Does Univera Healthcare Cover Rehab Treatment?

Univera Healthcare is a health insurance provider that offers a variety of plans to its members. One of the most common questions asked by members is whether Univera Healthcare covers rehab treatment. The answer is yes, Univera Healthcare does offer coverage for rehab treatment, but the extent of the coverage depends on the plan you have.

Types of Rehab Treatment Covered by Univera Healthcare

Univera Healthcare covers a wide range of rehab treatments for its members. These include:

Inpatient rehab treatment: This is when a patient stays in a facility for a period of time to receive treatment for their addiction.
Outpatient rehab treatment: This is when a patient receives treatment on an outpatient basis, meaning they don't stay in a facility.
Medication-assisted treatment: This is when medications are used to help manage withdrawal symptoms and cravings for drugs or alcohol.
Behavioral therapy: This is when a patient receives therapy to help them change their behavior and address the underlying issues that led to their addiction.

Coverage for Rehab Treatment

The amount of coverage for rehab treatment depends on the plan you have with Univera Healthcare. Some plans may cover the full cost of treatment, while others may require you to pay a portion of the cost.

It's important to note that some plans may have certain restrictions on rehab treatment coverage. For example, some plans may only cover a certain number of days of inpatient treatment, or they may require pre-authorization before coverage is provided.

How to Find a Rehab Facility Covered by Your Univera Healthcare Plan?

Finding a rehab facility that is covered by your Univera Healthcare plan can be overwhelming, but it's important to do your research to ensure you receive the best care possible. Here are some steps you can take to find a rehab facility that is covered by your plan:

Check Your Provider Network: Univera Healthcare has a network of providers that have agreed to provide services at a discounted rate for members. You can check if a specific rehab facility is in-network by using the provider search tool on the Univera Healthcare website.
Contact Your Insurance Company: If you have questions about coverage for a specific rehab facility, contact Univera Healthcare directly. The customer service team can help answer any questions you may have and provide you with more information about the rehab treatment options available under your plan.
Ask for Recommendations: Talk to your primary care physician or mental health provider about rehab facilities they recommend. They may have experience working with patients who have used their insurance at certain facilities and can provide valuable insight.
Research Online: Look up reviews and ratings of different rehab facilities online. This can give you an idea of what other patients have experienced and whether a facility is right for you.

By taking these steps, you can find a rehab facility that meets your needs and is covered by your Univera Healthcare plan. It's important to remember that while cost may be a factor, finding high-quality care should be your top priority when seeking treatment for addiction.

Pre-Authorization Requirements

Under certain Univera Healthcare plans, pre-authorization may be required before coverage is provided for rehab treatment. Pre-authorization means that you must get approval from your insurance company before receiving services or treatments.

If your plan requires pre-authorization, it's important to contact Univera Healthcare as soon as possible to avoid any delays in receiving care. The customer service team can provide you with more information about the pre-authorization process and help you get started.

It's important to remember that while pre-authorization may be an extra step, it's in place to ensure that you receive the appropriate care for your needs. By following the requirements of your plan, you can receive the coverage you need for rehab treatment.

Cost-Sharing Responsibilities for Rehab Treatment

While Univera Healthcare covers rehab treatment, members are still responsible for some of the costs associated with their care. The amount you will need to pay depends on the plan you have and the specific services you receive.

Some plans may require a copayment or coinsurance for rehab treatment services. A copayment is a fixed dollar amount that you pay at the time of service, while coinsurance is a percentage of the total cost of care that you are responsible for.

It's important to review your plan documents carefully to understand your cost-sharing responsibilities. You can also contact Univera Healthcare directly if you have questions about your coverage or costs.

In addition to cost-sharing responsibilities, members may also be responsible for paying any fees associated with going out-of-network for rehab treatment services. If you choose to receive care from an out-of-network provider, you may be responsible for paying more out-of-pocket expenses than if you had stayed in-network.

By understanding your cost-sharing responsibilities and staying in-network whenever possible, you can help manage your healthcare costs while still receiving high-quality rehab treatment through Univera Healthcare.

Duration of Coverage for Inpatient and Outpatient Rehab Treatment

The duration of coverage for inpatient and outpatient rehab treatment under different Univera Healthcare plans can vary. While some plans may provide coverage for the entire length of treatment, others may have limits on the number of days or visits covered.

For example, one plan may cover up to 30 days of inpatient rehab treatment per year, while another plan may cover up to 90 days. Similarly, some plans may limit outpatient rehab treatment to a certain number of visits per year.

It's important to review your plan documents carefully to understand the duration of coverage for inpatient and outpatient rehab treatment under your specific plan. If you have questions about your coverage or need help finding a provider that accepts your insurance, contact Univera Healthcare directly for assistance.

By understanding the duration of coverage under your plan, you can make informed decisions about your rehab treatment options and ensure that you receive the care you need without facing unexpected costs.

