Home

OptiMed Health Plans

Rehabs That Take OptiMed Health Plans

OptiMed Health Plans is a health benefits administrator serving employer groups in Louisiana. As an administrator, it handles claims and member services for plans that employers sponsor, and each employer decides the plan’s benefits. Plans it administers can include coverage for drug and alcohol treatment, with terms varying by plan, provider network and level of care.

Louisiana centers on this page name OptiMed Health Plans on their websites. Since coverage depends on your employer’s plan, ask the facility whether it has worked with your specific OptiMed plan. Then call OptiMed before admission to ask about network status, whether precertification is required, and what your deductible and coinsurance will be.

Rehab Centers Near You

Drug and Alcohol Rehab Centers That Accept OptiMed Health Plans

Capital Area Human Services – Saint Francisville

5266 Commerce Street, Saint Francisville, Louisiana, 70775

3.8★★★★☆32

SAMHSA listed

OutpatientTelehealthWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

SeniorsYoung adultsCouples+2

Capital Area Human Services operates from 5266 Commerce Street in Saint Francisville, close enough to St. Francisville and New Roads to serve both. Anyone within about 14 miles can reach it without a major journey, which takes in New Roads, Ventress, Jackson and Morganza. The facility falls within West Feliciana County for the purposes of state and county-funded treatment. Capital Area Human Services delivers intensive outpatient and outpatient care. This is a mental health service…

2.6 miWoodriff Falls22 miBaton Rouge Metropolitan AirportServes4 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Online Rehab and Telehealth · Outpatient Rehab · Walk-In Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Co-Occurring Mental Health Conditions · Crisis Intervention · Depression and Anxiety · Family Education Programs · Illness Management and Recovery · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · Mobile Crisis Response · Psychiatric Walk-In Clinic · +2 more

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Young Adult Rehab

Support services

Case Management · Chronic Illness Management · Health and Wellness Support · Housing and Employment Support · Intensive Case Management · Nutrition and Fitness Counseling · Peer Support · Recovery Support Services · Suicide Prevention Services · Supported Employment

Insurance accepted

90 Degree Benefits · AAG Benefit Plan Administrators · ACUITY Group · Administrative Concepts · Aetna · AIG · Aither Health · Allegiance Benefit Plan · All Savers Insurance Company · AllyAlign Health · +83 more

Capital Area Human Services – 2455 Wooddale Boulevard, Baton Rouge

2455 Wooddale Boulevard, Baton Rouge, Louisiana, 70805

4.0★★★★☆~~165~~

CARF accredited

DetoxResidentialTelehealth+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

Co-occurring DisordersMATTrauma-informed+5

Deaf and HoH

2455 Wooddale Boulevard in Baton Rouge puts Capital Area Human Services inside a short drive of Merrydale, Monticello and the towns around them. Monticello, Brownfields, Port Allen and Central all sit within 7 miles of the door. Baton Rouge sits in East Baton Rouge County, and the county's own provision is limited enough that this site draws from a wide area. What is available here is detox and residential treatment. Medication for opioid dependence is…

7.6 miComite River4.6 miBaton Rouge Metropolitan AirportServes5 towns

Substances treated

Adderall Rehab · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Beer Addiction Treatment · Binge Drinking Treatment · Carfentanil Rehab · Cocaine Rehab · Codeine Rehab · Concerta Rehab · +40 more

Levels of care

14-Day Rehab · 21-Day Rehab · 30-Day Rehab · 45-Day Rehab · 60-Day Rehab · 90-Day Rehab · Addiction Retreat · Aftercare and Continuing Care · Anxiety Retreat · Carfentanil Detox Program · +42 more

Therapies

12 Step Rehab · Addiction Counseling · Anger Management · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Contingency Management · Counseling and Therapy · Couples Counseling · Evidence-Based Therapy · Family Therapy · +4 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Mental Health Conditions · Mental Health Treatment · Psychiatric Medication Management · Psychosocial Rehabilitation · Social Skills Training

Groups served

Adult Rehab · Couples Rehab · Early HIV Intervention · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Medicare Rehab · Men's Rehab · Men's Residential Rehab · +11 more

