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.
Walking through the doors of Silver Pines is life changing, for sure. Everyone is so understanding, informative and genuine. I feel safe coming to SP knowing that I don’t have to be ashamed of mental health or co-occurring disorders. The facility is broken up into different sections. There is a detox, men’s residential, women’s residential and a mental health section. As a resident at SP we all co exist under the same roof. It’s amazing how diverse everyone is. I love getting to know each other and allowing ourselves to open ourselves up in order to heal. I’ve seen a lot of us come in a mess and leave these doors with a plan on how to cope and heal. The facilitators come up with an after plan and it’s up to us as individuals to follow through with it. I have reached out to Jenn C., Chelsea and Randy in times of trouble and they have always had my back and always welcomed me with open arms. If you struggle to pay financially the finance department is willing to work with you when having to pay anything. We eat three times daily and you can substitutions if need be. We have a black out period of a week where we don’t really have the freedom of using our phones. This is the first facility that allows me to use my phone at certain times. They are lenient if you have school or work related things going on. If you need to make court, medical appointments or have an interview they can take you. The facility brings in H and I Na meetings and AA meetings. The food is good and there are plenty of snacks. There are nurses there 24/7. The bonds that I have made in this facility is unbreakable. I have so much love to SP. Thank you 🙏
ALICIA JACOBACCI
2 months ago
Silver Pines is a highly effective behavioral health treatment facility. Intake is very smooth and efficient. They understand how difficult it can be to ask for help and are very accommodating through the entire process. They even offer intake and completion transport to and from the facility. Silver Pines provides clients with a top notch medical program, case management, individual therapy with a set therapist, highly detailed daily programming, family support, community support, an on-site gym, and the food and beverages provided are plenty. Personally Silver Pines brought me in swiftly yet treated me very attentively and thoroughly yielding great results for both my mental and physical health. Silver Pines also treats all of their alumni as part of the family and are always willing to assist those that journey with them throughout their stay and beyond.
Elliott Maglio
2 months ago
Silver Pines is def the best treatment facility I been to, there are pretty much no complaints about it. The staff genuinely care about you and made me feel loved which I appreciate so much ofc. They make recovery fun!! The food is so good and they be getting the best snacks sometimes. You get so much out of being here if you really care. I like how they run things here, like the groups or fun activities etc. I definitely recommend coming here if you're ready to get sober. They help you with anything you need. :)
So Blessed to have found St. Joseph’s! Saved my Life! As a mature 50 something grandma, I would never have believed that I would get so sucked into addiction that I could give up everything for one thing! But Nothing Shy of a Miracle would make me quit.God heard my plea for Help and St Joseph’s delivered! 3 weeks into my rehab I had a heart attack, I would probably be dead had I been outside of St Joseph’s using like I was, and after a quick procedure I was back to finish my rehab 48 hours later. My stay extended beyond 60 days, and sure there were days I felt trapped inside this village, but I needed precisely there to be rules, stability, structure. Quitting One thing for Every Thing would not be my New Reality had it not been for St. Joseph’s!
Pattie
3 months ago
SJI is in an idyllic setting where the peaceful atmosphere integrates wellness, educational programming, and both individual and group therapy sessions lead by competent and compassionate staff. Homemade meals include a well stocked salad bar and fresh fruit. If Grace is cooking, you are in for a treat!
The individual therapy was most beneficial to me. I was fortunate to be assigned to Emily B. (but all counselors are lovely and I benefited from the group sessions they provided on a rotation schedule). Guest speakers were profound, offering hope and keys to resilience.
The peace, quiet, and support I received allowed me to unplug and really get to the crux of my personal issues in ways outpatient therapy didn't, and could never, touch.
As a client, I took ownership of my progress, never "skipping" sessions, no excuses given, and took advantage of early morning sessions that were optional offered by Val during the week (She's a true gem, and I highly recommend taking advantage of the opportunities she offers). The RA's Joe, Dave and Bri were supportive and compassionate, and always available throughout the day and into the night, 24/7. My counselor, Emily, was firm, fair and consistent. She called me out when necessary and truly helped me get where I needed and wanted to be - Happy, Joyful, and Free.
It was a pleasure to serve as community leader during my time at Saint Joseph's Institute (when I was ready). Happily sober now, involved in daily AA meetings both virtually and in-person in my local community, I refer others to SJI on the regular, and am pleased to do so here in this forum.
