcare Options (PPO)

Best for: PPO flexibility with more affordable premiums

Network: Same extensive Optum network as Choice Plus Out-of-network: Covered at 50-60% Referrals: Not required Typical coverage: 60-80% in-network, 40-60% out-of-network after deductible Average out-of-pocket for 30-day inpatient: $6,000-$20,000

Options PPO is similar to Choice Plus but with slightly reduced out-of-network benefits and lower premiums.

UnitedHealthcare Navigate (HMO)

Best for: Lower premiums with regional network

Network: Regional network varies by location Out-of-network: Not covered except emergencies Referrals: Required from PCP for specialty care Typical coverage: 70-85% in-network after deductible Average out-of-pocket for 30-day inpatient: $5,000-$17,000

Navigate HMO plans have lower premiums but less flexibility in facility selection.

UnitedHealthcare EPO

Best for: PPO-level convenience without out-of-network costs

Network: Similar to PPO network Out-of-network: Not covered except emergencies Referrals: Not required Typical coverage: 65-80% in-network after deductible Average out-of-pocket for 30-day inpatient: $5,500-$18,000

EPO plans offer middle ground between PPO and HMO.

UnitedHealthcare Medicare Advantage

Best for: Medicare beneficiaries (65+) seeking integrated coverage

Network: Regional/national depending on plan type Out-of-network: Varies by plan Referrals: Varies by plan Typical coverage: Varies; many use copay structures ($300-$400/day for inpatient) Average out-of-pocket for 30-day inpatient: $4,000-$12,000

Medicare Advantage plans often have more generous behavioral health benefits than commercial plans.

Understanding Optum Behavioral Health

UnitedHealthcare’s substance use disorder benefits are managed by Optum Behavioral Health (formerly United Behavioral Health), a specialized division focused on mental health and addiction services.

What Optum Does

Preauthorization and utilization review: Optum manages all authorization requests for inpatient and residential treatment using ASAM criteria.

Provider network: Optum contracts with addiction treatment facilities, establishing negotiated rates and quality standards.

Care coordination: Optum assigns care coordinators for complex cases, helping navigate treatment and step-down care.

24/7 crisis support: Optum operates 24/7 behavioral health crisis lines for members in crisis.

Contacting Optum

Optum Behavioral Health: 1-855-204-4058 (number also on your UnitedHealthcare member card)

When you call about substance abuse treatment, you’ll be directed to Optum’s specialized team who can:

• Verify your benefits
• Check facility network status
• Explain preauthorization process
• Provide referrals to treatment facilities
• Answer coverage questions

Preauthorization Requirements

UnitedHealthcare (through Optum) requires preauthorization for all inpatient and residential substance abuse treatment:

Before Treatment

1. Clinical assessment — You complete an intake evaluation at the treatment facility
2. Facility submits authorization — The facility’s utilization review team submits preauthorization request to Optum including clinical assessment, diagnosis, treatment plan, and ASAM level of care justification
3. Optum reviews — Behavioral health clinicians review using ASAM (American Society of Addiction Medicine) criteria
4. Authorization decision — Typically 24-48 hours for urgent requests, up to 5 business days for standard requests

Medical Necessity Criteria

Optum uses ASAM criteria to assess medical necessity across six dimensions:

1. Acute intoxication/withdrawal potential
2. Biomedical conditions and complications
3. Emotional, behavioral, or cognitive conditions
4. Readiness to change
5. Relapse, continued use, or continued problem potential
6. Recovery/living environment

During Treatment

Concurrent review: Optum conducts ongoing reviews every 3-7 days during your stay. The facility provides clinical updates demonstrating:

• Progress toward treatment goals
• Continued medical necessity
• Appropriate level of care
• Discharge planning

Denial and appeals: If Optum denies continued stay, the facility can request peer-to-peer review where a physician discusses the case with an Optum medical director.

Typical Out-of-Pocket Costs with UnitedHealthcare

Your costs depend on your specific plan’s cost-sharing structure. Here’s a typical example:

Example: UnitedHealthcare Choice Plus PPO

Plan details:

• Deductible: $2,000 (individual)
• Coinsurance: 80/20 (UnitedHealthcare pays 80%, you pay 20%)
• Out-of-pocket maximum: $8,700 (individual)

30-day inpatient program (in-network):

• Facility negotiated rate: $36,000
• You pay deductible: $2,000
• Remaining balance: $34,000
• You pay 20%: $6,800
• Total you pay: $8,800
• But: Capped at out-of-pocket max of $8,700

Medical detox (7 days, in-network):

• Facility cost: $5,000
• You pay: $2,000 (deductible) + 20% of $3,000 ($600) = $2,600

MAT (monthly costs):

• Generic buprenorphine/naloxone: $15-$60 copay
• Suboxone brand: $80-$150 copay
• Sublocade injection: $50-$250 copay
• Vivitrol injection: $50-$250 copay

Example: UnitedHealthcare Medicare Advantage

Plan details:

• Inpatient mental health/substance abuse: $390/day for days 1-5, $0 thereafter
• Out-of-pocket maximum: $7,550

30-day inpatient program:

• Days 1-5: $390 × 5 = $1,950
• Days 6-30: $0 × 25 = $0
• Total: $1,950

Many UnitedHealthcare Medicare Advantage plans have excellent behavioral health benefits with limited copays after initial days.