Support services

Case Management · Community Outreach · Employment Support · Health and Wellness Support · Health Education · Hepatitis C Treatment · HIV Treatment · Housing and Employment Support · Housing Assistance · Intervention Services · +7 more

Languages

CARF Accredited Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Detox · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Residential Rehab

Insurance accepted

Capital Area Human Services – 2751 Wooddale Boulevard, Baton Rouge

2751 Wooddale Boulevard, Baton Rouge, Louisiana, 70805

4.0★★★★☆~~165~~

CARF accredited

IOPOutpatientTelehealth+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

Co-occurring DisordersMATTrauma-informed+7

Deaf and HoH

Capital Area Human Services is located at 2751 Wooddale Boulevard in Baton Rouge, within a few minutes of Port Allen and Merrydale. Anyone within about 6 miles can reach it without a major journey, which takes in Port Allen, Merrydale, Gardere and Monticello. Baton Rouge sits in East Baton Rouge County, and the county's own provision is limited enough that this site draws from a wide area. Services run to intensive outpatient and outpatient care.…

9.2 miComite River6.1 miBaton Rouge Metropolitan AirportServes5 towns

Substances treated

Adderall Rehab · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Beer Addiction Treatment · Binge Drinking Treatment · Carfentanil Rehab · Codeine Rehab · Concerta Rehab · Dexedrine Rehab · +34 more

Levels of care

Aftercare and Continuing Care · Continuing Care · Discharge Planning · Evening Treatment · Intensive Outpatient Program (IOP) · Online Rehab and Telehealth · Outpatient MAT Clinic · Outpatient Rehab · Overdose Prevention Education · Recurrence Prevention · +2 more

Therapies

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Dual Diagnosis Rehab · Court Ordered MAT · Court Ordered Medicare Rehab · Court Ordered Outpatient Rehab · Court Ordered Rehab · Court Referral Accepted · Early HIV Intervention · Hepatitis Support Services · +23 more

Support services

Case Management · Chronic Illness Management · Community Outreach · Employment Support · Health and Wellness Support · Health Education · Housing and Employment Support · Housing Assistance · Intensive Case Management · Intervention Services · +9 more

Languages

CARF Accredited Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab

Insurance accepted

Capital Area Human Services – Plaquemine

24705 Plaza Drive, Plaquemine, Louisiana, 70764

4.0★★★★☆~~165~~

SAMHSA listed

OutpatientTelehealthWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

SeniorsYoung adultsCouples+2

24705 Plaza Drive in Plaquemine puts Capital Area Human Services inside a short drive of Crescent, Bayou Goula and the towns around them. That radius takes in Bayou Goula, Addis, Dorseyville and St. Gabriel, all within 9 miles. Iberville County is the relevant authority here, which matters for anyone using state-funded care. Capital Area Human Services delivers intensive outpatient and outpatient care. This is a mental health service rather than an addiction treatment facility. Remote…

5.2 miUpper Grand River20 miBaton Rouge Metropolitan AirportServes6 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Online Rehab and Telehealth · Outpatient Rehab · Walk-In Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Young Adult Rehab

Support services

Insurance accepted

Capital Area Human Services – Gonzales

1056 East Worthey Street, Gonzales, Louisiana, 70737

2.9★★★☆☆16

CARF accredited

IOPOutpatientTelehealth+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

MATTrauma-informedTeens+7

Deaf and HoH

1056 East Worthey Street in Gonzales puts Capital Area Human Services inside a short drive of Sorrento, Prairieville and the towns around them. The practical catchment runs to roughly 8 miles, covering Sorrento, Prairieville, Darrow and Port Vincent. Gonzales sits in Ascension County, and the county's own provision is limited enough that this site draws from a wide area. Services run to intensive outpatient and outpatient care. Medication-assisted treatment is part of the offer, the…

7.2 miNew River26 miBaton Rouge Metropolitan AirportServes6 towns

Substances treated

Levels of care

Therapies

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Early HIV Intervention · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Medicare Rehab · Men's Outpatient Rehab · +34 more

Support services

Languages

CARF Accredited Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab

Insurance accepted

Capital Area Human Services – Donaldsonville

901 Catalpa Street, Donaldsonville, Louisiana, 70346

3.5★★★★☆2

CARF accredited

OutpatientTelehealthWalk-in+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

