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Insurance · UMR · UnitedHealthcare TPA · Boeing self-funded plans

UMR rehab coverage at Gev’s Recovery — for self-funded employer plan members

For UMR members on self-funded employer plans — Boeing’s largest plan tier, manufacturing employers, large public-sector groups, and other self-funded employers that contract UMR (a UnitedHealthcare subsidiary) for claims administration. We verify your UMR benefits at no cost, file prior authorization, and advocate through peer-to-peer review and ERISA-track external appeals when the level of care your clinical assessment supports is challenged.

▸ Verify your UMR benefitsCall (844) 501-5005

Does UMR cover rehab in California?

In most cases, yes — though “UMR coverage” is a slightly different concept than coverage with a primary insurance carrier. UMR is a third-party administrator owned by UnitedHealthcare; it processes claims, manages utilization, and handles member services for self-funded employer health plans. The actual coverage rules are set by your employer (the plan sponsor), not by UMR — but the day-to-day verification, prior-authorization, concurrent-review, and appeals work runs through UMR using UHC-style protocols. Most UMR-administered plans cover medical detox, residential treatment, MAT, partial hospitalization, intensive outpatient, and structured aftercare. Our utilization-review team verifies your UMR plan and sends a written breakdown — covered levels of care, expected length-of-stay authorization, and any cost-sharing — typically within 30 minutes.

If your card lists UMR with any group prefix or affiliation, this is the verification path that applies to you. For UnitedHealthcare-administered (non-TPA) plans, see our dedicated UnitedHealthcare page.

What UMR-administered plans typically cover

UMR follows UnitedHealthcare’s behavioral-health utilization-management framework. Specifics depend on your employer’s plan design — self-funded plans have flexibility to set higher or lower coverage limits than fully-insured commercial plans — but most large UMR-administered plans look like:

  • Medical detox — 3 to 14 days, depending on substance, withdrawal severity, and medical or psychiatric complexity. UMR applies UnitedHealthcare protocols for alcohol, opioid, and benzodiazepine detox.
  • Residential / inpatient (ASAM Level 3.5) — initial authorizations of 14 to 30 days are common, with concurrent reviews evaluating continued stay every 5 to 7 days.
  • Partial hospitalization (ASAM 2.5) — authorized in 4-to-6 week blocks, evaluated through concurrent review. The day is structured; the evening is not.
  • Intensive outpatient at ASAM Level 2.1 — 4 to 8 weeks of group, individual, and family work scheduled around your week.
  • Medication-assisted treatment (MAT) — buprenorphine for opioid use disorder, naltrexone for alcohol or opioid use disorder, acamprosate for alcohol craving. The prescription benefit is typically administered by OptumRx (also a UnitedHealth Group subsidiary) on UMR-administered plans.
  • Dual-diagnosis psychiatric care — for co-occurring depression, anxiety, PTSD, bipolar disorder, or trauma. Worked on at the same time as the substance use, because separating them is how people relapse.
  • Aftercare coordination — sober-living placement when indicated, continued therapy, continued case management, and direct handoffs to community providers.

Specific authorization length depends on your employer’s plan design, the clinical assessment at intake, and concurrent-review decisions UMR’s utilization-management team makes during your stay. Medical necessity is built into the file from intake through discharge planning.

Why Gev’s Recovery is built for UMR members on self-funded plans

Insurance covers the level of care. The facility decides what the level of care actually delivers. UMR members on self-funded employer plans — Boeing engineers, manufacturing workers, large public-sector employees — arrive with specific employer relationships, FMLA timing, and security or operational considerations that need to fit alongside the clinical work.

  • Joint Commission accredited. ASAM Levels 3.1, 3.2, 3.3, and 3.5 in-house. CA DHCS license #191288AP.
  • Medical Director: Eric Chaghouri, MD. Board-certified psychiatrist with subspecialty training in forensic psychiatry — relevant when a self-funded employer plan member arrives with a fitness-for-duty evaluation, an FMLA situation, a return-to-work clearance question, or a workers’-comp coordination need. UCLA undergrad, Keck School of Medicine of USC, LAC+USC residency, USC Institute of Psychiatry and Law fellowship. Clinical Faculty at USC. Clinical oversight is direct, not delegated.
  • Low staff-to-client ratio across clinical, medical, and case-management staff.
  • Evidence-based therapy core: CBT, DBT, EMDR, motivational interviewing, group therapy, MAT — supported by complementary modalities that work alongside the clinical work.
  • Length-of-stay flexibility. Shorter inpatient programs for Boeing engineers and manufacturing professionals with shift or operational timing constraints. Longer stays for complex medical or psychiatric cases. Treatment length is built around the client, not the calendar.
  • Structured family program. Family sessions, couples therapy, family-systems work. Discreet — confidentiality matters at the engineering and management level.
  • Detailed aftercare with employer-coordination support. Sober-living placement when indicated, continued therapy, continued case management, plus FMLA and return-to-work documentation when an employee needs it.

What UMR pays for and what actually changes a person’s life are not the same equation. We work the second one.

