How to Find Adolescent Treatment Covered by UMR/United Healthcare

Understanding Your Plan

United Healthcare is the insurance company and UMR is their third party administrator of member benefits. These benefits and policies are diverse and offer a wide range of covered services. Understanding the specifics of your policy and the services provided to you is crucial when considering adolescent treatment coverage. You can access your plan documents through the United Healthcare website or through customer services. When perusing your plan documents, pay particular attention to the mental health and substance abuse sections as this is generally where you will find information about coverage for adolescent treatment services. Make sure to familiarize yourself with your plan specifics around copays, deductibles, out-of-pocket costs, and in-network providers. This will help you accurately assess your financial responsibilities. 

Identifying Network Providers and Services

To maximize coverage with your United Healthcare plan, make use of their in-network provider list. Utilize their online search tool or contact customer service directly to find covered providers that offer adolescent treatment services. When talking with United Healthcare, clarify what services are covered versus which may not be. This will let you know what, if any, out-of-pocket costs you may be responsible for. 

Verifying Coverage for Adolescent Treatment

Adolescent behavioral health treatment encompasses various services. These can  include therapy, counseling, medication management, and specialized programming. Prior to commencing treatment, verify your coverage for these specific services. Some treatments may necessitate pre-authorization, so it's essential to thoroughly review your plan documents to prevent unexpected expenses or service denials. Scrutinize any limitations or exclusions related to adolescent treatment services within your plan. Ask questions!

Understanding Denials and Navigating Appeals

Occasionally, coverage for adolescent treatment may face initial denial. Insurance companies pay out coverage based on a medical necessity model. Understanding the appeals process is pivotal in such situations. Carefully analyze the denial letter and compile supporting documentation, such as detailed healthcare provider statements or comprehensive medical records, to bolster your appeal. Adhere to the instructions outlined in the denial letter or seek guidance from UMR/United Healthcare regarding the appeals procedure. Advocate for yourself and your child!

Seeking Additional Assistance and Advocacy

The complexity of insurance coverage, denials, and appeals can often be overwhelming. Advocacy groups, mental health professionals, insurance experts, and local treatment facilities can all provide guidance. Each of these resources have experience working with insurance companies and can offer valuable insight and support throughout the process of finding the right adolescent treatment program for your loved one. Ask if they have any strategies or tips for navigating the nuanced insurance systems and advocating for your child’s needs. 

What’s Next?

Continuously stay updated on any and all updates and revisions to your insurance coverage. This will help  to guarantee uninterrupted access to necessary treatment for adolescents. Consult directly with United Healthcare for the most accurate and up-to-date information regarding your specific plan's coverage.

Leverage what you’ve learned in this blog and you’ll find that navigating the process of finding adolescent treatment becomes more manageable which ensures the best possible care for your adolescent's needs.

If you’re ready to start looking into adolescent treatment programs, need help with insurance, or just need to figure out what the next step is, call Stonewater Adolescent Recovery Center today. We can help you get your child back, better.