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va optum insurance

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VA Optum Insurance

Taking proper care of your health as a veteran is key. If you live in the US, using VA Optum insurance is a good option. 

Here’s everything you should know about VA Optum insurance.

What is VA Optum Insurance?

VA Optum Insurance is a subsidiary of United Healthcare insurance. They act more like third-party administrators.

They aim to provide healthcare insurance services to veterans in the US. Currently, more than 6 million veterans use Optum insurance.

Unlike other insurance providers, Optum insurance operates through the Community Care network. They are the link between the department of veteran affairs (VA) and other care partners. 

They support VA centers, staff, and provide any other necessary assistance.

How Does VA Optum Insurance Work?

Optum works closely with the Community Care network. This network is responsible for helping veterans get affordable healthcare in the absence of a VA facility.

They operate 6 regional networks. Optum serves as their sole administrator for 3 regions. Optum acts as the coordinator between the VA and any other insurance provider. 

Thus, they handle most of the logistics involved. This includes claims, bills, and other services. In summary, Optum insurance is more of an administrator for the VA Community Care network and less of an insurance company.

What Are the Requirements to Join VA Optum Insurance?

The first requirement is that you must be a veteran. The families of veterans are not included. Veterans must also seek permission from the VA before applying for Optum insurance/community care. 

The approval will depend on several factors such as your present health and other circumstances. Veterans must also meet one of the following requirements.

  • Getting Optum healthcare services is in your best interest
  • The healthcare service you need is not available in VA’s medical facilities
  • The medical service line is not up to VA’s medical standards.
  • There is poor or no VA medical establishment in the city or state you reside.

For more requirements, you can check out this document released by the VA

Does VA Optum Insurance Cover Addiction And Rehab?

Health plans must cover substance use and disorders. This is in accordance with the Affordable Care Act. So, addiction and rehab treatment are covered by Optum insurance. 

Specific treatments include detox problems, inpatient and outpatient treatments, and so much more. Veterans will also enjoy certain benefits such as TRICARE, Medicaid, and medicare. 

Most veterans that are in the areas covered by Optum will have their treatment covered. However, it’s recommended that you find out more about your coverage plans before any treatment.

Optum insurance also covers medications prescribed during substance addiction treatment. Some of these medications include

  • Naltrexone– Usually prescribed for opioids
  • Methadone– Usually prescribed to curb opioids craving
  • Naloxone– Used to soften the effects of an overdose
  • Suboxone– Used to reduce the effects of withdrawal

For more medications and their coverage plans, contact your network facility or provider.

What Does VA Optum Insurance Not Cover?

Optum will not cover experimental treatments or therapy. This stands even when it involved substance use and addiction.

What States Are VA Optum Insurance Available?

VA Optum insurance is divided into three regions in the US. 

Region 1 is made up of

  • Connecticut
  • New Jersey
  • West Virginia
  • Virginia
  • Delaware
  • Maine
  • Maryland
  • Rhode Island
  • Vermont
  • New Hampshire
  • Columbia
  • Massachusetts

Region 2 is made up of

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

Region 3 is made up of 

  • South Carolina
  • Florida
  • Oklahoma
  • Louisiana
  • Alabama
  • Arkansas
  • Georgia
  • Mississippi
  • US virgin Islands

Get Started Now

Take charge of your journey to recovery.

At New Hope Health in Tennessee, we offer free insurance verification for our clients who feel they need some help. When you contact us, we will carry out the thorough analysis of your addiction problem, and then recommend a workable drug treatment program. Next, we will contact your insurance provider on your behalf and verify your benefits. We will also let you know if you will be responsible for any out-of-pocket expense not covered under your plan.

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Admission Coordinators are available 24/7.

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