MATTrauma-informedTeens+7

Deaf and HoH

Capital Area Human Services is located at 901 Catalpa Street in Donaldsonville, within 4.3 miles of Darrow and Lemannville. Within around 8 miles that includes Lemannville, Belle Rose, Union and Welcome. Donaldsonville is in Ascension County, which shapes which public funding routes apply. What is available here is intensive outpatient and outpatient care. Medication-assisted treatment pairs buprenorphine, methadone or naltrexone with counseling. Substance use and mental health are treated together rather than in sequence. Telehealth…

7.5 miClaiborne Island31 miBaton Rouge Metropolitan AirportServes4 towns

Substances treated

Levels of care

Aftercare and Continuing Care · Continuing Care · Discharge Planning · Evening Treatment · Online Rehab and Telehealth · Outpatient MAT Clinic · Outpatient Rehab · Overdose Prevention Education · Recurrence Prevention · Walk-In Rehab · +1 more

Therapies

Mental health

Groups served

Support services

Languages

CARF Accredited Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab

Insurance accepted

Capital Area Human Services – New Roads

282A Hospital Road, New Roads, Louisiana, 70760

2.3★★☆☆☆3

SAMHSA listed

OutpatientTelehealthWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

SeniorsYoung adultsCouples+2

Capital Area Human Services sits at 282A Hospital Road, New Roads — around 2.0 miles from Ventress and 8.5 from Morganza. Morganza, St. Francisville, Livonia and Erwinville all sit within 11 miles of the door. New Roads is in Pointe Coupee County, which shapes which public funding routes apply. What is available here is intensive outpatient and outpatient care. Licensing sits with the Louisiana Department of Health, alongside federal SAMHSA registration. The focus here is…

6.5 miWoodriff Falls21 miBaton Rouge Metropolitan AirportServes5 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Online Rehab and Telehealth · Outpatient Rehab · Walk-In Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Young Adult Rehab

Support services

Insurance accepted

Capital Area Human Services – Howell Boulevard, Baton Rouge

7855 Howell Boulevard, Baton Rouge, Louisiana, 70807

4.0★★★★☆~~165~~

SAMHSA listed

OutpatientTelehealthWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

SeniorsYoung adultsCouples+2

Capital Area Human Services is located at 7855 Howell Boulevard in Baton Rouge, within a few minutes of Brownfields and Merrydale. Anyone within about 7 miles can reach it without a major journey, which takes in Merrydale, Baker, Baton Rouge and Port Allen. Baton Rouge sits in East Baton Rouge County, and the county's own provision is limited enough that this site draws from a wide area. Capital Area Human Services offers intensive outpatient and…

11 miComite River1.1 miBaton Rouge Metropolitan AirportServes8 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Online Rehab and Telehealth · Outpatient Rehab · Walk-In Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Young Adult Rehab

Support services

Insurance accepted

Capital Area Human Services – Port Allen

685 Louisiana Avenue, Port Allen, Louisiana, 70767

4.0★★★★☆~~165~~

SAMHSA listed

OutpatientTelehealthWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

SeniorsYoung adultsCouples+2

Capital Area Human Services is at 685 Louisiana Avenue in Port Allen. Baton Rouge is 4.8 miles away and Brusly 5.3. Baton Rouge, Brusly, Merrydale and Addis all sit within 7 miles of the door. Port Allen sits in West Baton Rouge County, and the county's own provision is limited enough that this site draws from a wide area. Capital Area Human Services provides intensive outpatient and outpatient care. Capital Area Human Services is federally…

10 miProfit Island6.1 miBaton Rouge Metropolitan AirportServes7 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Online Rehab and Telehealth · Outpatient Rehab · Walk-In Rehab · Weekend Rehab

Therapies

Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy

Mental health

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Senior Telehealth · Young Adult Rehab

