How UMR Insurance Covers Addiction Treatment

UMR Health Insurance is a third-party administrator (TPA) that manages health benefits on behalf of an employer or organization. Plans vary widely based on your employer, but most cover substance use and mental health treatment. 

Unlike a traditional insurance company that takes on financial risk and handles claims, UMR focuses on administrative functions such as processing claims, managing provider networks, handling customer service, and ensuring that members can access the benefits their employer provides. 

This means that while UMR manages the logistics and day-to-day operations of a health plan, the actual risk of covering medical expenses typically falls on the employer or an insurance provider that partners with UMR, such as United.

Employers who self-fund their employee health plans often use TPAs like UMR to handle claims and administrative tasks, giving them greater flexibility and control over plan design, benefits, and costs.

How Does Accessing Care With UMR Work? 

Using UMR means employees interact with a system that functions like an insurance plan, they have ID cards, can visit doctors, and submit claims, but what happens behind the scenes is slightly different from that of a typical insurance company. 

UMR ensures claims are processed correctly, benefits are applied properly, and providers are paid, but the funding and risk are managed by the employer or an associated insurer. This structure can enable more customized plans, potentially lower costs, and more direct oversight of claims than a standard fully insured plan offered directly by an insurance company.

Is UMR Part of UnitedHealthcare? 

UMR is a subsidiary of UnitedHealthcare, and its plans often give members access to major UnitedHealthcare provider networks rather than UMR having its own standalone insurance network. 

Some provider networks that UMR plans typically leverage so members have access to broad in‑network care include [1]:

• United Healthcare Choice Plus Network: One of the largest PPO provider networks in the U.S., often used by UMR‑administered plans.

• United Healthcare Options PPO: Another PPO network frequently available through UMR plans.

• United Healthcare Dental PPO: Dental networks associated with UMR plans.

In UMR’s provider search listings, other network names may appear as well, although actual plan participation varies widely by employer/plan. Some of these include:

• Aetna Signature
• Fortcare Network
• Frontpath Coalition
• Health One Alliance
• Teachers Health Trust

Does UMR Cover Rehab and Addiction Treatment? 

UMR itself doesn’t directly provide health insurance or pay for treatment; it acts as a third-party administrator (TPA) that manages benefits on behalf of employers and insurance carriers such as UnitedHealthcare. 

However, most health plans administered through UMR do include coverage for rehab and addiction treatment due to federal laws such as the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act. These require that mental health and substance use disorder services be covered at levels comparable to other medical care. 

Depending on your specific plan design, medically necessary services such as medical detox, inpatient residential rehab, outpatient programs, intensive outpatient (IOP), partial hospitalization (PHP), and medication-assisted treatment (MAT) can be covered. 

However, the exact scope and cost of coverage vary. Some self-funded plans aren’t required to offer every “essential benefit” under the ACA, and specifics such as prior authorization, deductibles, copayments, in-network vs. out-of-network rules, and coverage length vary by employer and plan. 

It’s important to verify your benefits with your HR/benefits administrator or directly through UMR before starting treatment to understand what’s covered and what out-of-pocket costs you might face. 

How to Verify Your UMR Insurance Coverage for Rehab 

If you have UMR benefits and want to verify your coverage for treatment, you should:

1. Contact UMR: Call the number on the back of your insurance card to verify coverage. Ask about coverage for specific types of treatment (inpatient vs outpatient), the length of stay, and any out-of-pocket costs you might be responsible for.

2. Check UMR’s Provider Network: Visit the UMR website to find a list of in-network doctors, hospitalists, therapists, and other healthcare providers to connect you to a facility that is covered by your insurance.

3. Contact the treatment center directly. If you’re struggling to verify your UMR benefits, our admissions team at AnchorPoint has experience working with TPAs like UMR to help you navigate the process. 

What if UMR Doesn’t Cover My Treatment? 

If your insurance does not cover the treatment you require, it’s important to explore alternative ways to make care more affordable. Many healthcare facilities offer flexible payment plans, financial assistance programs, grants, scholarships, sliding-scale fees, or even crowdfunding options to help patients access necessary treatment.

Specialized treatment centers, like AnchorPoint in Arizona, often go a step further by collaborating directly with you and your healthcare provider to identify the best options for both care and cost. 

Drug & Alcohol Rehab in Arizona: UMR Insurance Accepted  

You can use your UMR plan to receive affordable addiction treatment today. 

We are committed to helping those in need find the care they deserve, regardless of their financial situation. We accept a wide range of insurances, including Cigna, Aetna, GEHA Health Plans, and more. 

To confirm your benefits, coverage limits, and preferred providers, review your policy, contact UMR directly, or call us at AnchorPoint. Our admissions team is ready to answer the phone, verify your benefits, and help you begin your path toward recovery.

Sources 

[1] UMR. Employer.