How we work with UMR on your coverage

UMR claims administration follows UnitedHealthcare’s UM framework, but with self-funded-plan-specific overlays — the employer, as plan sponsor under ERISA, has set the actual coverage rules. Our utilization-review and billing team handles UMR verification, prior authorization, concurrent review, peer-to-peer, and ERISA external appeal end-to-end.

Benefit verificationOur UR and billing team contacts UMR directly using your member ID and group number — and identifies your employer’s specific plan design and any unique coverage rules. We pull a written breakdown of your behavioral-health benefits — covered levels of care, prior-authorization requirements, in-network versus out-of-network cost-sharing, and any deductible, coinsurance, or out-of-pocket maximum information. Within about 30 minutes you have a written summary of what’s covered, the prior-auth requirements, and any cost-sharing.
Prior authorizationWhen UMR requires prior authorization for medical detox or residential admission, our UR team files the request with the clinical documentation that supports medical necessity — substance-use history, withdrawal-risk assessment, prior treatment episodes, co-occurring psychiatric conditions, and the ASAM-criteria-based recommendation from our medical and clinical teams. UMR submissions follow UnitedHealthcare’s behavioral-health intake format.
Concurrent reviewOnce you’re admitted, UMR schedules concurrent reviews on a 5-to-7-day cadence — checkpoints where the carrier evaluates whether continued treatment at the current level of care remains medically necessary. Our UR team tracks every review window and submits the documentation that supports continued authorization. When concurrent review tries to step a client down to a lower level of care before clinical readiness, this is where the active work begins.
Peer-to-peer reviewWhen UMR’s medical director questions or denies continued care, our medical director — Dr. Chaghouri — conducts a peer-to-peer review directly. This is a clinical conversation, medical-director to medical-director, on the basis of the diagnosis, the ASAM criteria, the treatment plan, and the clinical reasoning. Forensic and psychiatric credentials matter here; the conversation is about medical necessity, documented and defended in clinical language.
Internal appeals (Level 1 and Level 2)If a denial holds after peer-to-peer, we file the Level-1 appeal with supporting clinical documentation and the medical-necessity argument. If the Level-1 is also denied, we file the Level-2 appeal. UMR has expedited appeal pathways for urgent clinical situations involving substance-use treatment — we use the expedited track when the clinical picture warrants.
External appeals — ERISA-track external reviewUMR-administered plans are almost always self-funded employer plans subject to ERISA, the federal law that governs employee benefit plans. When internal appeals are exhausted and the denial is not clinically defensible, we file an ERISA-track external review request — an independent reviewer evaluates whether the denial complied with the plan’s terms and federal MHPAEA parity requirements. The external reviewer’s decision is binding on the plan sponsor.

The decision to escalate is not commercial. It’s clinical. When a client is denied care that’s clinically indicated, we advocate for them — through every step above — to support coverage of the level of care our team believes is medically appropriate.

The legal framework behind your UMR coverage

UMR-administered plans are typically self-funded ERISA plans, which means the regulatory framework is primarily federal.

Federal: the Mental Health Parity and Addiction Equity Act (MHPAEA, 2008)Group health plans that cover mental-health and substance-use disorder benefits must apply financial requirements (deductibles, copays, out-of-pocket maximums) and treatment limitations (visit caps, prior-authorization rules) no more stringently than they apply to medical and surgical benefits. Enforced by the U.S. Departments of Health and Human Services, Labor, and Treasury. MHPAEA fully applies to ERISA self-funded plans.
Federal: ERISA (Employee Retirement Income Security Act, 1974)ERISA governs most self-funded employer benefit plans — which includes most UMR-administered plans. ERISA establishes the appeals process (internal Level-1, Level-2, then external review), requires plan sponsors to provide written reasons for denials, and gives members the right to sue plan sponsors for benefit denials in federal court after exhausting administrative appeals.

When we appeal a UMR denial, the appeal is built on the clinical documentation, federal MHPAEA, and the plan’s own terms as set by the employer plan sponsor. All three matter.

What the research says about length of stay

The 28-day inpatient stay became the industry default in the 1980s based on insurance design, not clinical evidence. The clinical evidence points the other direction. The National Institute on Drug Abuse, summarizing decades of research in its Principles of Effective Treatment, states that participation in treatment for less than 90 days is of limited effectiveness for most substance-use disorders, and that better outcomes are associated with longer durations of treatment. This includes time across the full continuum — detox, residential, PHP, IOP, and continuing care.

This is why we build for length-of-stay flexibility. Some UMR members — Boeing engineers, manufacturing workers, public-sector employees — need a focused inpatient stay because of work, family, or operational constraints, then continue at PHP or IOP. Others — those with severe withdrawal risk, complex psychiatric comorbidity, or chronic relapse history — need extended residential care. The right length of stay is a clinical decision, not a calendar decision.

When concurrent review tries to cut a stay short, our UR and medical teams document the clinical reasoning, file the peer-to-peer request, and pursue appeals — including ERISA-track external review — when warranted.

