How Much Will I Pay Out Of Pocket
The amount you pay out of pocket for addiction treatment will depend on your health plan and its deductibles, co-pays, and coinsurance.
A deductible is the amount you pay for covered services before UPMC begins to provide coverage. For example, if your health plan has a $1,700 deductible, that is the amount you must pay out of pocket before UPMC begins payment. A co-pay is a fixed amount you pay for a covered service , and coinsurance is a fixed percentage you pay for a covered service. Your co-pay and coinsurance rates will likely be higher if you receive treatment from an out-of-network provider.
Most substance abuse and mental health treatments must be preauthorized for you to receive coverage from UPMC. Preauthorization is when your health insurer determines that a certain medical treatment or service is medically necessary for your recovery.
UPMC requires preauthorization for the following addiction and mental health services:4
- Psychological and neuropsychological testing
- Electroconvulsive therapy
Behavioral health emergencies do not require preauthorization from UPMC. A behavioral health emergency is when care is required immediately for life-threatening emergencies, such as when drug and alcohol use leads to violence or suicidal thoughts, or when a person is suffering from alcohol poisoning or a drug overdose.4
Federal Employees Health Benefits
Three HealthyU options are available to Federal employees. They are:
High Deductible Health Plan Deductibles are $2,000 for a single policy and $4,000 for a family policy. Monthly HSA contributions into the account are $75 for a single plan, and $150 for a family plan. The coinsurance is 15%, and maximum out-of-pocket expenses for one person is $6,000, and $12,000 for a family.
High Option HMO Deductibles are $700 and $1,400 with 15% coinsurance. Maximum out-of-pocket expenses are $5,000 and $10,000 for an individual and family. $15 and $40 office visit copays with $75 Urgent Care copay. Generic, preferred brand, and non-preferred brand drug copays are $20, $50, and $100 .
Standard Option HMO Deductibles are $850 and $1,700 with 20% coinsurance. Maximum out-of-pocket expenses are $6,000 and $12,000 for an individual and family. $20 and $50 office visit copays with $75 Urgent Care copay. Generic, preferred brand, and non-preferred brand drug copays are $20, $50, and $100 .
HealthyU provides 100% coverage for qualified preventative expenses. Also included is a Health Incentive Account that provides the opportunity to earn $250 or $500 for making healthy choices. Several personalized activities will earn reward dollars, that can be utilized to pay out-of-pocket expenses, such as copays, coinsurance, and deductibles.
Health Plan Maternity Program
Both mother and baby receive special care and attention with this special program. A unique gift is also presented when all requirements are met. Both pre-delivery and post-delivery assistance is provided. Participation should begin before the 34th week of pregnancy. Several of the program requirements include 10 prenatal office visits, completion of required lab tests and x-rays, and signing of consent form. A visit with a provider within the first 13 weeks of pregnancy also must be completed.
text4baby is also offered to recent mothers and pregnant women. After signing up , periodic tips and assistance will be provided, with information based upon the expected delivery date.Texts are free and do not count against a maximum limit, if you use one of these carriers: Alltel, Assurance Wireless, AT& T, Bluegrass Cellular, Boost Mobile, Cellular South, Cellcom, Centenial Cellular, Cincinnati Bell, Cricket, Metro PCS, nTelos, Nex-Tech Wireless, Sprint Nextel, T-Mobile, US Cellular, Verizon, and Virgin Mobile USA.
Womens health has always been a priority. Resources and information are always provided, and all plans feature the most comprehensive benefits. MyHealth OnLine topics include women in business, domestic abuse and violence, pregnancy, health and wellness, breast and cervical cancer, depression, stress, and anxiety, and heart disease.
Recommended Reading: How To Qualify For Government Health Insurance
What If My Provider Is Out Of Network
It is best to choose an in-network provider to benefit from lower treatment costs.
Out-of-network providers do not have contracts with UPMC in which they have agreed to offer services at predetermined rates. If you choose a treatment center that is out of network, you may be required to pay a large portion of the treatment cost or the entire cost.
Whenever possible, it is best to choose an in-network provider to benefit from lower treatment costs. If you are interested in receiving treatment from an out-of-network provider, ask the provider about other available payment options and payment plans like sliding scale fees that can make treatment more affordable for you or your loved one.
Find Cheap Health Insurance Quotes In Pennsylvania
The cheapest health insurance in Pennsylvania for most people is the Silver PPO 5950/20/40, the most affordable Silver plan in 24% of the state’s counties. Alternatively, the cheapest Silver plan overall is the Together Blue EPO Silver 3450 HSA. This plan is only available in three counties.
Cheap health insurance plans in Pennsylvania are available through the state exchange, though some shoppers can qualify for Medicaid depending on their household income. In 2021, the average cost of health insurance in the state is $449 per month, down 5% from the 2020 average.