Cost Comparison by Plan Type

Verifying Your UnitedHealthcare Coverage

Before entering treatment, verify your specific benefits:

Call Optum Behavioral Health

Optum Behavioral Health: 1-855-204-4058

Information to have ready:

• Member ID number (on your insurance card)
• Group number (if employer-sponsored)
• Name and location of facility you’re considering

Questions to ask:

• Is [facility name] in-network for my plan?
• What is my deductible, and how much have I met this year?
• What is my coinsurance percentage for inpatient behavioral health?
• What is my out-of-pocket maximum, and how much have I met?
• How does preauthorization work, and who initiates it?
• How many days will be initially authorized?
• Does my plan cover MAT medications, and what are my copays?
• Are there any plan-specific limitations or exclusions?

Check Online

myUHC Portal: Log in at myuhc.com

• Find providers/facilities using behavioral health search tool
• View your benefits and coverage details
• Check deductible and out-of-pocket maximum progress
• Review claims and prior authorization status
• Access Optum resources

Have the Facility Verify Benefits

Most treatment facilities have insurance verification specialists who will:

• Contact Optum on your behalf
• Obtain detailed benefits breakdown
• Provide estimated out-of-pocket costs
• Initiate the preauthorization process
• Answer questions about payment options and financing

This is often the easiest route, as facilities are familiar with Optum’s processes.

UnitedHealthcare/Optum’s Behavioral Health Network

Optum operates the largest behavioral health network in the United States:

Network size: 2,200+ contracted addiction treatment facilities nationwide

Types of facilities:

• Hospital-based detox and inpatient programs
• Freestanding residential treatment centers
• Luxury and executive rehab programs
• Intensive outpatient programs (IOP)
• Partial hospitalization programs (PHP)
• Medication-assisted treatment providers
• Opioid treatment programs (methadone clinics)

Geographic coverage:

• Facilities in all 50 states
• Particularly strong in major metropolitan areas
• Growing rural coverage
• Extensive options across Northeast, Southeast, Midwest, Southwest, and West Coast

Network strengths:

• Most major accredited facilities accept UnitedHealthcare
• Includes CARF-accredited and Joint Commission-accredited programs
• Good representation of specialized programs (adolescent, gender-specific, dual diagnosis)

What Makes UnitedHealthcare/Optum Different

Largest Network

UnitedHealthcare’s Optum network is the largest in the industry, providing more facility choices than any other carrier.

Integrated Health Management

• Coordination between medical and behavioral health providers
• Data-sharing between UnitedHealthcare medical and Optum behavioral health
• Holistic approach to care

Technology Integration

• Rally Health app integration
• Telehealth options for therapy and MAT follow-up
• Digital care management tools

Level Funded and Self-Insured Employer Plans

Many large employers use UnitedHealthcare for third-party administration of self-insured plans, meaning the employer (not UnitedHealthcare) bears the financial risk. These plans may have different coverage terms than fully-insured plans.

Out-of-Network Coverage with UnitedHealthcare

UnitedHealthcare Choice Plus offers some of the best out-of-network coverage in the industry:

How Out-of-Network Works

Coverage: Choice Plus typically covers 60-70% of out-of-network costs after a higher deductible

Balance billing: Out-of-network facilities can bill you for the difference between their charges and what UnitedHealthcare reimburses

Example:

• Facility charges: $50,000
• UnitedHealthcare’s “reasonable and customary” reimbursement: $36,000
• UnitedHealthcare pays 60% of $36,000 = $21,600
• You pay: Higher deductible + 40% of $36,000 ($14,400) + potential balance bill of $14,000

Better option: Use in-network facilities whenever possible, or request single-case agreement if specific out-of-network facility is medically necessary.

What If UnitedHealthcare/Optum Denies Coverage?

You have appeal rights under federal law:

Internal Appeals

1. File appeal within 180 days of denial
2. Submit additional documentation — Include clinical records, letters from treating physicians, evidence of medical necessity
3. Peer-to-peer review — Request physician-to-physician review
4. Timeline — UnitedHealthcare must respond within 30 days (72 hours for urgent appeals)

External Review

If internal appeal is denied:

1. Request external review — Independent review organization evaluates your case
2. Timeline — Decision within 60 days (72 hours for urgent)
3. Binding decision — UnitedHealthcare must comply with external reviewer’s determination

State Insurance Department

File complaints with your state insurance department if you believe UnitedHealthcare violated mental health parity laws or your plan terms.

Don’t Have UnitedHealthcare (or Any Insurance)?

If you’re currently uninsured, obtaining coverage is often the most cost-effective path to treatment. A 30-day inpatient program costs $15,000-$50,000 without insurance, while monthly premiums for a PPO plan with comprehensive addiction coverage typically range from $400-$800.

All ACA marketplace plans must cover substance use disorder treatment as an essential health benefit. A licensed insurance specialist can help you:

• Compare UnitedHealthcare and other carriers during open enrollment
• Identify qualifying life events that allow special enrollment outside open enrollment
• Navigate income-based subsidies and cost-sharing reductions
• Understand network differences and coverage levels between carriers

Sources

• UnitedHealthcare. “Behavioral Health Benefits and Coverage.” Member Resources. 2026.
• Optum Behavioral Health. “Treatment Authorization Guidelines.” 2026.
• Centers for Medicare & Medicaid Services. “Mental Health Parity and Addiction Equity Act.” 2024.
• Healthcare.gov. “Substance Use Disorder Services Coverage.” 2026.