Unfortunately in the United States, health care isn’t a given. Yet, many employers see the benefit of providing their employees access to affordable healthcare. UMR isn’t an insurance provider but helps individuals get access to the medical services they need. It’s a third-party administrator (TPA) hired by employers to make sure claims are paid the right way. Also, UMR ensures members receive health care services at an affordable price. 

In 2019, the Kaiser Family Foundation (KFF) reports that 73.3% of uninsured Americans didn’t have it because they couldn’t afford it. Marginalized Americans suffer the most from this. Those with low-income and people of color were most likely to be uninsured. UMR helps all members get health care services at a minimum cost. 

Will UMR Cover Substance Use Disorder Treatment? 

As aforementioned, UMR isn’t an insurance provider. So, they won’t directly cover treatment for a substance user disorder. That said, there are thousands of medical service providers in the third-party UMR network. 

One of the best characteristics of UMR is that they deeply care about their members’ mental health. Around one in five (51.5 million) American adults suffer from a mental illness as of 2019. Additionally, half of the people with a substance use disorder also suffer from mental illness. 

For this reason, they are dedicated to negotiating the costs of mental health services between health care providers and members. This includes substance use disorder treatment. UMR sees the benefit of detox and rehabilitation services. They also understand that members need affordable coverage to receive treatment. Members can call their insurance provider to see what they cover and UMR will work to make sure the cost isn’t excessive. 

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UMR and Coverage Based on Length of Treatment 

The length of time a member at Sana Lake needs to undergo treatment depends upon each individual. Some members require longer and more treatment than others. UMR knows that cutting treatment short can hurt how effective it is. Health insurance companies affiliated with UMR don’t have to provide a certain amount of treatment. However, UMR asks insurance companies to keep in mind that treatment is effective when it’s completed in full.  

Doctors are the best people to come up with the right length of treatment for a person with a substance use disorder. Ultimately, they’ll be able to come up with an appropriate length of treatment. Dismissing the importance of the right length of treatment may increase the chances of relapse. Around 40%-60% of people with a substance use disorder will relapse, according to the National Institute on Drug Abuse (NIDA).

What the MHPAEA Means to UMR Members

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) helps individuals suffering from a substance use disorder get the most out of their insurance without discrimination. Health care providers affiliated with UMR recognize their duty to help people with substance use disorders per the MHPAEA. The Centers for Medicare and Medicaid Services (CMS) outlines what the MHPAEA means to members of UMR. 

Key points UMR members should know are: 

Of course, there are exceptions to this act. But UMR understands the rights that people with a mental health disorder and/or substance use disorder have. That way, UMR can sort it out with insurance providers if an issue surrounding coverage emerges. Sana Lake Behavioral Wellness Center believes that every member should have the right to receive the best treatment without going into serious debt. 

What Likely Won’t Be Covered Through UMR 

UMR indirectly offers health care benefits and coverage through more than 3,000 providers across the nation. Benefits and coverage depend upon the plan an employee has and what kind of health insurance an employer offers. Some plans may cost more per month, but offer more benefits when it comes to specialty substance use disorder treatment. 

So, UMR may not be able to fully cover individuals who want to attend a substance use disorder treatment facility with luxury features. Or potential members of a facility may not be able to use certain amenities. UMR doesn’t enforce rules on health care providers. Instead, it has guidelines that help minimize the cost of essential mental health services. 

What Might Be Covered Through UMR 

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Sana Lakes Behavioral Wellness Center wants to stress that UMR doesn’t directly cover services because they aren’t an insurance provider. But their connection to thousands of them as a TPA helps members get a wide range of coverage for services. We offer individualized treatment plans in Missouri to effectively help all members. 

Our residential programs are likely covered indirectly through UMR. A residential program is when a member lives at a facility such as ours. It’s a good option because it’s one of the most intense forms of treatment and UMR might be able to work with your health insurance provider to cover the bulk of the cost. Residential treatment allows members to completely focus on recovery without external triggers. 

UMR may also help with our outpatient programs. This is when a member won’t live at a facility but will receive treatment. A member’s outpatient plan might be made up of various therapies. A comprehensive detox plan is another essential program that UMR could help with. 

We’re Here To Help 

With or without health insurance, we can work out a plan for you to get the help you need. We’re also here to provide confidential consultations on how UMR and your health insurance provider can cover your treatment. For speedy assistance with either, contact us now. 

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