Don’t Miss: How Much Are Employers Required To Pay For Health Insurance
How Do I Make An Appointment If I Have A Highmark Product
Call us at 1-800-533-8762, and our schedulers will work with you to make appointments at your convenience. Our team is happy to help you schedule whether you have a Highmark product with full, in-network access to UPMC or a narrow-network product that may require seeing UPMC providers on an out-of-network basis.
Individual And Family Plans
On and off are separated into five tier classifications: Catastrophic, Bronze, Silver, Gold, and Platinum. Premiums, out-of-pocket-expenses, copays, coinsurance, and deductibles, will vary, depending on the specific policy. Three different provider network options are available and discussed later in the article.
Catastrophic
Advantage Catastrophic $8,550/$0 Deductible is $8,550 with 0% coinsurance. The concept of this policy is simple. Once you meet the deductible, there are no out-of-pocket expenses for covered benefits. However, you can not utilize a federal tax credit for this type of contract. Thus, Bronze-tier options should always be considered. Applicants of this plan must be under age 30, unless proof of financial hardship is provided. Applicants with major pre-existing conditions that have frequent specialist visits and non-generic prescriptions should also consider other available plans.
Also Check: Is Health Insurance Really Worth It
Health And Wellness Coverage: Upmc Health Plan
The General Student Medical Plan is available to:
- Graduate Students without an Academic Appointment*
- Health Sciences Fellows, Pre-Doctoral Fellows, Post-Doctoral Fellows , Certificate Trainees*
- Full-time undergraduate students
*Graduate students without academic appointments or Fellows are eligible to choose between the general plan or the . Graduate students with academic appointments are only eligible for the Graduate Student Medical Plan.
When Can I Enroll In A Bronze Plan
The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.
In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.
Recommended Reading: Does Health Insurance Cover Tooth Extraction
Is There Anything You Cannot Treat At Upmc Urgent Care
There are times when it is not appropriate to visit UPMC Urgent Care and you should instead seek emergency medical attention. These include chest pain, stroke, heart attack, abdominal pain, shortness of breath, and other serious health conditions.
If you think you are experiencing a life-threatening condition, call 911 or seek immediate medical attention at the nearest emergency department.
Upmc Special Needs Plan
Medicare SNPs are Medicare Advantage plans designed to help individuals with specific conditions by providing greater coverage and reduced fees.
SNPs are available to individuals meet specific criteria, such as:
- living in an inpatient facility, such as a nursing home
- having a chronic condition or disability that Medicare states qualifies you for an SNP
- being eligible for both Medicare and Medicaid
Medicare requires that all SNPs provide prescription drug coverage.
You May Like: What Is Employer Group Health Insurance
How Do I Get Started
Your first step toward getting addiction treatment is to verify your insurance benefits with American Addiction Centers. Our admissions navigators are available 24/7 to check your insurance benefits and help you choose the best rehab facility and treatment program based on your health plan, coverage, and individual circumstances.
There are several ways to verify your insurance benefits. You can call to speak to an admissions navigator or use the live chat feature on our website to chat with a navigator. Alternatively, you may also fill out our free insurance verification form to learn more about your benefits and get a response instantly before speaking to an admissions navigator.
Your information will always be kept safe, secure, and confidential. American Addiction Centers is dedicated to helping people experience safe and fulfilling recoveries from addiction.
What Is Upmc Insurance
UPMC is the largest medical and behavioral health insurer in western Pennsylvania, insuring more than 3.5 million lives. UPMC Insurance Services Division serves as the centralized hub for a wide array of health insurance plan services and operates in the Downtown Pittsburgh campus located at the US Steel Tower.
Don’t Miss: How To Get Health Insurance Self Employed
What Is An Upmc Hospital
UPMC Altoona is a 380-bed acute care hospital with a surgery center and regional trauma center serving Blair and surrounding counties in west-central Pennsylvania. UPMC Bedford. UPMC Bedford is an acute care general hospital with medical, surgical, obstetrical, intensive care, coronary care, and telemetry units.
Your Treatment Is Likely Covered
UPMC Health Plan is the 2nd largest health insurer in western Pennsylvania and includes several partner companies. The companies provide a full range of health insurance, including behavioral health. UPMC Health Plan is part of a wide network that includes over 11,500 physicians in Pennsylvania, Maryland, West Virginia, and Ohio. There are always benefits to using in-network providers when seeking substance abuse treatment, from the physician suggests and authorizes treatment to the facility where it takes place.
Any person that requires drug or alcohol rehab wants to know just how much their UPMC Health Plan alcohol rehab coverage will cover before entering treatment. Whether it is a 60-day inpatient program that includes full detoxification, or a few brief outpatient counseling sessions, health insurance coverage is what can set the wheels in motion and make it possible.
Recommended Reading: Can You Buy Health Insurance Any Time Of The Year
Finding Your Best Health Insurance Coverage In Pennsylvania
Where you live in Pennsylvania and your income will determine your best health insurance plan available. Pennsylvania expanded Medicaid under the Affordable Care Act, so if your household income is up to 138% of the federal poverty level, you’ll qualify for this coverage in the state.
