UPMC Health Detox & Rehab Benefits Guide

UPMC Health Detox & Rehab Benefits Guide

UPMC is a private insurance company that provides healthcare to nearly 4 million people in the United States.1 Created through the University of Pittsburgh Medical Center (UPMC), the plan works in conjunction with UPMC facilities and other healthcare providers within local communities to offer cost-efficient, integrated services.

This page is intended to help you learn more about how to use your UPMC insurance plan to cover detox and rehab services for substance use disorders and explain some of the services available at American Addiction Centers. You can find answers to questions you may have about health insurance, such as:

  • What kind of plans are offered by UPMC insurance?
  • What does UPMC cover?
  • Does health insurance cover detox?
  • What kind of UPMC detox coverage is available?
  • What kind of UPMC rehab insurance coverage is offered?
  • Does UPMC cover therapy?
  • How can I check my benefits?

Does UPMC Insurance Cover Detox?

UPMC drug rehab coverage and detox benefits may be included with your plan, especially if services are deemed to be medically necessary.3, 4, 5 Such services may include:

  • Inpatient detox care, where you stay in a hospital or treatment facility for the duration of withdrawal while being monitored around the clock.3,4,5 Staff can provide medication to manage withdrawal symptoms and prevent complications. They can also help you find additional treatment after detox is completed.
  • Outpatient detox care, where you can receive support and withdrawal management medications while living at home.3,4,5 This is best for people who have minor withdrawal symptoms, aren’t likely to experience complications, and have a strong support system.
  • Inpatient rehab care, in which you receive detox services and rehabilitation in a hospital or facility setting that is staffed by medical and counseling professionals.3,4,5 Rehab typically lasts about 4 weeks.
  • Partial hospitalization programs (PHP), where you attend a day program for up to 8 hours a day.3,4,5 You can receive detox and rehabilitation at a similar level to inpatient care while still residing at home.
  • Intensive outpatient programs (IOP), in which you attend treatment for a minimum of 3 hours, several times a week while residing at home.3,4,5 You may receive group and individual counseling. Medical staff is available to monitor your physical health and each program has a psychiatrist to attend to your mental health as well.
  • Outpatient programs, which offer similar services as IOPs, but at a lower intensity.3,4,5 Care is provided in group and individual sessions, with additional support offered through the medical and psychiatric staff. You live at home and can participate in your usual responsibilities at work, school, or home.
  • Office-based therapy, where counseling and medication are provided by a psychiatrist, psychologist, or addiction counselor in a private office setting.3,4,5 Individual, group, and family sessions may be offered as part of the treatment plan.

Detox and drug rehab insurance coverage extend to family members who are covered on your UPMC plan. Even if your loved ones aren’t on your insurance plan, they may be able to attend family counseling sessions with you.

How to check your UPMC Insurance benefits

Before beginning treatment, it is best to find out specifically what your plan covers. For example, you may be wondering how long your detox insurance will last, or what specifics your plan covers for rehab.

You can find out the details of your UPMC plan benefits in the following ways:

  • Getting in touch with Member Services by calling the phone number on the back of your insurance card.3 This will connect you to a representative who can answer any questions that you may have.
  • Using the phone app for UPMC Health Plan,2 live chat with a representative.2
  • You can also create and log in to an online portal at this website. Once you are signed in, you can check your plan benefits.

You’ll also need to know if the facility you choose will work with your UPMC plan. American Addiction Centers (AAC) has an online tool that makes it easy to verify your coverage for detox and rehab services. If you prefer to talk with AAC directly, you can also contact our toll-free hotline at 1-888-935-1318 We are available 24 hours a day, 365 days a year to help you navigate every step of your recovery, from insurance questions and admissions to detox and rehab.

 

Types of UPMC Insurance plans

UPMC offers a range of plans to meet your healthcare needs:

  • Exclusive Provider Organization (EPO), which allows you to see any UPMC provider or certain providers that are outside the UPMC system.2  You must use in-network providers unless it is an emergency or you have prior authorization.3 (p12) You don’t need a referral to see a specialist with an EPO plan.
  • Health Maintenance Organization (HMO), which allows you to visit any UPMC provider, specific providers outside the UPMC system, and most hospitals within the community.2, 4 Your care is provided through your primary care physician, who can give you a referral if you need to see a specialist.2 , 4  You must see providers in the network for your treatment to be covered unless it’s an emergency.2 , 4 
  • Preferred Provider Organization (PPO), which allows you to choose between in-network and out-of-network providers.2, 5  If you choose to see out-of-network providers, your copays may be higher.2, 5 

You can find out more about the different UPMC plans here. In-network providers are located in all areas of Pennsylvania and certain parts of Maryland, Ohio, and West Virginia.1

UPMC also works with Medicare, a federal health insurance program available to people aged 65 or older or those with certain disabilities.6 The UPMC for Life plan is a Medicare plan that provides integrated care.7

UPMC Insurance at American Addiction Centers

American Addiction Centers is one of the foremost providers of substance use disorder treatment in the United States.8 (your recovery begins here) With treatment facilities across the country, American Addiction Centers works with many different healthcare companies, including UPMC Insurance.8 , 9 

All American Addiction Centers detox and rehab facilities maintain the highest medical and psychological standards to offer a variety of effective treatments.8 Treatment doesn’t just focus on the substance use; AAC aims to improve your physical and mental health and address any social issues that may be present..8, 10 

Medical detox at American Addiction Centers is accomplished in an inpatient facility and typically lasts 5 to 7 days.10 (medical detox) With medical monitoring around the clock, our staff can help ease discomfort and mitigate potentially dangerous withdrawal symptoms.10 This ensures you’ll have the safest possible detox while receiving the support you need, physically and emotionally, to help you get through the first part of your recovery journey.10

For more information about detox at American Addiction Centers—or just to answer any questions that you may have—a free and confidential helpline is available. You can call and speak with a knowledgeable and supportive Admissions Navigator any time of day or night by calling 1-888-935-1318.

 

  1. UPMC Health Plan. (2020). Our company.
  2. UPMC Health Plan. (2020). Health insurance.
  3. UPMC Health Plan. (2020). UPMC Advantage EPO policy.
  4. UPMC Health Plan. (2020). UPMC Advantage HMO policy.
  5. UPMC Health Plan. (2020). UPMC Advantage PPO policy.
  6. Centers for Medicare and Medicaid Services. (2020). What’s Medicare?
  7. UPMC Health Plan. (2020). Care and coverage.
  8. American Addiction Centers. (2020). American Addiction Centers.
  9. American Addiction Centers. (2020). Treatment centers.
  10. American Addiction Centers. (2020). Substance abuse treatment services