Does UMR Cover Mental Health Treatment?
If you’re covered by UMR (United Medical Resources), you likely have questions about what mental health services are included in your plan.
At Peachtree Wellness Solutions, we’re committed to helping you navigate the complexities of your UMR insurance coverage for mental health so you can focus on what matters most: your healing.
Learn more about mental health insurance coverage options or call us now at 770-202-1260.
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Does UMR Cover Mental Health Treatment?
Yes, UMR does cover mental health treatment. As a major insurance provider, UMR is required to comply with the Mental Health Parity and Addiction Equity Act, which mandates that mental health and substance use disorder benefits be provided on par with medical and surgical benefits. This means that UMR cannot impose more restrictive limitations on mental health treatment than they do on other medical services.
UMR typically covers a wide range of mental health services, including therapy sessions, psychiatric consultations, medication management, and various levels of care from outpatient counseling to residential treatment programs.
However, the specific coverage details, copayments, deductibles, and authorized providers can vary significantly depending on your particular UMR plan and your employer’s benefit selections.
It’s important to note that while UMR covers mental health treatment, you may still be responsible for copayments, coinsurance, or deductibles as outlined in your specific policy. Additionally, some treatments may require prior authorization or referrals from your primary care physician, depending on your plan structure.
About UMR Insurance
UMR (United Medical Resources) is a third-party administrator that provides healthcare benefits administration services for self-funded employer health plans. Unlike traditional insurance companies that assume financial risk, UMR administers benefits on behalf of employers who choose to self-fund their employee health plans. This means that while UMR processes claims and manages benefits, your employer is actually the entity funding your healthcare coverage.
Founded in 1975, UMR has grown to become one of the largest third-party administrators in the United States, serving millions of members across the country. The company specializes in providing flexible, cost-effective healthcare solutions for employers while ensuring that employees receive comprehensive coverage for their medical needs.
Types of Mental Health Treatment UMR Covers
UMR generally covers multiple levels of mental health care to meet individuals’ varying needs throughout their treatment journey. The level of care required depends on the severity of symptoms, safety concerns, and individual circumstances.
Understanding these different levels can help you and your treatment team determine the most appropriate care setting.
Residential Treatment
Residential treatment represents the highest level of care for mental health conditions, providing 24-hour supervision and intensive therapeutic intervention in a structured environment. UMR typically covers residential treatment when it is deemed medically necessary, often for individuals who require constant monitoring due to severe mental health symptoms, safety concerns, or when lower levels of care have been insufficient.
Residential programs usually last between 30 to 90 days, though the duration depends on individual needs and treatment progress. These programs provide comprehensive care including individual therapy, group therapy, medication management, family therapy, and specialized treatments tailored to specific conditions. UMR may require prior authorization for residential treatment and will often review the necessity for continued care throughout the treatment period.
Partial Hospitalization Program (PHP)
Partial Hospitalization Programs offer intensive treatment while allowing individuals to return home each evening. PHP typically involves 4-6 hours of structured programming per day, 5-7 days per week, making it an ideal step-down from residential care or an alternative to hospitalization for those who need intensive support but can safely remain in their community.
UMR usually covers PHP when it’s medically necessary and appropriate for the individual’s treatment needs. These programs often include individual and group therapy, medication management, psychiatric services, and skills training. PHP allows individuals to maintain some connection to their daily lives while receiving comprehensive mental health treatment, making it an effective middle ground between residential and outpatient care.
Intensive Outpatient Program (IOP)
Intensive Outpatient Programs provide structured treatment while allowing individuals to maintain their work, school, or family responsibilities. IOP typically involves 3-4 hours of treatment per day, 3-4 days per week, offering flexibility while still providing comprehensive care for mental health conditions.
UMR generally covers IOP services when they are deemed medically necessary and appropriate for the individual’s level of functioning and treatment needs. These programs often focus on skill-building, relapse prevention, group therapy, and ongoing support while individuals continue to live at home and maintain their daily routines. IOP can serve as a step-down from higher levels of care or as an intensive treatment option for those who need more support than traditional outpatient therapy provides.