Support services

Insurance accepted

Capital Area Human Services – Colonial Drive, Baton Rouge

422 Colonial Drive, Baton Rouge, Louisiana, 70806

2.8★★★☆☆11

CARF accredited

OutpatientTelehealthWalk-in+1

Accepts InsuranceAccepts MedicaidAccepts Medicare+5

MATTrauma-informedTeens+6

Deaf and HoH

Capital Area Human Services sits at 422 Colonial Drive, Baton Rouge — around 3.7 miles from Merrydale and 4.3 from Monticello. Within around 6 miles that includes Merrydale, Monticello, Gardere and Port Allen. East Baton Rouge County is the relevant authority here, which matters for anyone using state-funded care. Capital Area Human Services offers intensive outpatient and outpatient care. Medication-assisted treatment is part of the offer, the approach with the strongest evidence for opioid dependence.…

6.7 miComite River6.7 miBaton Rouge Metropolitan AirportServes5 towns

Substances treated

Adderall Rehab · Carfentanil Rehab · Codeine Rehab · Concerta Rehab · Dexedrine Rehab · Fentanyl Patch (Duragesic) Rehab · Fentanyl Rehab · Heroin Rehab · Hydrocodone Rehab · Hydromorphone (Dilaudid) Rehab · +25 more

Levels of care

Abstinence-Based Rehab · Aftercare and Continuing Care · Continuing Care · Discharge Planning · Evening Treatment · Non-12-Step Rehab · Online Rehab and Telehealth · Outpatient MAT Clinic · Outpatient Rehab · Overdose Prevention Education · +3 more

Therapies

Activity Therapy · Addiction Counseling · Anger Management · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Contingency Management · Counseling and Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · +6 more

Mental health

Groups served

Support services

Case Management · Community Outreach · Employment Support · Health and Wellness Support · Health Education · Housing and Employment Support · Housing Assistance · Intensive Case Management · Intervention Services · Nutrition and Fitness Counseling · +5 more

Languages

CARF Accredited Deaf and Hard of Hearing Rehab · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab

Insurance accepted

Why Trust RehabSeekers.com?

RehabSeekers is an independent behavioral health directory covering drug and alcohol addiction and mental health treatment providers.

Learn More

Every listing has a source: an official register, a licensing record, or details the facility sent us.

Credentials shown honestly. Accreditation, licensing and registration listed separately.

Reviews shown exactly as written. Never edited, never removed because a facility asked.

No commission, no referral fees. Nothing a facility pays for changes where it appears.

Contact details always go direct. Calls reach the facility itself, never a call centre.

See where our data comes from and our editorial policy.

Common questions

Answered from what is listed here.

Does OptiMed cover rehab?

Substance use treatment benefits are not described on any OptiMed product page, so the answer sits in your employer's plan document. Level funded major medical plans are sold as ACA compliant, limited medical and MEC plans pay only fixed amounts for listed services, and GAP pays only toward costs left by an underlying major medical plan.

Ask your employer or OptiMed for the summary of benefits and coverage before admission, and call 800-836-6036 with questions about what a given plan includes.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

Does OptiMed cover detox?

Detox is not named in any published OptiMed benefit summary. A level funded major medical plan is the product that would pay for medical detox, since limited medical and MEC designs pay set dollar amounts for listed services such as hospital confinement, doctor visits and emergency room care.

Whether a fixed hospital confinement benefit applies to a detox admission is not stated, so get that answer from the plan administrator in writing first.

Detox Centershttps://rehabseekers.com/programs/detox-centers/

Does OptiMed cover inpatient rehab?

Nothing in OptiMed's published product materials addresses inpatient rehab. The level funded major medical program, with deductibles from $500 to $8,150, is the product that would pay a hospital or residential claim, while limited medical plans pay only fixed hospital confinement and ICU amounts.

Residential programs usually ask for the plan document and network details before admitting, so request both from your employer's benefits contact early.

Inpatient Rehabhttps://rehabseekers.com/programs/inpatient/

Does OptiMed cover mental health treatment?

No mental or behavioral health benefit is described on OptiMed's product pages, so the employer's plan document decides. Level funded major medical plans are sold as ACA compliant, while MEC Edge limits office visits to three specialist visits a year at a $50 copay.

Whether counseling counts as a specialist visit under MEC Edge is not stated; the United Group Programs claims department at (800) 810-9892 can point you to the plan terms.

Counseling and Therapyhttps://rehabseekers.com/therapies/counseling-and-therapy/

Does OptiMed need prior authorization for rehab?

