Explore UPMC Health Plan’s coverage for addiction treatment, including inpatient and outpatient options, plus mental health support.
UPMC Health Plan Coverage for Addiction Treatment
Explore UPMC Health Plan’s coverage for addiction treatment, including inpatient and outpatient options, plus mental health support.
UPMC Health Plan is the insurance arm of the UPMC (University of Pittsburgh Medical Center) health company that provides integrated health care and insurance coverage to residents of western and central Pennsylvania plus parts of Maryland and Ohio and West Virginia. They are headquartered in Pittsburgh Pennsylvania.
UPMC has their own network of hospitals and doctors and they also contract with other providers including the Cigna PPO network to serve members who live or travel outside of their main service locations. UPMC actively supports Pennsylvania community arts and education groups such as the Pittsburgh Promise, an educational scholarship fund to which they donated $10 million in 2023.
Does UPMC Health Plan Cover Addiction Treatment?
As required by the 2010 Affordable Care Act (ACA) most UPMC Health Plan insurance plans offer mental health and substance abuse treatment along with other medical care. However there are exceptions to the law and every insurance plan is different, so be sure to check with your insurance provider to find out which addiction treatments are covered by your specific plan.
Most UPMC in network substance abuse rehabs are in Pittsburgh, but there are some UPMC covered rehabs in Maryland and New York.
If you have a Cigna PPO plan or other out of network plan that has a partnership with UPMC Health Plan, you may have other rehabs available to you as well. Check with your insurance provider to find out which addiction treatments are covered by your specific plan.
Hello im Ashley and im an addict. My whole life has been filled with chaos and trauma. Some from my own doing and some that wasnt my fault. There is not a single bad word i can say abouy my experience at Beachway Therapy Center. My time there was cut short thanks to my own self-sabotaging behavior. Even then Beachway still treated me with compassion and the desire to help me. My situation was a unusual one. I came into the trauma program with a clean date of April 16th 2014. So at 11 years clean i was dealing with bipolar disorder, intense anxiety, a very unhealthy toxic relationship and an intense desire to break generational curses for my children. My history is one that involves homelessness, street drugs and a street mentality. Beachway took on the challenge of helping me work thru that trauma. I opened up to the program and other woman like never before. I had an amazing counselor, amazing case manager, and amazing staff that were there anytime i had moments of high anxiety or worry. I am so disappointed i ruined my chances of having a chance at going thru a trauma program with Beachway. Just in the short time i was there i did gain a small sense of self back. If you were like me and worry about making friends with the other clients because they wont understand you or like you, that is not even close to true. I found a sense of community that i couldnt find anywhere else in my life. If i manage to find a magic lamp, one of my wishes would definitely be used on looking young forever after that id wish to feel the peace and serenity i felt at Beachway. Thanks to them i had just enough courage to get me and my kids out of my bad situation. Now my goal is to continue with trauma therapy. Do not be me and let your past dictate your future. No matter how clean you are from drugs that trauma will creep up on you and when it does use tools like Beachway to seek help instead of the alternative, and please for the love of your higher power get out of your own way and accept their help before you get kicked out like i did. I am forever grateful. Thanks for letting me share my expierence, strength and hope.
Ashley Wilburn
1 month ago
My experience at Banyan was very good. The staff was very helpful, the therapy was extremely beneficial , and the food was great! Like with all rehabs, it is what you make of it. If you go there thinking everything is perfect, you’ll be disappointed, it’s not. If you go for simply a social experience, it’s not a resort. If you go because you’re serious about your recovery, it’s a great place to take the first step !
Brian Koppen
1 month ago
Loved Beachway. I was extremely anxious with everyday panic attacks, and the medicine was no longer working. At Beachway I found a way to control my attacks and anxiety. It is not easy and sometimes I felt like it wasn’t going to work.
We worked through my childhood traumas and I learned techniques on how to defuse my anxiety.
Loved Dina’s honest and hardcore classes and also Gigi’s trauma class.
From the intake department, to the counselors, security, kitchen staff, Directors, Nurses and everyone that worked there I thank you. ❤️
Prosperity Haven/ Wellbrook Recovery is such a wonderful place that helped me get sober. From the moment you walk in, everyone is so warm and welcome. When looking for a facility, WRC covered all the bases with being male only with fewer patients than a traditional set-up.The group instructors are diverse and will push you to be vulnerable and work outside of your comfort zone. There are all different types of therapies that are used to help you heal.The entire place/ program is about fellowship. Seeing the alumni come through the doors and support the guys in the house was huge for me.10/10 would recommend this facility to anyone seeking sobriety!