Freedom from alcohol addiction is attainable if you work for it (other addictions, too), and I was given the tools I needed to live alcohol and hangover free for life, full of patience, forgiveness, tolerance of others, and love. Is everything perfect for me? No. But SJI gave me what I needed at a time when I was lost and desperate for change and hope. I got what I needed, and you can, too. I'm determined to make it despite the challenges I face personally today at work, at home, and in my relationships. Make the call. Give yourself this gift of sobriety, and do it at St. Joe's. One Day At A Time.
Brenda Smith
3 months ago
I went to this place and honestly it changed my life. It wasn't just the place but the people that work there 💜 I know it's a business but the compassion and understanding is unbelievable. If I didn't have kids to get home to I would have stayed longer. They do do extensions as well. If recovery ang getting your life back is what you are looking for, I highly recommend this place.
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
2 months 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
2 months 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. ❤️
I was a client and when I tell you this place saved my life, believe it. I've never met a group of professionals who care so much, every single one of them!! If you or a loved one are suffering and you choose anywhere else, you're making the wrong decision.
Jeffrey Rice
2 months ago
This place was absolutely amazing! This was my third treatment center and Wellbrook is by far the best! The staff was incredible and very informative! One on one counseling, along with dual diagnosis treatment was very helpful.
I love that after you leave the house, anyone is welcome back to attend meetings or group activities. The location and seclusion of the house was perfect, along with there being no more than 10 guys at a time.
The staff again was amazing! They keep you engaged and genuinely care about you as a person. I'am forever grateful for the experience and continued guidance Wellbrook provides!
Ben
2 months ago
Top notch staff, could not have asked for a better experience. Highly recommend.
When life has handed us more than we can handle on our own, Swift River offers a comprehensive and tailored treatment program that more than helps alleviate the worry , guilt and stress of seeking professional help. Making a step like this is difficult, but it can be the first stepping stone to the life we all deserve.
Ryan Snee
2 months ago
Swift river is an amazing place great staff, I am currently here leaving in 10 days and I couldn't have pick a better place. I highly recommend this place.
Thank you, joe g
Joseph Giunta
2 months ago
Swift river honestly has been a god send for me. The staff, nurses, therapists, and case workers have been phenomenal and super supportive throughout my month of treatment. If you’re an outdoors person or even just a laid back introvert they will have an assortment of activities for you to do and teach you coping skills for the outside world while doing so. I highly recommend coming here. Thanks to everyone at swift river. Keep putting one foot in front of another.
This is an amazing place to do any kind of recovery be it with mental health or substance abuse. I really enjoyed my time and it was a very helpful and loving community. Would highly recommend!!
Jeremiah Olsen
2 months ago
This is my first rehab facility, and it was an extremely welcoming experience. From being greeted at the door to the discharge procedure, everyone was respectful and accommodating. The kitchen staff was accommodating to my medical needs. The techs there were some of the nicest people, and even the clientele was a positive influence. Would definitely recommend for mental or dependency care.
Chris Morgan
2 months ago
It’s a beautiful place to recover The staff and therapist there really care about the individual’s health whether it’s mental or addiction. You feel the love when you come here at Silvermist thank you all for being such an inspiration and helping me discover who I am and how to cope with life. It’s a place where they’ll love you until you start loving yourself.
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
10 months ago
Life-Changing Experience at AKUA
My 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
10 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!
Mount laurel saved my life when I couldn’t save it myself. The came hours to pick me up and gave me a beautiful facility to take time to heal. They fed me excellent food, gave me a nice warm bed to sleep in, and taught me so much in just 30 days in order to lay such a solid foundation for my recovery journey! I will be forever grateful to the wonderful staff here and I thank them for showing me that this IS POSSIBLE!
Dakoda Olmsted
3 months ago
Place helped me save my life amazing staff and I tell anyone who needs help to call here
Doug Preston
4 months ago
The staff at Mount Laurel are so caring and helpful. And it is beautiful there! I admit I did want to leave at times when someone would set off my PTSD but staff was always able to calm me down. I am so grateful for the connections I made there!
Successfully completed IOP treatment with Ethan Green as my therapist. He was an amazing source of empowerment and strength in my recovery journey, his down to earth and human approach shatters any hesitation anyone may have to get treatment. I truly recommend this treatment center.
Luis Gonzalez
3 months ago
Treatment here was a great experience, the staff really cares about the clients!
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Frequently Asked Questions
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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