What You Should Know About Optum Insurance Rehab for Veterans

Over 20 million people suffer from addiction globally, but only a few of them seek treatment. One critical step in seeking treatment is to find out if there is an insurance plan that can fully or partially cover your treatment. One of the insurance providers you can check out is Optum.

If you are a veteran struggling with alcohol or drug addiction, you have various insurance options offered by VA insurance. Optum provides medical coverage for millions of its members throughout the US, offering resources for military personnel to get proper health coverage.

What Is Optum?

Optum is a subsidiary of UnitedHealth Group. It operates throughout the US, from Florida to California, with a membership of over 70 million people. It is dedicated to working with all addiction and mental health patients to ensure they get the best and most professional level of care.

Optum is one of the largest insurance providers in the US, with over 50,000 physicians working as a team to offer top-notch healthcare services. The company operates under the Mental Health Parity Act, specializing in various addiction and mental health treatments for its clients. If you suffer from substance use disorder, mental health illness, or alcoholism, Optum will cover a large percentage of your health and addiction treatment.

Optum operates as a third-party administrator for the Department of Veteran Assistance, providing military personnel with health insurance coverage through the Veteran Assistance Community Care Network. This company can help you get the rehab treatment you need and will fully or partially cover the cost of your treatment.

This insurance coverage will depend on the nature of care you need, the insurance plan you choose, your eligibility, and your location. Whether there’s a co-pay or not, the insurance plans under Optum must offer addiction treatment as stipulated in the Affordable Care Act.

Note that as a veteran, you won’t sign up on Optum. Instead, you’ll interact with it when you use the Veteran Assistance Community Care Network services. The network is a service under the VA program, and it will connect you with private healthcare providers when VA insurance can’t meet your needs. Optum will facilitate a working relationship between the VA and the healthcare providers. It will also answer any questions from healthcare providers and the VA, support VA staff and facilities, and process claims.

Which States Does Optum Cover?

Optum health insurance helps people receive medical care both virtually and in person and provides a wide range of healthcare services to its members, from specialty services (behavioral and addiction treatment) to primary care.

High-quality healthcare services are available at affordable prices. Optum has a team of case managers who help facilitate communication between members and providers by connecting patients to appropriate resources, such as mental health doctors, medical specialists, and therapists when you need them. Even if you need emergency care, Optum will be there for you. The company offers services in:

1. Washington
2. Utah
3. Texas
4. Ohio
5. New York
6. New Mexico
7. New Jersey
8. Nevada
9. Massachusetts
10. Indiana
11. Florida
12. Connecticut
13. Colorado
14. California
15. Arizona

The provider accepts a range of insurance plans, such as:

1. UnitedHealthcare
2. TriCare
3. Scripps
4. Magellan
5. HealthSmart
6. HealthNet
7. Cigna Behavioral Health
8. Cigna
9. Blue Shield
10. Blue Cross
11. Anthem
12. Aetna

Just like many other insurance companies, the extent of Optum’s insurance coverage will depend on where you live and whether you have a PPO or HMO plan.

Will Your Optum Insurance Cover Your Alcohol and Drug Rehab Treatment?

The alcohol and drug coverage you receive from Optum will vary depending on the plan you choose and the type of addiction treatment you are seeking. For this reason, make sure the insurance plan you choose covers your unique needs.

Optum will offer you support and resources to help you achieve sustained recovery, resilience, and stability. It operates a Substance Use Disorder Helpline that provides referrals and immediate assistance to members. You can take advantage of this service if you are far from a treatment facility.

Remember that the federal government considers the treatment of substance use disorders and other mental health issues as an important health benefit. These treatments are guaranteed under the Affordable Care Act. Nearly all insurance programs for veterans, including Marketplace plans, Medicaid, Medicare, TRICARE plans, VA care benefits, and even private healthcare plans, provide insurance coverage for veterans’ rehab treatments.

In general, nearly all healthcare insurance plans cover rehab treatments, either partially or wholly, for active servicemen or veterans. However, it is best to contact your healthcare insurance provider to find out exactly what their plan(s) cover.

If you are actively in service or a veteran, make sure you confirm your coverage before you seek treatment in any facility. This will help you prevent any unexpectedly high costs or surprise bills.

What Addiction Treatments Does Optum Cover?

Optum insurance coverage takes care of many types of treatments.

Medical Detox

This is the first step in addiction treatment. It will help you withdraw from alcohol or drugs safely and comfortably without suffering severe withdrawal symptoms. This process gets rid of all the toxins from your body and facilitates your transition to a sober lifestyle. Detox is necessary whether you are in outpatient or inpatient rehab.

Outpatient Programs

If your addiction is not severe, your doctor may suggest outpatient treatment. In this case, you’ll continue living in your home as you get treatment. You can attend regular group or individual counseling sessions to learn how to control your addiction. You’ll also learn the strategies you can use to recover and sustain your sobriety.

Inpatient Programs

Inpatient treatment is necessary for severe addiction or mental health problems. This program provides structured and intensive care, so you will need to live at the treatment facility until you complete the program. You’ll attend group or individual therapy sessions as required, and you’ll be under medical care 24/7.

