Does Optum Health Cover PHP at ChoicePoint?

Understanding Optum Health and Its Role in Behavioral Health Coverage

Optum Health manages behavioral health benefits for many types of insurance plans in the United States. It reviews treatment requests for substance use disorders and determines whether treatment meets medical necessity guidelines.

Optum does not provide therapy services. However, it works with licensed treatment centers across the country. Optum Health manages the following areas:

What Is a Partial Hospitalization Program (PHP) for Substance Addiction Treatment?

A partial hospitalization program is a daytime substance addiction treatment program. During PHP, patients attend regular in-center therapy sessions for 20-30 hours a week, and return home or to sober housing at night.

PHP is for people who need more intensive care than standard outpatient therapy, while the substance use symptoms are not so extreme that the person needs Optum-covered inpatient rehab.

Eligibility Criteria for PHP

PHP is recommended when a person needs continuous addiction treatment but doesn’t require 24-hour medical supervision. A patient may qualify for PHP if,

• A licensed clinician confirms medical necessity.
• Substance use is severe, and relapse risk is high
• Cravings interfere with daily functioning
• Substance withdrawal symptoms are stable but require monitoring
• Have co-occurring mental health symptoms
• Patient does not require 24-hour inpatient supervision
• The home environment is safe and supportive
• Patient can participate in several hours of therapy per day
• There is no immediate medical or psychiatric emergency

Does Optum Health Cover Partial Hospitalization Programs for Alcohol and Drug Addiction? 

Yes, Optum Health may cover PHP for alcohol and drug addiction. Optum Health coverage for PHP is not automatic. It requires a licensed provider to submit a detailed patient’s history explaining why PHP is the appropriate level of care.

Factors That Influence Optum PHP Coverage

Optum approves alcohol or drug addiction treatment only when documentation supports clinical need. Here are the factors that influence Optum Health partial hospitalization programs coverage:

What Services Are Included in PHP When Covered by Optum? 

When approved, Optum Health coverage for PHP may include a full range of addiction treatment services. They help stabilize patients’ symptoms and reduce the risk of relapse. These include,

What Substances Are Commonly Covered Under Optum PHP Benefits?

Optum plans may cover PHP for a wide range of substance use disorders. The deciding factors for coverage are not the substance itself but the documented severity of the disorder and clinical needs.

Substances commonly covered under the Optum plan include,

Does Optum Health Cover PHP for Dual Diagnosis Treatment?

Yes, Optum may cover dual diagnosis treatment during PHP when both addiction and mental health disorders require daytime care. Optum insurance supports the treatment when documentation clearly shows how both diagnoses are interacting and why the PHP level of care is necessary.

Common co-occurring conditions Optum covered PHP caters to include:

Ready to recover with Horizon Coverage?

Call 844.445.2565 to confirm your addiction and dual diagnosis benefits & schedule a virtual or in-person intake

How In-Network and Out-of-Network Coverage May Influence Total PHP Costs?

Network status plays a major role in total treatment cost. It is important to understand both, as insurance companies quote different payment rates for each.

How to Verify Your Optum Health Insurance Coverage for PHP At ChoicePoint

At ChoicePoint, verifying your Optum Health partial hospitalization benefits before admission is essential. It prevents unexpected bills and identifies your estimated out-of-pocket costs. Here is our complete verification process.