Brock Spurling
2 months ago
Prosperity is an excellent facility. They have an amazing and knowledgeable staff there to support clients throughout their stay that show a genuine Interest in client long term success. They do a fantastic job of making sure needs are met, including helping with coordination of any after care. I highly recommend this facility to anyone seeking to improve their situation.
Brandon Epp
2 months ago
I worked at Prosperity Haven for two years. Working here was a truly transformative experience, both personally and professionally. The leadership at Prosperity Haven was exceptional supportive, open to feedback, and always striving to provide the best care possible. The culture of compassion and respect that permeates the facility is remarkable, and it s evident (in everything they do) that the staff is fully committed to the mission of helping individuals heal and thrive. If you're looking for a place where you can start or pick up your recovery journey in a supportive and compassionate environment, I cannot recommend Prosperity Haven Treatment Center highly enough. The success stories I got to witness were genuinely life changing and my time there was an experience I will always cherish.
Made a review when I was mad. Just keep a look out for that kind of thing. I m sure the rehabs nice.
Alesha Antonelli
3 months ago
SJI provides a space for true healing to take place. I would recommend St. Joseph Institute to anyone seeking to address substance use disorder or mental health issues. You will be met with kindness and expertise to help you navigate recovery.
Melissa P
3 months ago
This program was very educational and rewarding for me
Akua is where I got clean.The staff is very patient and kind. Because of this, I eventually came around to opening my mind more. I didn t want to participate in meetings and put minimal effort in facilitated group on the beginning. Over time, I felt more comfortable and staff shared their struggles and how they overcame it. I felt like I was able to face the destruction of my past and eventually did. The different groups that they provide help build a well rounded foundation and I thank them for the time clean I have today.Thank you Akua
Vanessa Myrick
8 months ago
Life-Changing Experience at AKUAMy time at AKUA's residential treatment program was truly transformative, and I can say with confidence that it has helped me become the man I am today. From the moment I arrived, the staff was nothing short of amazing. They were not only professional but also compassionate, understanding, and genuinely invested in my recovery and healing.The AKUA team was instrumental in guiding me through one of the most challenging times in my life. Their dedication, support, and holistic approach helped me find a sense of peace and purpose. The environment fostered my growth and allowed me to confront and overcome the issues that had been holding me back.I'm forever grateful and thankful for AKUA and the incredible staff who played such a key role in my journey. They are more than just a treatment center; they are a lifeline for those looking to rebuild their lives. My deepest thanks and love to everyone at AKUA for helping me reclaim my future.If you or a loved one are looking for a place that truly cares and can help facilitate real change, I wholeheartedly recommend AKUA.
Lester J
8 months ago
The staff was very knowledgeable, caring and accommodating through my early recovery efforts! Plenty of time is made to provide access to the gym, AA/NA meetings, healthy and delicious food, therapy, group sessions, down time and yoga to name a few of the highlights. I had my reservations before enrolling with Akua but by the end of my month-long time there I was sad to have to leave, knowing that I would miss all the staff and clients, as well as the tools they provided me to succeed within my next chapters of the recovery process. I plan to attend their Wednesday AA alumni meetings!
I had a great experience here at Swift River. I detoxed else where, but when I arrived here I was very nervous how everything would play out. All of the staff and peers I had around me were very welcoming and comforting in my transition process. I completed the full program, and although I have a good form of nervousness to leave I am quite excited to continue on my sober journey.
Jack Langley
2 months ago
Beautiful location very helpful wonderful staff
Nina Marie
2 months ago
Had an awesome experience here! It wasn't my first rehab but it was definitely the best program, an enjoyable program and everyone was extremely nice! Would definitely recommend it to a person in search of recovery!
Silver pines saved my life. I will be forever grateful for the staff, therapists and fellow patients here. If you are looking for help, please come here
Olivia
2 months ago
Everyone was so nice and caring. I would recommend to anyone needing help.
