Yes, UMR insurance provides mental health treatment coverage for adolescents in California.
As the Admission Coordinator at Key Healthcare, I understand the challenges that parents face when seeking help for their teens struggling with mental health issues. You want the best possible care for your child, but navigating the complexities of insurance coverage—especially with a provider like UMR—can feel overwhelming.
At Key Healthcare, we are committed to helping parents in California maximize their UMR insurance benefits while minimizing their out-of-pocket teen mental health treatment costs. This guide will help answer your most common questions about UMR insurance and how it applies to your teen’s treatment for mental health challenges. By the end, you’ll have the confidence to take the next step and enroll your teen with Key Healthcare.
Understanding UMR Insurance in California
UMR is not an insurance company but acts as a third-party administrator (TPA) for self-funded or employer-sponsored health insurance plans. It is part of UnitedHealthcare, one of the largest health insurance companies in the U.S., meaning it often uses UnitedHealthcare’s vast network of healthcare providers.
UMR does not provide the insurance itself but rather administers these employer-funded plans. The company focuses on self-funding solutions, which means UMR helps employers design and manage custom health plans while the employer pays for the healthcare costs directly. UMR often uses UnitedHealthcare’s provider network to access in-network services.
What are the Key Features of California UMR Insurance?
- Custom Plans: UMR manages custom health plans designed by employers, meaning your specific benefits may vary depending on your employer’s plan.
- In-Network and Out-of-Network Coverage: UMR plans often provide coverage for both in-network and out-of-network providers. However, staying in-network significantly reduces out-of-pocket expenses.
- Pre-Authorization: Pre-authorization is required for certain treatments, especially inpatient or residential treatment. Key Healthcare handles this process to ensure your teen’s treatment is approved.
- Claims Management: UMR processes all claims related to your teen’s care, ensuring seamless coverage for services when everything is handled correctly.
What UMR Covers for Teen Mental Health Treatment in California?
UMR generally covers a wide range of services for teens needing treatment for mental health issues. At Key Healthcare, we work closely with UMR to ensure that your plan covers the necessary treatments.
1. Teen Inpatient & Residential Treatment
Teen Inpatient care is ideal for California teens needing 24/7 supervision and a structured environment to recover from mental health conditions. UMR covers inpatient services, but pre-authorization is required to ensure the treatment is deemed medically necessary.
At Key Healthcare, we assist you in securing pre-authorization so that your teen can begin their recovery without delays. Once authorized, UMR typically covers 90% of costs for in-network inpatient services, while out-of-network services may only be covered at 50% after your deductible is met.
2. Teen Outpatient Services
Teen Outpatient care in California, which includes teen individual therapy, teen group therapy, teen intensive outpatient programs (IOP), and teen partial hospitalization programs (PHP), allows your teen to receive treatment without staying overnight at a facility. This is suitable for teens who need structured treatment but can still live at home.
For outpatient services, UMR generally covers:
- $30 co-pay for in-network therapy visits.
- 10% coinsurance after meeting your deductible for other services.
- Higher out-of-pocket costs for out-of-network services, usually 50%.
3. Teen Medical Detoxification
If your teen needs medical detox to manage withdrawal symptoms safely, UMR typically covers this service. Key Healthcare offers medically supervised detox services and ensures that UMR pre-authorizes this critical step in recovery.
4. Teen Therapy and Counseling
UMR covers a variety of therapy sessions—including individual counseling, family therapy, and group therapy—as part of mental health treatment plans. Depending on your plan, these sessions can be conducted in person or through telehealth options.
How Key Healthcare Helps You Maximize Your UMR Insurance
At Key Healthcare, we go above and beyond to ensure that your UMR insurance plan is used to its full potential. Here’s how we assist you at every stage of the process:
1. Insurance Verification: Making Sure You’re Covered
To help parents smoothly navigate the insurance verification process with Key Healthcare, here’s a detailed guide on how to fill out the Insurance Verification Form. Here’s how we assist you at every stage of the process:
Step-by-Step Guide to Filling Key Healthcare’s Insurance Verification Form
1. Teenager's First & Last Name
What to Enter: Enter your teen’s full legal name as it appears on any official documents or the insurance plan.
2. Email Address
What to Enter: Provide a valid email address that you frequently check. We will send important updates and confirmations about your teen’s coverage and treatment options to this email address.
3. Phone Number
What to Enter: Provide the best contact phone number (mobile or home) where we can reach you for follow-up information. Our team will contact you to discuss your insurance details, coverage, and next steps.
4. Teenager's Date of Birth
What to Enter: Enter your teen’s date of birth in the format MM/DD/YYYY. Insurance providers often use the dependent’s date of birth to verify eligibility for coverage.
5. Parent's First & Last Name
What to Enter: Provide the full name of the parent or guardian responsible for the teen’s care and likely the insurance plan’s policyholder. This matches the insurance plan holder to the policy and ensures all legal responsibilities are clear.
6. Are You the Primary Policy Holder?
What to Select: Indicate whether you are the primary policyholder (Yes/No).
- If No, you may be asked to provide the name of the primary policyholder. Insurance companies need to know whether the person submitting the form is the one directly responsible for the policy.
7. Who is Your Insurance Provider?
What to Enter: Enter your insurance provider’s name, e.g., UMR, Cigna, GEHA, Kaiser Permanente, etc. We need to know which insurance company we’ll be verifying benefits with.
8. Type of Insurance Plan
What to Enter: Indicate the type of plan (e.g., PPO, HMO, HDHP). The type of plan affects coverage levels, deductibles, and out-of-pocket costs.