Filing a Claim for Rehab Treatment with Univera Healthcare

If you have received rehab treatment that is covered by your Univera Healthcare plan, you may need to file a claim to receive reimbursement or payment for the services provided. Here are the steps you can take to file a claim:

Obtain Necessary Documentation: Before filing a claim, make sure you have all of the necessary documentation related to your rehab treatment, such as receipts, invoices, and bills.
Fill Out Claim Form: You will need to fill out a claim form to request payment or reimbursement for your rehab treatment. You can find this form on the Univera Healthcare website or by contacting customer service.
Submit Claim Form and Documentation: Once you have completed the claim form and gathered all necessary documentation, submit it to Univera Healthcare for processing. This can typically be done online or through mail.
Wait for Review and Payment: After submitting your claim, it will be reviewed by Univera Healthcare to ensure that it meets their coverage guidelines. If approved, you will receive payment or reimbursement according to the terms of your plan.

It's important to note that there may be certain time limits for filing claims related to rehab treatment under your Univera Healthcare plan. Be sure to review your plan documents carefully and file your claim within any specified timeframes.

By following these steps and submitting all necessary documentation in a timely manner, you can ensure that you receive payment or reimbursement for rehab treatment covered under your Univera Healthcare plan.

The Impact of the Affordable Care Act on Rehab Treatment Coverage under Univera Healthcare Plans

The Affordable Care Act, also known as Obamacare, has had a significant impact on healthcare coverage in the United States. One of the key changes brought about by the ACA was the requirement that all health insurance plans cover essential health benefits, including mental health and substance abuse treatment.

As a result of this requirement, Univera Healthcare plans are now required to cover rehab treatment for addiction under all of their plans. This means that members can receive coverage for inpatient and outpatient rehab treatment, medication-assisted treatment, and behavioral therapy regardless of which plan they have.

In addition to coverage requirements, the ACA also introduced several consumer protections related to rehab treatment coverage. For example, insurance companies are no longer allowed to deny coverage based on pre-existing conditions or lifetime limits on coverage.

This means that individuals with a history of addiction cannot be denied coverage for rehab treatment and can receive care without worrying about hitting a lifetime limit on their coverage.

What to Do When Your Claim for Rehab Treatment is Denied by Univera Healthcare?

If your claim for rehab treatment is denied by Univera Healthcare, it can be frustrating and overwhelming. However, you have the right to appeal the decision and fight for coverage of your rehab treatment. Here are the steps you can take to navigate the appeals process:

Understand Why Your Claim Was Denied: The first step in navigating the appeals process is to understand why your claim was denied. Review the denial letter from Univera Healthcare carefully and make note of any reasons given for the denial.
Gather Additional Information: If your claim was denied due to lack of medical necessity or another reason that requires additional information, gather any additional documentation from your healthcare provider that may support your case.
Submit an Appeal: Once you have a better understanding of why your claim was denied and have gathered any additional information, submit an appeal to Univera Healthcare. This can typically be done online or through mail.
Wait for Review: After submitting your appeal, Univera Healthcare will review it and make a decision on whether to overturn their original decision. This process can take several weeks or even months.
Consider Hiring an Advocate: If you're having trouble navigating the appeals process on your own, consider hiring an advocate who specializes in healthcare appeals. They can help guide you through the process and increase your chances of success.

It's important to remember that while appealing a denial can be challenging, it's worth fighting for coverage of your rehab treatment. By following these steps and advocating for yourself, you may be able to receive coverage for services that are essential to your recovery from addiction.

FAQs

What if I need to go to an out-of-network rehab facility?

If you need to go to an out-of-network rehab facility, your costs may be higher than if you had stayed in-network. Some plans may not cover any out-of-network care, while others may cover a portion of the cost.

It's important to review your plan documents carefully and contact Univera Healthcare directly for more information about coverage for out-of-network care.

Will I have to pay anything upfront for rehab treatment?

The amount you will need to pay upfront for rehab treatment depends on your specific plan with Univera Healthcare. Some plans may require a copayment or coinsurance at the time of service, while others may not require any payment upfront.

It's important to review your plan documents carefully and contact Univera Healthcare directly if you have questions about your cost-sharing responsibilities.

Can I choose my own rehab facility, or do I have to go to one that is in the Univera Healthcare network?

You can choose any rehab facility that accepts your Univera Healthcare insurance, whether it is in-network or out-of-network. However, going out-of-network may result in higher costs for you.

It's recommended that you use the provider search tool on the Univera Healthcare website or contact customer service for help finding an in-network provider that meets your needs.

How do I know if my specific rehab treatment will be covered by my plan?

The specific types of rehab treatment covered under your plan with Univera Healthcare may vary. It's important to review your plan documents carefully and contact customer service directly if you have questions about coverage for a particular type of treatment.

Will my primary care physician be involved in my rehab treatment?

Your primary care physician may be involved in your rehab treatment, depending on the specific services you receive and the recommendations of your treatment team. It's important to talk to your primary care physician about any concerns or questions you have regarding your rehab treatment.

What if I need help finding a rehab facility that is covered by my Univera Healthcare plan?

If you need help finding a rehab facility that is covered by your Univera Healthcare plan, there are several resources available to you.

You can use the provider search tool on the Univera Healthcare website, contact customer service for assistance, ask for recommendations from your primary care physician or mental health provider, or research different facilities online. It's important to take the time to find a facility that meets your needs and is covered by your insurance plan.

Conclusion

In conclusion, Univera Healthcare does offer coverage for rehab treatment for its members. The extent of the coverage depends on the plan you have, so it's important to review your plan documents and contact Univera Healthcare directly if you have any questions.

By taking advantage of the rehab treatment options available under your plan, you can get the support you need to overcome addiction and achieve lasting recovery.