Susan Biggs
2 months ago
Silver Pines saved my life and gave my children their mother back. Thank you all for meeting me where I was and giving me the tools to move forward. Forever Grateful
The counseling and people that work there were just amazing
Erica Ewing
2 months ago
Restore saved my life at first I wanted to leave the 24 hour hold on my things was helpful kept me from making a bad decision and the staff was extra helpful and caring to my needs. The food was awesome. This day was great. Went to the ocean and also learned a lot about sobriety and how to use the tools that they gave me to stay clean for 112 days as of right now never thought I could do it thank you restore
Courtney Niles
3 months ago
Restore Health and Wellness Center provides compassionate, professional addiction treatment in a supportive environment. The staff is knowledgeable and truly cares about each individual's recovery journey. Their comprehensive approach makes a real difference for those seeking lasting change.
I have had a fantastic experience at Silvermist. Every single staff member was extremely helpful and caring. The clients create such a deep Brotherhood that makes the experience easy. The campus is absolutely beautiful!
Bruce Lewis
2 months ago
This place is amazing. It has a very positive atmosphere for recovery. Everyone is very knowledgable from the tech's to the therapist's. Highly recommend this facility. 5 stars all the way
Steve Hamilton
2 months ago
I was struggling to get medical records for a resident after discharge and the team stepped right up and made sure that I had the appropriate paperwork before the clients appointment! Great teamwork!
I want to extend my heartfelt gratitude to Dream Life Recovery, the staff and the community I ve had the privilege of being a part of during my recent stay. It has been by far the best therapy I ve received on my recovery journey. The lessons I ve learned about my myself there are paramount in my recovery efforts. I have a firm foundation moving forward and I owe that to so many great influences there. I am truly blessed to have found this place. Thank you
Pat McNicholas
2 months ago
My recovery journey has spanned over two decades and included dozens of treatment centers. After 8 years of sobriety, I spent 6 years in a devastating series of relapses. Arriving at DreamLife, I had lost the will to live and determined myself hopeless. I wasn't a friendly face or an easy case. Despite my best efforts to sabotage myself, the staff at DreamLife fought for me. They saw value in my life that I couldn't. Having been to many rehabs, none are perfect. Some have 5-star amenities or an ideal climate and location. But what matters are the staff and the treatment itself. DreamLife is second to none in these departments. Many staff are in recovery and know what it takes to live successfully with this devastating disease. The therapists are top notch and provide holistic and proven modalities to fit clients unique needs. My trauma, self-defeating behaviors and cognitive distortions were all addressed. Because of DreamLife, I have a life again, one I was convinced was beyond reach. Eternally grateful.
Meredith Bushman
2 months ago
This place is an absolute amazing place! Because of this place my sister just celebrated her 5 years of being sober. Dream life is definitely a wonderful place!
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What UPMC Health Plans Are Available?
UPMC offers individual and family plans through the state Insurance Marketplace and through employers. If you qualify you can also get Medicare or Medicaid plans through UMPC.
The individual and family plans have several different options. They have Exclusive Provider Organization (EPO) plans, which require you to get care in the provider network but you don’t need a referral to see a specialist such as an addiction counselor.
They also have Health Maintenance Organization (HMO) plans, which require you to stay in network and to get a referral for specialist care. However, HMOs are often the least expensive on a monthly basis. Finally, a Preferred Provider Organization (PPO) gives you the most flexibility with some out of network coverage and no referrals required. However these plans tend to cost the most each month.
UPMC Health Plan offers Medicare Advantage (“Medicare part C”) HMO and PPO plans. Medicare plans by UPMC healthcare are called UPMC for Life. These plans provide the same services as regular Medicare, including coverage for addiction care, but they generally offer extra benefits like prescription coverage and vision and dental care.
Your Medicare Advantage plan will have its own coverage limits and requirements to get addiction treatment, so be sure to work with your doctor and get the referrals and preauthorization you need before you commit to treatment.
Medicaid plans by UPMC healthcare are called UPMC for You. Like regular Medicaid, these plans cover medical treatment and substance abuse treatment. However, they also cover prescriptions and dental and vision care.
If you qualify for both Medicare and Medicaid, UPMC for Life Complete Care offers $0 premium fees and $0 copays on medical care and $0 copays for prescriptions. It also offers dental and vision and hearing benefits. Members can get free transportation to healthcare providers and grocery stores along with fitness centers and adult day care centers. There’s also an allowance you can use to buy over the counter products.
What Inpatient Addiction Treatment Does UPMC Health Cover?
All insurance plans will focus on covering medically necessary care which is often defined by the treatment plan your doctor creates. It’s also important to verify your insurance and make sure you get a referral or preauthorization if necessary.