9. Upload Insurance Card (Front & Back)
What to Do: Upload a clear image of your insurance card’s front and back. Ensure that all details are legible.
- Front: Displays policyholder information and the insurance ID number.
- Back: Often contains customer service contact information and additional policy details.
This lets us quickly verify your insurance details and confirm your plan’s coverage.
10. Type of Treatment
What to Enter: Specify the type of treatment you seek for your teen (e.g., inpatient treatment, outpatient therapy, intensive outpatient program (IOP), or residential care). This helps us verify if your insurance covers the specific type of treatment you’re interested in and if any pre-authorization is required.
11. How Did You Hear About Us?
What to Select: Please select how you learned about Key Healthcare (e.g., Google, Referral, Social Media). This will help us understand how you found us and improve our outreach.
12. Message (Optional)
What to Enter: Enter any additional information or specific questions about your teen’s treatment or insurance coverage. This is your opportunity to share any concerns or requests for additional clarification. You can mention that here if you’d like to discuss coverage over the phone.
This process ensures that there are no surprises, and you’ll know exactly what to expect regarding your out-of-pocket costs.
2. Pre-Authorization: Ensuring Approval for Necessary Treatments
For inpatient and residential treatments, UMR requires the pre-authorization form to be filled to confirm that the treatment is medically necessary. Key Healthcare handles this process for you by:
- Submitting the necessary medical documentation, treatment plans, and doctor recommendations to UMR.
- Following up with UMR to ensure that the authorization is granted in a timely manner.
With Key Healthcare managing pre-authorization, your teen’s treatment will begin without delays, ensuring they get the help they need as soon as possible.
3. Claims Submission: Taking the Burden Off Your Shoulders
Once your teen’s treatment begins, we manage the entire claims submission process. This includes:
- Submitting all itemized bills and required documentation to UMR.
- Ensuring that claims are processed correctly and on time.
- We provide real-time updates on the claim status so you always know what to expect.
By letting Key Healthcare handle the claims, you can avoid the administrative burden and focus on your teen’s recovery.
4. Denied Claims Appeal: Advocating for You
If UMR denies any claims, we work closely with their team to resolve the issue. Our process includes:
- Reviewing the denial to understand the reason.
- Filing an appeal with UMR and submitting any additional documentation or proof of medical necessity.
- Facilitating peer-to-peer reviews between our healthcare team and UMR reviewers to clarify treatment needs.
In many cases, we’re able to reverse the denial and ensure your teen’s treatment continues without disruption.
5. Transitioning Between Care Levels: Seamless Support
Treatment often involves moving between different levels of care—such as from inpatient to outpatient or from active treatment to aftercare. At Key Healthcare, we ensure a smooth transition by:
- Re-verifying UMR coverage for the continuity of care.
- Securing any necessary pre-authorizations for ongoing or aftercare services.
- Coordinating with UMR and your teen’s care providers to maintain continuity of care.
Exclusions and Limitations to Be Aware Of with UMR Insurance in California
While UMR provides comprehensive coverage for mental health treatment, some exclusions may apply:
Exclusions Related to Mental Health
The document also lists some exclusions that may apply:
- Cosmetic or elective treatments unrelated to mental health is not covered.
- Non-FDA approved treatments or experimental therapies are excluded.
- Services related to custodial or domiciliary care (care that is not medically necessary but is provided for convenience) are not covered.
At Key Healthcare, we work within your UMR plan’s guidelines to ensure that covered services are provided and will always be upfront about any potential exclusions.
Dependent Coverage for Teens Under UMR
UMR typically covers dependents, including teens, under your health plan until age 26. Your teen can receive coverage for all eligible mental health services under your UMR plan. UMR plans also comply with the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires equal coverage for mental health and medical services.
Why Choose Key Healthcare for Your Teen’s Treatment?
At Key Healthcare, we offer a holistic, evidence-based approach to teen mental health treatment. As an in-network provider with UMR, we ensure that you get the best possible care for your teen while minimizing out-of-pocket costs.
What Sets Us Apart:
- In-Network Provider: We are part of the UMR provider network, which means lower co-pays, deductibles, and coinsurance for you.
- Comprehensive Services: We offer the full spectrum of teen treatment services, from inpatient treatment to outpatient care, detox, and family therapy.
- End-to-End Support: We handle every aspect of your UMR insurance—from verification and pre-authorization to claims management and appeals—so you can focus on your teen’s recovery.
Key Healthcare Mental Health Treatment for Teens with UMR Coverage
UMR covers treatment for a broad spectrum of mental health disorders, including:
- Teen Anxiety and Teen Depression
- Adolescent Bipolar Disorder
- Teen PTSDÂ (Post-Traumatic Stress Disorder)
- Teen ADHDÂ (Attention-Deficit/Hyperactivity Disorder)
- Teen Eating Disorders
- Oppositional Defiant Disorder (ODD)
- Teen Obsessive-Compulsive Disorder (OCD)
Whether your teen is struggling with anxiety, depression, ADHD, bipolar disorder, or other behavioral health issues, UMR’s behavioral health benefits include:
- Psychiatric evaluations and diagnoses
- Individual and family counseling
- Teen Cognitive Behavioral Therapy (CBT)
- Medication management for mental health disorders
- Inpatient mental health services for teens requiring intensive care and monitoring
Get Started with Key Healthcare Today
If your teen is struggling with mental health issues, Key Healthcare is here to help. Our team will guide you through the process of using your UMR insurance to cover the costs of treatment, ensuring a seamless and stress-free experience.
Contact us today to begin the insurance verification process or to learn more about our treatment programs. Call us at 1-800-KEY-CARE or visit our website at www.keyhealthcare.com.