OptiMed publishes no precertification rules, authorization line or medical necessity criteria for any of its products, so the requirement sits in your employer's plan document. Call the general line at 800-836-6036 or the claims department at (800) 810-9892 before an admission and ask whether precertification applies.

Getting that answer before the first treatment day protects you from a denial that leaves the whole bill with the member.

Residential Rehabhttps://rehabseekers.com/programs/residential/

Does OptiMed cover Suboxone?

Formulary details for buprenorphine, naltrexone and methadone are not published by OptiMed. Level funded plans use a Cigna or US-Rx pharmacy benefit manager, and Broadreach and CVS Caremark are also listed for prescription drug management, so the drug list depends on which vendor your plan uses.

Limited medical plans include only a fixed indemnity outpatient drug benefit, and GAP adds an optional rider covering generics, or generics plus brand.

Suboxone and Buprenorphinehttps://rehabseekers.com/medications/mat/buprenorphine/

How much does rehab cost with OptiMed?

Deductibles on OptiMed level funded major medical plans run from $500 to $8,150, with copay, coinsurance and HSA-compatible options, so your share of a rehab bill starts there. Limited medical and MEC plans instead pay set dollar amounts per service, leaving the balance with the member.

Reference based reimbursement plans pay providers a reference price, and a facility that does not accept that price can balance bill the difference.

Payment Assistance Availablehttps://rehabseekers.com/payment/payment-assistance-available/

Does OptiMed cover out-of-network rehab?

Out-of-network rules are not published for any OptiMed product. Plans rent networks from Cigna, First Health or PHCS/MultiPlan, and the logo on the member ID card shows which one applies, so a program outside that network is usually paid at a lower level or not at all.

On reference based reimbursement plans there is no traditional network contract, and the plan offers tools for finding willing practitioners and handling balance billing disputes.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

What network does OptiMed use?

OptiMed rents provider networks rather than building its own. The directories listed are Cigna shared administration, First Health, and several PHCS and MultiPlan networks, including PHCS Practitioner and Ancillary Only, limited benefit plan networks, and PHCS Primary PPO in major medical, specific services and preventive-only versions.

Look at the network logo printed on your medical ID card, then search only that directory, because the wrong one gives misleading results.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

How do I find a rehab that takes OptiMed?

Start with the network logo on your medical ID card, then search the matching directory: Cigna shared administration, First Health or the PHCS/MultiPlan search. Then call the treatment program and ask whether it bills OptiMed, since the card may show a rented network rather than the administrator's name.

Programs that name OptiMed on their own websites are listed here, which gives you a short call list to work through.

Outpatient Rehabhttps://rehabseekers.com/programs/outpatient/

Is OptiMed Health Plans the same as OptiMed Health Partners?

No, they are two different companies. OptiMed Health Plans is the employer benefits business, legally Optimed Health, Inc. of Peachtree Corners, Georgia. OptiMed Health Partners, in Kalamazoo, Michigan, is an independently owned specialty medication and infusion provider reachable at 877.232.2857.

Billing offices sometimes mix the two up, so give the plan name and claims address printed on your card when you call.

Who owns OptiMed Health Plans?

CarynHealth has owned OptiMed since September 30, 2025. CarynHealth is a privately held benefits and technology company founded in 2018 in Alpharetta, Georgia, reporting more than $40 million in annual revenue, over 76,000 individuals and health-sharing members, and over 300 employer groups.

The OptiMed trademark previously belonged to United Group Programs, Inc., which an affiliate of Gemspring Capital invested in during December 2016.

Does OptiMed offer Medicaid or Medicare plans?

No, OptiMed sells only to employer groups through brokers, and no Medicaid, CHIP or Medicare Advantage product appears in its lineup. Its products are level funded major medical, GAP group supplemental, limited medical and minimum essential coverage plans, plus administrative services for employers.

If you qualify for Medicaid, that coverage is applied for through your state agency rather than through an employer benefits administrator.

Medicaid Rehabhttps://rehabseekers.com/insurance-accepted/medicaid/

What states does OptiMed operate in?

State-specific notices are published for 46 states, with Alaska, Hawaii, Montana and New York absent from that list. Availability still varies by product, and older company notices said the programs are not offered in every state, so eligibility has to be settled group by group.