For those who don’t qualify for Medicaid, your best health insurance options will typically be through the state marketplace, particularly if you have a low household income.
Many households can qualify for tax subsidies to help lower the cost of health insurance coverage for an exchange plan.
Health insurance plans on the Pennsylvania exchange are divided into metal tiers, which indicate a plan’s level of benefits, out-of-pocket expenses and monthly costs.
Gold and Platinum plans: Best for high expected medical costs
The higher metal tier health plans, such as Gold and Platinum plans, come with higher premiums but significantly lower out-of-pocket expenses, such as deductibles, copays and coinsurance.
For instance, people with consistent prescription needs may want to consider Gold and Platinum plans that have cheap out-of-pocket expenses for prescription drugs.
Silver plans: Best for average medical costs or people with low incomes
In addition, if you have a lower-income household, Silver plans are eligible for cost-sharing reduction subsidies, meaning you may qualify for even more affordable deductibles, copays and coinsurance.
What Is A Bronze Plan
Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.
Read Also: How Much Subsidy For Health Insurance
The Top 5 Benefits You Probably Didnt Know You Had
Did you know that you can get discount tickets to the zoo with your UPMC Health Plan insurance? How about free health coaching to help you manage your weight or stop smoking? Health insurance with UPMC Health Plan gives you more benefits than just medical health coverage.
Here Are Five Benefits That You May Not Have Realized You Have:
Now that you know, make sure to take advantage of these FREE benefits by logging in to your MyHealth OnLine account.
Read Also: When Does Health Insurance Enrollment Start
All Information Presented On This Page Including Links To Plan Documents And Descriptions Is Specific To The Plan Year Of July 1 2021
Pitt employees may choose among four medical benefit plans offered by UPMC Health Plan, including a health maintenance organization plan and three preferred provider organization options that provide greater flexibility to meet specific health care needs. All four plans offer a broad range of comprehensive benefits, including wellness and preventative-care benefits and the same .
Inpatient And Residential Rehab
Many of these programs offer 24-hour medical care, support, and monitoring, as well as counseling and a range of therapies in a structured setting. UPMC inpatient and residential rehab programs focus on helping patients adapt to a healthier lifestyle without drugs and alcohol. Patients live at the facility for the duration of their treatment programs and receive services such as daily meals and housing.
UPMC covers a wide range of treatments for addiction and mental health.
Read Also: What’s Open Enrollment For Health Insurance
Senior Upmc Medicare Advantage Health Plans
Medicare Open Enrollment is not related to the Health Exchange. Affordable Medicare Supplement rates in Pennsylvania are also offered by many large and reputable carriers. The previously-mentioned UPMC Advantage plan options that are available in Allegheny County and the surrounding area are very moderately-priced. UPMC For Life contracts have earned 4.0 stars from Medicare for the PPO and HMO plans. Most plans offer preventative dental benefits . More than 19,000 physicians and 3,000 facilities area available.
The available options are:
HMO No Rx No deductible with $0 and $45 office visit copays. Telehealth copays are $0 and $40. Inpatient hospital charge is $300 per stay and maximum out-of-pocket expenses are $7,550. $225 outpatient surgery copay with $90 and $65 copays for ER and Urgent Care visits. Skilled nursing facility daily copays are $20 for first 20 days and $80 for days 21-100. Out-of-pocket costs for lab services and x-rays are approximately $5 and $30. MRIs, PET scans, and CT scans are subject to $110 copay. The physical therapy visit copay is $40.
SilverSneakers Fitness Program and Travel Concierge are included. The MyHealth 24/7 Nurse Line, RxWell, Assist America are also included. Every three months, a $50 allowance is provided for the purchase of daily health and wellness items.
Part D prescription drug benefits are also not included.
$0 HMO No Rx
Paying Your Healthcare Bill Five Options
1. Check or money order through US mail. The address is PO Box 371842 Pittsburgh, Pa 15250-7842.
2. Submit your payment online. Payments are accepted from checking accounts, credit cards, and debit cards. The website link is secure. Please email us for the specific url.
3. Autopay. Your premium can be electronically deducted from your account the same day every month. There are no fees.
4. By phone. We provide a toll-free phone number that is open until 7 p.m. most evenings.
5. In-person. Visit a customer-service location during normal business hours. Mall locations can be found at the Ross Park Mall, Monroeville Mall, Mall at Robinson, Millcreek Mall, and South Hill Village.
Read Also: Can I Cancel My Health Insurance
What Is Medicare Advantage
Medicare Advantage plans are health plans offered through private insurance providers. Part C combines all the parts of original Medicare inpatient care through Medicare Part A and outpatient care through Medicare Part B plus extra products and services like prescription drug coverage.
Plan availability and prices vary based on where you live. You can tailor your Medicare Advantage plan to fit your specific healthcare needs and budget.
Additional coverage and services will cost more, and there may be limitations set by your plan on which providers, services, and products you can use.
You can compare several different Medicare Advantage plans in your area using Medicares plan finder tool.
