Our dedication lies not just in treating symptoms but in addressing the root causes, offering a holistic approach that integrates the best of therapeutic practices with the warmth of community support.
Does UnitedHealthcare Cover Addiction Treatment?
Yes. Encore Outpatient Services is in-network with UnitedHealthcare/Optum for outpatient addiction treatment. Your specific coverage and costs will depend on your plan.
UnitedHealthcare/Optum Coverage for Addiction Treatment in Arlington, VA
Encore is in-network with UnitedHealthcare/Optum for both our Intensive Outpatient Program (IOP) and General Outpatient Program (GOP). We accept UnitedHealthcare, UMR, and GEHA plans administered through Optum.
Coverage works differently at each level of care. IOP is billed as a program that includes the services you receive during treatment. In GOP, services such as individual therapy, psychiatric care, medication management, and MAT are covered separately.
Your costs may change when you move from IOP to GOP. We review your benefits before treatment and again before you step down to GOP so you understand any changes to your copay or coinsurance.
How We Help You Use Your UnitedHealthcare/Optum Benefits
We review your benefits, handle applicable IOP authorization requirements, and keep you informed about coverage and costs as your treatment changes.
Benefit Verification
We verify your benefits using your member ID number and date of birth. We also need a copy of your insurance card before or on the date of admission.
IOP Authorization Support
Optum typically requires prior authorization for IOP. Our verification team handles the authorization process and any needed continued-stay reviews.
Planning for Step-Down Care
Before you move from IOP to GOP, we review your benefits again. We explain any changes to your coverage, copay, or coinsurance before your level of care changes.
Your Treatment Needs Guide Your Level of Care
Your UnitedHealthcare/Optum benefits help pay for covered care, but they do not determine which level of treatment is right for you. Our clinical team considers your substance use, mental and physical health, treatment history, current circumstances, and the amount of support you need.
You may begin with the added structure of IOP or receive care through GOP. As treatment continues, we monitor your progress and adjust your care when your needs change.
If you are ready to step down from IOP to GOP, that decision is based on your clinical progress and current needs. We then help you understand how your UnitedHealthcare/Optum benefits apply to the next stage of care.
Take the Next Step Toward Treatment
If you have UnitedHealthcare, UMR, or GEHA coverage through Optum, our team can help you understand what happens next. You can ask questions about treatment, discuss what is bringing you to care, and learn what to expect before you begin.
When you contact us, you can:
- Talk with our team about what brings you to treatment
- Ask questions about IOP and GOP
- Learn what to expect during the admissions process
- Discuss questions or concerns before starting care
- Get guidance on your next steps toward admission
Get Started Today
Frequently Asked Questions About UnitedHealthcare/Optum
The number of authorized IOP days depends on your individual plan and Optum’s authorization decision. Encore handles the authorization and continued-stay review process when additional days need to be requested.
Additional IOP coverage may require another review and approval from Optum. Our clinical team determines whether you still need IOP based on your progress and current treatment needs, and our team submits the required continued-stay review when additional authorization is needed.
Not necessarily. GOP services are covered individually, so your copay or coinsurance may change when you step down. We review your benefits and costs before the change so you know what to expect.
Yes. Admissions explains your applicable deductible, copay or coinsurance, out-of-pocket responsibility, and coverage limitations after verifying your benefits. You also receive a fee schedule at admission.
Yes. UnitedHealthcare/Optum benefits can be used for VASAP services at Encore. We verify your individual benefits before treatment so you understand how your coverage and costs apply.
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