Optum is a third-party administrator for the VA Community Care Network (CCN) that provides health coverage services for Veterans. Over 6 million Veterans are currently served by the VA Community Care Network.1 Read on to learn about using Optum and VA benefits for drug and alcohol treatment.
Does Optum Cover Addiction Treatment for Veterans?
Yes, Optum does cover addiction treatment in some capacity for Veterans. Treatment for mental health conditions (including substance use disorders) is considered an essential health benefit that must be covered by most health plans under the Affordable Care Act.2
Most forms of health care coverage for Veterans—including VA health care benefits, TRICARE plans, Medicare, Medicaid, Marketplace plans, and private health plans—will provide coverage for drug and alcohol rehab in some capacity.2
Optum may cover various levels of addiction treatment partially or in full, including:
- Medical detox.
- Inpatient rehab.
- Outpatient addiction treatment.
- Partial hospitalization program (PHP).
- Intensive outpatient program (IOP).
No matter the plan, the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurers to offer substance use disorder benefits at the same level as they do for surgical/medical care. This ensures equality and representation in mental health and addiction treatment services.3
Does Using Optum Mean I Can’t Use VA Benefits?
No, on the contrary. Using Optum allows you to use your VA benefits for providers outside the VA for addiction treatment. Optum is a third-party administrator for the VA Community Care Network (CCN) which allows Veterans to receive care from an extensive network of community care providers outside the VA while still using their VA benefits.
Using the VA Community Care Network, Veterans get connected with private healthcare facilities when their medical needs cannot be met by a VA facility. Optum works to facilitate the relationship between these community care partners and the VA. Optum also helps by:1
- Processing claims from providers who see Veterans.
- Answering questions from the VA staff and providers.
- Supporting VA staff and providers with additional resources.
How Do I Use Optum Coverage With My VA Benefits?
Using Optum and VA benefits for drug and alcohol treatment starts by speaking with your VA care team to determine whether you are eligible for care from a community provider.1
You must meet one of the following criteria to be qualified to use community care:4
- There is no full-service VA medical facility in the state or U.S. territory where you live.
- Community care is in your best medical interest.
- Care within designated access standards cannot be provided to you at a VA medical facility or by a VA provider.
- You qualify under the “grandfather” distance eligibility provision for the Veterans Choice Program (VCP).
- The service you need isn’t provided at a VA medical facility.
- Medical service line doesn’t meet the VA’s quality medical standards.
For more questions regarding your eligibility for the VA’s Community Care Network, contact your local VA.5
If getting addiction treatment at an authorized VA community care provider is right for you, the VA will engage the community provider to accept a referral. Your VA medical staff can then use the Community Care Network to authorize care from a community care provider.1,6
Do Providers Outside of the VA Accept Optum for Addiction Treatment?
Yes, providers outside of the VA accept Optum for addiction treatment. However, the provider needs to be an authorized VA community care provider (CCP). The VA must authorize treatment from providers outside the VA before the Veteran receives treatment.7
VA Community Care & Optum Coverage
The VA Community Care Network and Optum coverage is a program that helps Veterans access high-quality substance use disorder treatment, especially when that care cannot take place at a VA facility for whatever reason.6
The Community Care Network works with community providers (those outside of the VA system) in 5 regional networks to ensure Veterans receive timely, quality care. Optum administers 3 of these 5 regional networks.8 Optum leverages its extensive network of services—including those at American Addiction Centers (AAC)—to open access to timely services.6
For example, if you needed drug and alcohol rehab treatment and were eligible to receive community care through the VA, the VA would work with Optum to purchase/contract out your rehabilitative treatment through a community provider, such as American Addiction Centers (AAC).
AAC would provide your services, and Optum would direct all billing, questions, and care coordination between AAC and the VA. While you may be required to pay a copay if your substance use disorder isn’t related to your military service, you will receive all other claims and bills the same way that you would for services rendered within the VA system.9
VA-Approved CCPs that Accept Optum
All of the American Addiction Centers (AAC) facilities are VA-approved community care providers (CCPs). To best serve the Veteran community, every AAC facility offers a specialized treatment program tailored to the individual needs of those who have served our country.
The following CCPs accept Optum coverage for addiction treatment:
- Recovery First Treatment Center in Florida.
- River Oaks Treatment Center in Florida.
- AdCare Hospital in Massachusetts.
- Oxford Treatment Center in Mississippi.
- Sunrise House Treatment Center in New Jersey.
- AdCare Treatment Centers in Rhode Island.