Some of the inpatient drug rehab treatment options that may be included in UPMC Health Plan’s behavioral health insurance policies are medical detox and residential treatment.
Detoxification is the process of letting substances leave your body. Many times you’ll get medical support to help you move through withdrawal symptoms. This may include medication assisted treatment (MAT). Commonly used MAT medications for treating alcohol or opioid addiction are methadone and buprenorphine along with naltrexone.
Inpatient treatment takes place in a clinic or hospital and residential care takes place in a non hospital facility and offers a more home like setting. Both options provide around the clock support and care.
Residential treatment often lasts 28 to 30 days or more. You’ll get a variety of therapy options which often includes holistic approaches like art or music therapy. Inpatient or residential treatment allows you to fully focus on your recovery without any distractions.
What Outpatient Rehab Does UMPC Health Plan Cover?
Outpatient programs, including intensive outpatient programs and regular outpatient programs, are available through UPMC Health Plan’s mental health benefits. Intensive outpatient programs typically involve up to nine hours of treatment each week, for between three to six weeks.
In a general outpatient program, counseling and education sessions may take place at a clinic or rehab facility. Addiction and relapse prevention education are provided, with individual sessions offered as needed.
There are multiple types of outpatient care. The most intensive outpatient treatment is a partial hospitalization program (PHP). This is a full day program that offers more than 20 hours of treatment per week. The treatment options are similar to inpatient or residential care.
At the next level are intensive outpatient programs (IOPs) which typically involve nine to 20 hours of treatment each week, with the hours spread over three to five days. Often 90 days of IOP treatment are recommended. The lowest intensity is general outpatient treatment, where counseling and education sessions may take place at a clinic or rehab facility once or twice a week. Addiction and relapse prevention education are provided, with individual sessions offered as needed.
Do UPMC Health Plans Have Additional Benefits?
Part of what makes UPMC Health stand out is the extra benefits members receive. For example preventive services may be free of charge and members can access virtual (telehealth or video) urgent care services to diagnose illness or prescribe medication.
They also have the MyHealth program that provides free health coaching for weight loss and smoking cessation along with tips on stress management and more. Finally, members can get six sessions of free counseling with a trained counselor through the Life Solutions program.
Does UMPC Health Plan Cover Methadone & Suboxone (MAT)?
MAT is covered by most UMPC plans. This treatment uses FDA approved medications to help those with alcohol and substance use disorder during the early recovery period. These medications such as naltrexone and buprenorphine along with methadone and acamprosate ease withdrawal symptoms and help to normalize brain chemistry. This is especially important during medical detox.
Some individuals only need MAT during the detox process while others need it throughout treatment to help manage cravings to reduce the risk of relapse and decrease the risk of overdose. Longer term MAT is combined with inpatient or outpatient treatment to help you establish long term recovery. Once treatment ends you can taper off the medication support and live a fully substance free life.
Does UMPC Cover Other Mental Healthcare?
In 2010 the Affordable Care Act was enacted into law. The ACA requires insurance plans to cover 10 essential health benefits which include mental health and substance use care. As a result most UMPC plans cover mental healthcare such as counseling and crisis intervention. You may get individual or group counseling along with mental health medication.
The extent of coverage differs from plan to plan. It is important to understand the details of your specific plan before starting treatment so you know whether you need a referral or preauthorization. You’ll also learn what out of pocket costs to expect.
Individuals with alcohol and substance use disorder often have co occurring mental health conditions. What’s most important in these cases is that you get treatment that addresses both mental health and addiction. That’s the only way to ensure you get the help you need to reach long term recovery.
Does Addiction Treatment Need to Be In Network?
Many UMPC plans require you to use an in network provider to get coverage. However some allow you to use an out of network provider although you’ll pay a lot more in out of pocket costs. For example your copayment and deductible may both be higher. Or you might have to pay a percentage of the cost instead of a flat copayment.
To maximize your insurance coverage it’s best to use high quality in network providers or facilities. To find out whether your plan allows non network care contact UMPC directly. This can be done by calling the phone number on the back of your ID card or by going online to their webpage at UPMC.com
Calls to any general helpline will be answered or returned by a paid advertiser.
By calling the helpline you agree to the terms of use. We do not receive any commission or fee that is dependent upon which treatment provider a caller chooses. There is no obligation to enter treatment.
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