UPMC Insurance Coverage for Rehab and Detox

Does UPMC Cover Drug Rehab?

If you are a UPMC Health policyholder, you can rest assured that UPMC Health does provide drug rehab coverage as well as alcohol rehab coverage. Additionally, UPMC benefits for detox and drug rehab 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 Use Your UPMC Rehab Benefits

Depending on what is deemed medically necessary by the rehab center or your primary care provider, you may be covered for the following rehab services though the exact coverage provided may vary by plan: ^{3, 4, 5}

To use your coverage for these services, you will need to verify that your UPMC coverage is accepted by the rehab center you would like to attend. Generally, any  UPMC rehab center should be considered an “in-network provider.” If you want to attend a rehab center that is not affiliated with UPMC directly, you’ll want to confirm that your UPMC rehab benefits can be used with Out-Of-Network rehab centers.

UPMC Drug & Alcohol Rehab Centers in Pittsburgh, PA

In-network UPMC rehab centers are located in all areas of Pennsylvania. While most UPMC rehab centers are located in Pittsburgh, Pennsylvania, you can also find UPMC rehab centers in certain parts of Maryland, Ohio, and West Virginia while plans with out-of-network coverage may allow you to attend rehab in other states.¹

How To Check Your UPMC Rehab Benefits

Before beginning treatment at a UPMC rehabilitation center, 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 UPMC’s online portal. 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), like many other rehab providers, allow you to check your benefits immediately to see if your coverage is eligible for treatment. If you prefer to talk with AAC directly, you can also contact our free & confidential detox hotline for more information for help answering UPMC insurance questions related to admissions.

Types of UPMC Insurance plans with Rehab Coverage

UPMC offers a range of plans to meet your rehab & recovery needs:² 

• Exclusive Provider Organization (EPO), which allows you to see any UPMC rehab center 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  You don’t need a referral to see a specialist with an EPO plan.³ 
• Health Maintenance Organization (HMO), which allows you to visit any UPMC rehab center, 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 rehab centers 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} 

Is UPMC for You Medicare or Medicaid?

UPMC also works with Medicare & Medicaid, a federal health insurance program available to people aged 65 or older or those with certain disabilities.⁶

The “UPMC for You” plan is a Medicare Advantage Program and also has Medicaid benefits associated with it as well. To find UPMC rehab centers or doctors that take “UPMC for You,” you should consult your insurance provider directly.

How to Find UPMC Rehab Centers

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

For more information about detox at American Addiction Centers—or just to answer any questions that you may have—you may call our free & confidential detox hotline or text us to learn more about our admissions process.