Intensive Outpatient Programs (IOPs)

IOPs are more time-intensive than outpatient programs. If you are enrolled in this program, you’ll need to attend multiple therapy sessions each week that will last several hours. You can continue living in your home as you receive treatment. This program is necessary if your condition is severe, but you aren’t required to reside in the treatment facility.

Partial Hospitalization Programs (PHPs)

With PHPs, you’ll attend long therapy sessions that last between four to six hours for about five days a week. You can do so while still living in your home.

Aftercare

Even after completing your treatment program, you may still relapse, so there’s a need for ongoing treatment and counseling. An aftercare program will provide you with the skills to help maintain your sobriety and find effective ways to prevent a relapse. It will also help direct you toward a more rewarding and fulfilling life free from alcohol and drugs.

What Kind of Optum Insurance Is Available?

Optum will cover your rehab treatment, but what are the different plans this company offers? Optum offers two main insurance plans.

Optum POS/PPO

With this plan, your choice will be limited to a specific network of doctors and treatment facilities enlisted by the PPO. This plan will give you a list of providers for you to choose from. The main benefit of this type of plan is that the insurance company will help you find the best provider for your case. If you’ve decided to look for a doctor by yourself, however, make sure the doctor is on the provided list. If you choose a doctor or facility outside of the network, you may receive limited coverage.

Optum HMO

With the Optum HMO insurance plan, you’ll have the freedom to choose whichever care provider or treatment facility you want, but it has to be within the HMO network. Once you choose a provider and facility, Optum will help you get the most specialized provider. If you choose a provider outside of an HMO, in some cases, you may have to pay your own bills. Therefore, it’s important to choose a provider within the HMO network as it’s very costly to treat addictions and mental health illnesses without plan coverage.

Are You Eligible for Optum Insurance?

Remember that Optum is a third-party administrator and not a provider of health insurance. If you are a veteran, you’ll be eligible to use the Veteran Assistance Community Care Network in your region that’s Optum eligible. However, in order to utilize the Community Care Network, there are six conditions you’ll have to meet. Note that your family is not eligible to use this network. It’s also worth mentioning that it’s ultimately a provider that will determine the eligibility criteria.

Before you seek community care, the VA must approve your request. Otherwise, you’ll have to bear the costs. Your eligibility for the Community Care Network will depend on your personal circumstances or unique health needs. The first requirement for community care is that you must be either qualified for or already enrolled in VA healthcare. The other conditions you must meet to qualify for community care include:

1. The territory or state where you reside has no full-service Veteran Assistance medical facility.
2. Community care is the best medical treatment option for you.
3. The type of care you need cannot be provided by a VA provider or in a VA facility.
4. You are eligible for the grandfather-distance provision for VCP (Veterans Choice Program).
5. You are eligible under the Veterans Choice Program’s 40-mile criterion. You must also continue living in a region that’s eligible for this criterion.
6. The medical service line in question falls short of Veterans Assistance quality standards.

If you have any questions regarding VA community eligibility, you can visit the VA’s Community Care Network official website or your local Veterans Assistance office.

Will Optum Pay for Your Prescriptions?

If a doctor prescribes some medicines for the treatment of your substance use disorder under the VA Community Care Network, the plan will likely cover the costs of these medicines. For MAT (medication-assisted treatment) for substance use disorder, the following drugs are normally prescribed by doctors:

• Naloxone: In cases of suspected or confirmed overdose, naloxone is prescribed. It acts quickly to reverse the effects of an overdose.
• Buprenorphine: Prescribed to alleviate opioid dependency, this is an opioid antagonist that also reduces opioid abuse potential and withdrawal effects.
• Naltrexone: This medication is prescribed to reduce cravings for opioids and block their effects.
• Suboxone: This drug combines buprenorphine and naltrexone and is used to reverse the symptoms of an overdose and lessen or prevent withdrawal symptoms.
• Methadone: This is another opioid antagonist that reduces the cravings for and effects of opioids.

Is Mental Health Treatment Covered Under Optum?

Since Optum operates under the Affordable Care Act, it provides some level of coverage for mental health problems. The Act states that insurers must cover at least 10 essential health issues, including substance use disorders and mental health issues. The law stipulates that anyone who needs mental health treatment should be able to get help whenever they need it.

If you are a veteran struggling with SUD or mental health problems such as depression or anxiety, rest assured that you will receive assistance for treatment and recovery. The mental health treatments covered by Optum include:

1. Telehealth (virtual counseling)
2. Psychotherapy/talk therapy
3. Medication
4. Outpatient/inpatient rehab
5. Group counseling

Optum may provide some level of cover for luxury or private rehab. However, such treatments come at a higher cost, meaning you may need to pay some amount out of pocket. Before you choose such a service, find out what Optum will cover and the amount you’ll pay out of pocket.

Lastly, remember that when you are enrolled in VA insurance, you can still sign up for other health insurance plans, including Medicaid and Medicare. When getting treatment through Optum, make sure you inform your healthcare provider about all types of insurance coverage that you have. For more information on veteran options, visit VeteranRehab.org.