United Healthcare Insurance | PAX Memphis TN Substance Abuse Treatment Coverage


United Healthcare is one of the nation’s largest health insurance providers, offering an array of policies with varying tiers of coverage. The majority of United Healthcare plans provide assistance for drug and alcohol rehab, the out of pocket costs may fluctuate based on the policy and location. United Healthcare provides mental health and substance abuse services with the goal of finding the most appropriate level of care for the individual. Policyholders with United Healthcare who are in need of substance abuse rehab have access to individualized care and a broad network of treatment providers. United Healthcare extends its coverage around the entire United States including substance abuse treatment in Memphis, Tennessee.


United Healthcare Insurance Coverage for Drug Rehab in Tennessee

The Affordable Care Act passed in 2010 requiring behavioral health services to cover addiction treatment. Since addiction is officially defined as a disease by the American Medical Association, it can no longer be denied coverage under both private and group health insurance plans. Instead, health insurance providers are now required to cover portions of behavioral health services – including residential addiction treatment.

In the state of Tennessee, there are many different drug and alcohol rehab facilities that are covered under United Healthcare plans. Every program is different in what coverage they offer and each insurance plan covers different types of treatment. United Healthcare insurance can cover detoxification, inpatient medical detox, outpatient rehabilitation, inpatient drug treatment services, and group therapy provided by a clinical professional. 

United Healthcare health insurance policies and plans are required to include substance abuse rehab. However, treatment will vary, and so may the coverage and services allowed based on your individual policy. As the ACA lists substance abuse concerns under the umbrella of “essential” health benefits that must be covered at similar rates as other medical and surgical procedures.


Generally, there are two main types of insurance policies covered by United Healthcare: preferred provider organizations (PPOs) and health maintenance organizations (HMOs). 

Preferred Provider Organization (PPO): A PPO plan will allow insured individuals to seek healthcare services from both providers that are considered “in network” and “out of network”. In-network providers maintain a partnership with United Healthcare in order to provide services for a discounted rate. 

Health Maintenance Organization (HMO): HMO plans require covered members to receive their medical and mental health needs “in network”. 

While both plans will cover portions of addiction treatment at PAX Memphis Recovery Center, it is best to speak directly with your insurance provider to learn more about the coverage your policy provides.


United Healthcare Levels of Care for Substance Abuse Treatment

United Healthcare plans are accepted at many treatment centers including PAX Memphis, but insurance coverage may vary according to the individual, the plan, the treatment center, and the type of treatment. Your specific plan may cover only a portion of your treatment, so it’s always best to check your insurance plan prior to enrollment in any program. Some of the available treatment services covered by United Healthcare are: 


Medical Detox

  • Recommended for individuals that require 24-hour intensive medical care to ensure their safety during the detoxification process.
  • Sometimes recommended when the individual is dependent on alcohol, sedatives, and some opiate-based drugs such as narcotic painkillers or heroin.
  • Typically intended for people whose situations are medically-complicated (Because withdrawal symptoms are common when stopping the regular use of most substances, this type of treatment may not be recommended for most people)
  • Medical detox helps individuals cope with withdrawal symptoms safely and comfortably. 

Inpatient/Residential Rehabilitation

  • Residential treatment at PAX Memphis Recovery Center is the next suggested step after medical detox.
  • This type of treatment consists of 24-hour care while patients live in a structured, therapeutic environment. 
  • May last 28 days or more.
  • Should include family counseling, group therapy, as well as individual therapy.
  • Typically consists of 5-7 days per week for 6-8 hours each day
  • Patients will live and remain on campus while receiving his/her individualized level of care and until treatment is complete.

Intensive Outpatient Program (IOP)*

  • Structured treatment that teaches about the concepts of addiction and recovery for individuals who may be unable to leave responsibilities at home to attend inpatient rehabilitation.
  • Intensive outpatient programs at PAX Memphis also serve as a step down from inpatient rehab for individuals wishing to participate in extended aftercare.
  • Generally encourages participation with 12-step programs.
  • Typically consists of 3-5 days per week and an average of 3-4 hours of treatment per day for a set number of sessions or period of time
  • Many programs are structured so individuals may continue to live and work in their community.


Understanding Your United Healthcare Rehab Benefits

When it comes to better understanding your United Healthcare coverage for drug rehab services, it is important to remember that mental health benefits are much different from general health benefits. Having great health benefits does not mean that you also have amazing substance abuse and mental health benefits. In other words, there is no direct correlation between your health benefits and mental health /addiction coverage.

It is also vital that you understand your policy. Whether you have United Healthcare insurance as an individual or through your employer, you should familiarize and weigh out both sets of benefits. It is also important to know that people with PPO United Healthcare Insurance policies (one that does not include an MNRP) may have the best coverage for drug and alcohol treatment services. Similarly, UnitedHealthcare’s coverage for outpatient treatment varies depending on the type of plan an individual has. Also, 20-30% coinsurance may be required.

Educating yourself and verifying insurance options can be overwhelming, especially if you or someone you know is suffering from addiction. Of course, knowledgeable advisors are available with United Healthcare. Here at PAX Memphis, we value all of our clients and our goal is to ensure every client receives quality addiction treatment that also addresses and treats any underlying co-occurring disorders as well. The PAX Memphis staff is well versed in treating substance abuse problems of all types. We strive to help our patients recover from the disease of addiction and we will always be ready to help. Our goal is to create a community that eases the stress of insurance coverage and financial insecurities by working with United Healthcare and a variety of other insurance companies to better serve our clients.


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