Who has UMR-administered coverage we commonly verify

UMR processes claims and administers utilization management for many self-funded employer plans. Some of the populations whose plans we commonly verify:

  • Boeing employees — Boeing’s largest self-funded plan tier uses UMR for claims administration, with UnitedHealthcare’s behavioral-health framework underpinning the UM rules
  • Manufacturing employer plans — many large industrial and manufacturing employers use UMR for self-funded plan administration
  • Large public-sector employer groups — some state and local government plans contract UMR for self-funded benefit administration
  • Higher-education employer plans — some universities and academic medical centers use UMR-administered self-funded plans
  • Large healthcare-system employer plans — some large healthcare systems use UMR for their own employee benefit administration
  • Spouses and dependents of all of the above on family group plans

If your card lists UMR with any group affiliation, our UR team can walk through the verification with you — including identification of your employer’s specific self-funded plan design.

How to verify your UMR benefits

Three steps. No commitment.

1. Call (844) 501-5005 or submit the contact formEither path connects you with our admissions and UR team. Calls are answered 24 hours a day. Boeing employees, family members, and HR-coordinator inquiries on behalf of an employee are all welcome.
2. We verify benefits with UMR directlyOur UR team contacts UMR using your member ID and group number — and identifies your employer’s self-funded plan design. We pull a written breakdown of your specific plan, including covered levels of care, prior-authorization requirements, expected length-of-stay authorization, and any in-network versus out-of-network cost-sharing.
3. Within about 30 minutes you have a written summary of what’s covered, the prior-auth requirements, and any cost-sharingNo commitment. The breakdown is yours to review with your family or your support system before any next step. Verification is free, confidential, and not a commitment to admit. Information is collected solely for benefit verification and is not shared with third parties.

UMR rehab coverage — frequently asked questions

Does UMR cover rehab for Boeing employees?

In most cases, yes. UMR is the third-party administrator for Boeing’s largest self-funded plan tier. Coverage rules are set by Boeing as plan sponsor, but the UM framework follows UnitedHealthcare protocols. Most plans cover medical detox, residential treatment, MAT, PHP, IOP, and aftercare. Our UR team verifies the specifics of your Boeing-UMR plan before admission.

What is the difference between UMR and UnitedHealthcare?

UMR is a third-party administrator owned by UnitedHealthcare. UMR processes claims, manages utilization, and handles member services for self-funded employer plans — but the actual coverage rules are set by the employer (plan sponsor), not by UMR. UnitedHealthcare itself directly administers fully-insured plans where UHC is the plan underwriter.

Does UMR cover medical detox?

Most UMR-administered plans cover medical detox when medically indicated. Authorization windows we typically see are 3 to 14 days, depending on substance, withdrawal severity, and medical or psychiatric complexity. Specifics depend on your employer’s plan design.

Will I need pre-authorization with UMR?

Most UMR-administered plans require prior authorization for medical detox and residential admission. Our UR team files the prior-auth request with clinical documentation supporting medical necessity, typically before admission. You don’t handle the prior-auth process yourself.

What happens if UMR denies coverage?

Our medical director conducts a peer-to-peer review with UMR’s medical director. If the denial holds, we file Level-1 and Level-2 internal appeals. When internal appeals are exhausted, we file an ERISA-track external review request — an independent reviewer evaluates whether the denial complied with the plan’s terms and federal MHPAEA parity requirements. The external reviewer’s decision is binding on the plan sponsor.

Are UMR plans regulated by state insurance law or federal law?

UMR-administered plans are almost always self-funded ERISA plans, which means the regulatory framework is primarily federal — MHPAEA for parity, ERISA for the appeals process. State insurance law generally does not apply to self-funded ERISA plans.

Does UMR cover MAT (medication-assisted treatment)?

Most UMR-administered plans cover MAT for opioid use disorder (buprenorphine, naltrexone) and alcohol use disorder (naltrexone, acamprosate) when prescribed as part of a clinical treatment plan. The prescription benefit is typically administered by OptumRx on UMR plans.

Does UMR cover dual-diagnosis treatment?

Most UMR-administered plans cover treatment of co-occurring psychiatric conditions alongside substance-use treatment when both are clinically indicated, per federal MHPAEA parity requirements.

Verify your UMR benefits

We call UMR for you. Within 30 minutes you have the answer in writing. Verification is free, confidential, and not a commitment to admit.

▸ Verify your UMR benefitsCall (844) 501-5005

UMR and any related marks are the property of UnitedHealth Group. References to UMR, UnitedHealthcare, OptumRx, and Boeing are made for informational purposes only; we are not affiliated with or endorsed by any of these organizations. Insurance acceptance is subject to benefit verification. Treatment outcomes vary by individual; statements about the authorization, peer-to-peer, and appeals process describe Gev’s Recovery’s standard practices and do not guarantee specific coverage decisions by your plan. Gev’s Recovery Center · 19448 Lassen St, Northridge, CA 91324 · CA DHCS license #191288AP.