Optum Serve: Military & Veteran Drug Rehab Insurance Coverage

Article at a glance:

– Optum Serve is a subsidiary of United Healthcare that delivers healthcare insurance services to U.S. veterans through the Community Care Network.
– The Community Care Network allows veterans to receive affordable healthcare when they can’t get it through a VA center, and Optum serves as a coordinator between the VA, insurance providers, and community care partners.
– Veterans who meet certain criteria can participate in the Optum Serve network and have coverage for drug and alcohol rehab through their insurance.
– Insurance providers usually cover mental health services, including rehab, under most policies due to the Affordable Care Act.
– Medication-assisted treatment for addiction may be covered by insurance when received through a member of the Community Care Network.
– Experimental treatments and therapies for addiction are generally not covered by insurance.

Although Optum Serve isn’t an insurance provider, the program can help veterans coordinate drug and alcohol addiction care.

Military service members and veterans often face higher rates of addiction and mental health diagnoses than the general public. Help and treatment options are available, and the costs are often covered by insurance.

What Is Optum Serve Insurance?

Optum Serve is a subsidiary of United Healthcare, not an insurance provider. They act as a third-party administrator, working to deliver healthcare insurance services to U.S. veterans. Millions of veterans use Optum, and the program works mainly through the Community Care Network. The Community Care Network or CCN links the Department of Veterans Affairs (VA) with other care partners in the community. Optum Serve also supports VA centers and staff and provides further help as needed.

The Community Care Network allows veterans in VA care to get affordable healthcare when they can’t get it through a VA center. The program has six regional networks, and Optum administers three of these. Optum acts like a coordinator or liaison between the VA and other insurance providers, facilitating most logistics, including billing and claims services.

Requirements for Joining Optum Serve

There are six requirements for veterans to participate in the Optum Serve network. A veteran has to meet at least one of these criteria to be eligible:

•  A veteran needs a medical service that is not available at a VA healthcare center.
• The veteran lives in a state or territory that doesn’t have a full-service medical facility.
• As a veteran, you qualify under a grandfather provision related to your distance from a VA facility.
• The VA cannot provide the needed care within certain access standards.
• The veterans’ best medical interest is to receive care from a community provider or facility.
• The VA service line doesn’t meet certain standards for quality.

Does Optum Serve Cover Drug and Alcohol Rehab?

Since Optum Serve is a third-party administrator, they don’t directly cover services. Instead, they arrange care between the VA for veterans with their healthcare, insurance companies and community providers. As part of that, if you have insurance and get care from a Community Care Network provider, you will likely have coverage for drug and alcohol rehab.

Does Optum Serve Cover Mental Health Services?

Insurance providers usually cover mental health services under most policies. It became a requirement that Marketplace plans offer mental health services and rehab coverage because of the Affordable Care Act. 

A veteran’s plan will likely cover a range of mental health services if they have insurance, such as:

• Medicare
• Medicaid
• Private insurance
• TRICARE or a similar type of insurance coverage

Mental health services that may be covered can include: 

• Cognitive-behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Eye movement desensitization and reprocessing therapy (EMDR)

Does Optum Serve Cover Medication-Assisted Treatment (MAT)?

Quality, effective addiction treatment relies on evidence and research. As part of this, medication-assisted treatment may be appropriate for some people. With MAT, there are Food and Drug Administration (FDA)-approved medicines used to help with drug and alcohol cravings and withdrawal symptoms. When medically appropriate, insurance providers may cover medication-assisted treatment when a veteran receives care from a member of the Community Care network. Specifical medication-assisted treatments that may be covered by insurance include: 

• Naltrexone
• Suboxone
• Vivitrol
• Sublocade

What Does Optum Serve Not Cover?

Optum Serve isn’t an insurance company, so they don’t have a list of services not covered. Instead, you should check with your insurance provider, the treatment center you’re considering or the VA to learn your coverage level and where you might be able to receive treatment. One note is that insurance companies, including those working within the Optum Serve network, don’t cover experimental treatments and therapies, including ones used for addiction.

Where Is Optum Serve Insurance Available in the U.S.?

Five regional networks make up the Community Care Network. Optum Serve covers regions one, two and three.

Optum Serve Region One includes:

• Maine
• Vermont
• New Hampshire
• Massachusetts
• Connecticut
• Rhode Island
• New Jersey
• Pennsylvania
• New York
• West Virginia
• Maryland
• Delaware
• Virginia
• North Carolina

Optum Serve Region Two includes:

• North Dakota
• Minnesota
• Wisconsin
• Michigan
• South Dakota
• Iowa
• Illinois
• Indiana
• Ohio
• Kansas
• Missouri
• Kentucky

Optum Serve Region Three includes:

• Oklahoma
• Arkansas
• Tennessee
• South Carolina
• Georgia
• Alabama
• Mississippi
• Louisiana
• Florida
• U.S. Virgin Islands
• Puerto Rico

Help for Military Members and Veterans

The Recovery Village Cherry Hill at Cooper is a leading New Jersey addiction treatment center. We work with service members and veterans to make sure they are able to access leading-edge, caring and research-driven addiction treatment and mental healthcare for co-occurring disorders. Our state-of-the-art facility is part of the VA Community Care Network. We encourage you to learn more about our programs or reach out to a Recovery Advocate to take the next steps.