UnitedHealthcare Community Plan Mental Health Coverage Guide
UnitedHealthcare Community Plan is UHC's Medicaid managed care division, serving approximately 7.5 million Medicaid and dual-eligible members across many states. Behavioral health is managed through Optum.
Low-Cost Mental Health Access
Medicaid covers mental health services at little to no cost to you. Coverage includes individual therapy, group therapy, psychiatric services, and substance use treatment. No prior authorization is typically required for outpatient therapy.
How to Verify Your Mental Health Benefits
Before your first appointment, verify your specific benefits so you know what to expect. Here is a step-by-step process for UnitedHealthcare Community Plan members:
- Call 1-800-328-5979 and have your member ID card ready.
- Ask to speak with the behavioral health benefits department.
- Ask: "What is my deductible for outpatient mental health services, and how much have I met?"
- Ask: "What is my copay or coinsurance for an in-network therapy session?"
- Ask: "Do I have out-of-network benefits, and what is the reimbursement rate?"
- Ask: "Is prior authorization required for outpatient therapy?"
- Ask: "Is there a session limit per year?"
- Ask: "Are telehealth sessions covered at the same rate as in-person?"
Know Your Rights: Mental Health Parity Act
Federal law requires UnitedHealthcare Community Plan to cover mental health services at the same level as medical and surgical benefits. If you are denied coverage, ask for the denial in writing and reference the Mental Health Parity and Addiction Equity Act.
Want to keep track of all these details? Use our free benefits verification worksheet to organize your coverage information.
Finding an In-Network Therapist
Search UnitedHealthcare Community Plan's provider directory directly: Find a therapist in your area
Tips for Using the UnitedHealthcare Community Plan Directory
- Filter by "Behavioral Health" or "Mental Health" specialty.
- Check that the provider is accepting new patients before calling.
- Confirm the provider is in-network for your specific plan (not just UnitedHealthcare Community Plan generally).
- Look for providers who specialize in your specific concern (anxiety, depression, trauma, etc.).
Types of Providers Covered
Telehealth Coverage
UnitedHealthcare Community Plan covers telehealth therapy sessions, so you can meet with a therapist from home via video or phone.
Couples & Family Therapy
Family therapy covered per state Medicaid guidelines.
Understanding Your UnitedHealthcare Community Plan Coverage
Available Plan Types
Behavioral Health Managed By
Optum Behavioral Health
Some UnitedHealthcare Community Plan plans outsource behavioral health management. You may need to call the behavioral health manager directly for authorizations and provider searches.
Prior Authorization
Varies by state Medicaid program.
Substance Use Treatment
UnitedHealthcare Community Plan covers substance use disorder treatment, including outpatient counseling, intensive outpatient programs, and inpatient rehabilitation.
Common CPT Codes for Therapy
These are the billing codes your therapist will use when filing claims with UnitedHealthcare Community Plan:
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Individual therapy (45 minutes) |
| 90837 | Individual therapy (60 minutes) |
| 90847 | Family / couples therapy (with patient present) |
| 90846 | Family therapy (without patient present) |
| 90853 | Group therapy |
How to Get Reimbursed (Out-of-Network)
If you are seeing a therapist who is not in UnitedHealthcare Community Plan's network, you may still be able to get reimbursed. Here is how:
- Pay your therapist directly at the time of your session.
- Request a superbill from your therapist after each session. This is a detailed receipt with the information UnitedHealthcare Community Plan needs to process your claim.
- Submit your claim to UnitedHealthcare Community Plan using one of these methods:
- Online: Submit through the member portal
- Mobile App: Submit via the UnitedHealthcare Community Plan app
- Mail: UHC Community Plan claims addresses vary by state.
- Wait for processing. Most claims are processed within 30 days. You will receive an Explanation of Benefits (EOB) showing what was covered.
UnitedHealthcare Community Plan Claims Note
Use the state-specific member portal and claims address.
What Your Superbill Should Include
- Therapist's name, credentials, NPI number, and tax ID
- Date of service
- CPT code (e.g., 90834 or 90837)
- ICD-10 diagnosis code
- Amount charged
- Your name and date of birth
UnitedHealthcare Community Plan tip: UHC Community Plan processes vary by state. Use your state-specific portal and claims address. Most services require in-network providers.
Save Money on Therapy with UnitedHealthcare Community Plan
Use Your HSA or FSA
Therapy is an eligible expense for Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these pre-tax dollars to pay for copays, coinsurance, and out-of-network therapy costs, effectively saving 20-35% on your therapy expenses.
Ask About Sliding Scale Fees
Many therapists offer reduced rates based on your income. If you have a high deductible UnitedHealthcare Community Planplan or high out-of-pocket costs, ask your therapist about sliding scale options. Some therapists will also offer "single-case agreements" with UnitedHealthcare Community Plan at a negotiated rate.
Low-Cost Access
As a Medicaid member, your therapy sessions should have little to no out-of-pocket cost. If you are charged a copay, it is typically $1-$5 per visit. Contact 1-800-328-5979 if you receive an unexpected bill.