Types of Mental Disorders UMR Will Cover
UMR covers treatment for a comprehensive range of mental health conditions, reflecting the understanding that mental health disorders are legitimate medical conditions requiring professional treatment. Coverage typically includes but is not limited to mental disorders and mood disorders such as depression and bipolar disorder, anxiety disorders including generalized anxiety disorder, panic disorder, and social anxiety disorder, and trauma-related conditions like post-traumatic stress disorder (PTSD) and acute stress disorder.
The coverage extends to personality disorders, eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder, as well as substance use disorders and co-occurring conditions. UMR also typically covers treatment for attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and other behavioral health conditions that significantly impact daily functioning.
Severe mental illnesses such as schizophrenia, schizoaffective disorder, and other psychotic disorders are generally covered, as are developmental disorders and conditions that may require specialized treatment approaches. UMR recognizes that mental health conditions often co-occur with medical conditions and substance use disorders, and coverage typically includes treatment for these complex, interconnected issues.
Aetna offers various types of plans that cover mental health treatment. The specific coverage and benefits provided can vary depending on your selected plan. Some Aetna plans that usually include Aetna mental health coverage are:
- Employer-sponsored group plans: Many employer-based Aetna health insurance plans include mental health coverage as part of their overall benefits package. These plans often provide various services, including therapy sessions, counseling, and psychiatric consultations.
- Individual and family insurance plans: Aetna also offers individual and family insurance policies that usually include mental health coverage. These plans are for individuals and families who have small businesses, are self-employed, or are gig workers.
- Medicare Advantage Plans: Aetna provides Medicare Advantage Plans that include both medical and mental healthcare services under one comprehensive plan for eligible seniors.
- Marketplace plans: Aetna offers plans through the Health Insurance Marketplace. Most of their marketplace plans include mental health coverage. Individuals can select from a variety of options based on their specific needs to ensure they get the coverage they need.
You are not alone. You deserve to get help.
Peachtree Wellness is an industry leader in mental health treatment. Our team of top medical experts specialize in dual diagnosis treatment and are committed to ensuring that each patient is treated as an individual. Call us today, we’re available 24/7.
Therapies Covered by UMR
UMR typically covers a wide range of evidence-based therapeutic interventions for mental health treatment.
Individual psychotherapy, including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy, is generally covered when provided by licensed mental health professionals. Group therapy sessions, which can be particularly effective for certain conditions and provide peer support, are also typically included in coverage.
Family therapy and couples therapy may be covered when they are deemed medically necessary for the treatment of a diagnosed mental health condition. UMR often covers specialized therapies such as trauma-focused treatments, addiction counseling, and behavioral interventions that are specifically designed to address particular mental health conditions or symptoms.
Psychiatric services, including medication management, psychological testing, and psychiatric evaluations, are typically covered under UMR plans. The coverage may also extend to innovative treatments such as intensive outpatient programs, partial hospitalization programs, and specialized treatment modalities that have been proven effective for specific conditions.
How Do I Determine My UMR Coverage?
At Peachtree Wellness, we provide comprehensive verification of benefits services to help you determine your UMR coverage before you begin treatment. Our dedicated insurance verification team works directly with UMR to obtain detailed information about your specific mental health benefits, taking the guesswork out of understanding your coverage.
When you contact us, we’ll handle the entire verification process for you. We’ll contact UMR directly using your insurance information to verify your mental health benefits, including your copayments, deductibles, out-of-pocket maximums, and any prior authorization requirements.
We provide you with a clear, easy-to-understand breakdown of your benefits, including what you can expect to pay out-of-pocket for different types of services. This verification process helps eliminate surprises and allows you to make informed decisions about your mental health treatment. We’ll also identify any pre-authorization requirements and handle the necessary paperwork to ensure your treatment is approved before you begin.
Find Mental Health Treatment with UMR Coverage Today
Don’t let uncertainty about insurance coverage prevent you from getting the mental health treatment you deserve. At Peachtree Wellness Solutions, we understand the complexities of navigating insurance benefits, and we’re here to help you every step of the way. Our experienced team works directly with UMR and other insurance providers to verify your coverage and ensure you receive the maximum benefits available under your plan.
We offer comprehensive mental health services across multiple levels of care, from intensive outpatient programs to residential treatment, all designed to meet you where you are in your recovery journey. Our clinical team specializes in evidence-based treatments for a wide range of mental health conditions, and we’re committed to providing personalized care that addresses your unique needs and circumstances.
Call us now at 770-202-1260 or verify your insurance.
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