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UMR Health Insurance for Drug and Alcohol Rehabilitation in California



UMR is not a traditional health insurance provider but a third-party administrator hired by an employer to ensure claims are paid correctly, and health care costs are kept to a minimum. UMR is a reliable resource to help people in California get the proper coverage they need for their employees and their companies. Millions of California residents have health insurance provided through an employer. Within the UMR network are over 3,000 health care providers that make up the third-party network. UMR specializes in working with each provider to expand behavioral health services, so they are covered by health insurance. Overall, UMR is not a health insurance company but provides services for the employer that pays the portion of the health care costs not paid by the employee.

The rehabilitation process for someone with health insurance is not different than for someone without health insurance. Health insurance plans in California cover drug and alcohol rehab. However, the extent of coverage depends on the plan type. The first step with drug rehab is drug detox, and this process is important to manage withdrawal symptoms and cravings. However, detox should not be considered the only approach to drug rehab. The next step with drug rehabilitation involves attending a residential or outpatient drug rehab program. It is also important for families to consider aftercare support like 12-step meetings and peer support groups or a sober living home. Health plans cover different aspects of drug rehab and recovery.


How Does Private Health Insurance Cover Drug Rehab in California?

UMR does not cover drug rehab directly as it is not a health insurance provider but provides access to thousands of care providers through the UMR third-party network. The first step when using health insurance to cover drug rehab is to contact the health insurance provider. The two most common health care plans are Health Maintenance Organization plans and Preferred Provider Organization plans. HMO plans allow patients to choose their primary care physician and see that doctor during their treatment. Someone with an HMO plan can also seek treatment outside of the network, yet a referral is needed by the primary care physician. HMO plans typically have lower deductibles, and overall coverage is a lower cost. The pros of an HMO plan are lower premiums but no access to out-of-network providers.

PPO plans allow patients to see healthcare providers in and out of their network without referrals. A PPO plan does have a higher deductible than an HMO plan, but there are more provider options. Usually, there are out-of-pocket costs, copay, or coinsurance. Some health insurance plans require the patient to pay everything upfront, and they are reimbursed later. Once the process has been sorted out with the health insurance provider, the next step is contacting the drug rehab center. In California, drug rehab programs are familiar with what health insurance plans they accept and how the admission process works with health insurance. Families should go through their health insurance plan as the first option when searching for California drug rehab centers.


What Type of Drug Rehab Does Health Insurance Cover in California?

As UMR is not a health insurance provider, the coverage for drug rehab in California is dependent on the health insurance plan. However, typically health insurance covers drug detox, whether medical detox or standard drug detox. Health insurance plans cover outpatient drug rehab and residential drug rehab, and some aftercare support options like sober living. When searching for drug rehab options in California, there are different avenues for a family. The first is contacting the health insurance provider and finding out what services are covered and how the admission process works. Families can also receive an addiction assessment through a state or private healthcare provider or drug rehab referral agency. The purpose of an addiction assessment is to determine the extent and severity of addiction and find the best possible drug rehab options in California. Finally, if a family is working with a professional interventionist, they would help the family arrange a drug rehab center.


Family Intervention for Drug Addiction in California

Watching a family member struggle with addiction is not easy, and many families are unsure of what direction to take. Family intervention helps the family regain control and motivates the drug-addicted loved one to accept treatment. Someone struggling with drug addiction is often in denial about their situation and unwilling to seek treatment. Moreover, they may not recognize the negative effects their addiction has on themselves and others. A family intervention presents the drug-addicted family member with a structured opportunity to make changes before things get even worse. Family intervention is a carefully planned process, and the best way is with the help of a professional interventionist.

During a family intervention, those involved provide specific examples of destructive behaviors and their impact on the addict and their family. The interventionist and the family offer the addict prearranged treatment plans with clear steps, goals, and guidelines. The interventionist also helps the family spell out what each person will do if the drug-addicted family member refuses to accept drug rehab. A successful family intervention is planned carefully to work as intended. However, a poorly planned family intervention can worsen the situation, and the drug-addicted family member may feel attacked.


Health Insurance for Drug Rehab and Drug Addiction Trends in California

In California, the uninsured rate has fallen from 17% to 7.1%, and the number of uninsured California residents has dropped by 3.7 million people. Approximately 1.5 million California residents are covered by Medi-Cal, including 3.7 million through the Affordable Care Act expansion. Unfortunately, in California, the rate of drug addiction among young adults aged 18 to 25 was approximately twice the overall average. Adults aged 26 and older were nearly three times more likely to have an alcohol addiction than a drug addiction. Alcohol addiction was more prevalent than other types of drug addiction. Moreover, alcohol accounted for more nonfatal emergency department visits than all other drug diagnoses combined.



California Health Care Foundation. How Many in Your Area are Covered by the Affordable Care Act. September 2020. https://www.chcf.org/publication/how-many-your-area-are-covered-affordable-care-act/

California Health Care Foundation. Substance Use in California:  A look at Addiction and Treatment. October 2018. https://www.chcf.org/wp-content/uploads/2018/09/SubstanceUseDisorderAlmanac2018.pdf