The GAP plan has been written down to five lives in most states, and for small groups of five or more in California.

What is the phone number for OptiMed?

Call 800-836-6036 for general questions about OptiMed offerings. Claims and benefit questions go to the United Group Programs claims department at (800) 810-9892, and since the CarynHealth acquisition, member support also runs through 800-915-9497 or customersupport@carynhealthms.com.

No separate behavioral health, nurse or crisis line is published, so benefit questions about treatment go through those same numbers.

Do you run a treatment service?

Get Verified to rank above unverified listings, show the Verified badge and be contacted directly.

Or claim or add your listing for free.

OptiMed Health Plans is not a household insurance carrier. Optimed Health, Inc. is a Georgia employer benefits company, in the business since 1968, that designs, markets and administers level funded major medical, GAP group supplemental, limited medical and minimum essential coverage plans sold through brokers to employers with anywhere from a team of 10 to a team of 10,000. The employer picks the product, and the plan document that comes with it decides what addiction treatment is paid for.

That ownership of the rules matters more here than with a national carrier. OptiMed has been a CarynHealth company since September 30, 2025, the OptiMed trademark sat historically with United Group Programs, Inc., and United Group Programs is still named as the claims department on the state notices OptiMed publishes for 46 states. Networks are rented rather than built: the logo on the medical ID card points to Cigna, First Health or a PHCS/MultiPlan network. There are no Medicare, Medicaid or marketplace products in the line-up.

The guide below covers which OptiMed products could pay toward detox, residential care and outpatient treatment, what is published about precertification and what is not, the deductibles and copays named on the product pages, how medication is handled through the pharmacy vendors, and how to work out which rented network an admissions team needs to bill.

Does OptiMed Health Plans Cover Drug and Alcohol Rehab?

It depends entirely on the product the employer bought, and OptiMed publishes no substance use benefit detail for any of them. Level funded major medical plans are described as ACA compliant, which is the line most likely to pay for treatment. Limited medical and MEC plans pay fixed amounts for listed services only. GAP pays toward costs left by an underlying major medical plan.

So the first job is not calling a program, it is finding the summary of benefits and coverage or the plan document from the employer’s human resources office. That document, not a marketing page, names the levels of care, the cost shares and the limits. Where the answer is not in writing, OptiMed can be asked on 800-836-6036, and claims questions go to the United Group Programs claims department on 800-810-9892.

Which OptiMed product do you hold? The named plans are the OptiMed Level Funded Major Medical Program, OptiMed Level Funded Health Plans with RBR, OptiMed GAP, OptiMed Limited Medical, OptiMed Minimum Essential Coverage and MEC Edge. A GAP or limited medical card on its own is not major medical coverage, and an admissions team needs to know which one it is before it can quote anything.

What Might Each Level of Care Look Like Under an OptiMed Plan?

Nothing level-specific is published, so the questions below are the ones that settle it. Treat each level as a separate line to ask about, because a plan that pays a fixed hospital confinement amount behaves very differently from a level funded major medical plan with a deductible and coinsurance.

Medical Detox

Ask whether inpatient withdrawal management is paid as a hospital admission and at what rate. OptiMed Limited Medical lists hospital confinement and intensive care benefits paid as fixed dollar amounts, and whether those amounts apply to a medical detox stay is not stated anywhere public. Alcohol and benzodiazepine withdrawal can produce seizures, and acute withdrawal belongs in an emergency department whatever the benefit question.

Residential and Inpatient

A residential rehab admission is the costliest item on this list and the one most worth settling in writing. Ask whether residential substance use treatment is a covered benefit, whether a day limit applies, and whether the plan pays on a negotiated network rate or on reference based reimbursement, which changes the exposure considerably.

PHP, IOP and Outpatient

For partial hospitalization and intensive outpatient care, ask whether the plan recognizes those billing codes at all, since limited benefit designs often do not. MEC Edge caps office visits at three primary care visits a year at a $20 copay and three specialist visits at $50, and whether counseling sessions count against the specialist allowance is not stated. Level funded plans include telemedicine, with iSelect listed as the enhanced services vendor, so ask whether behavioral online rehab and telehealth sits inside that service.

Does OptiMed Need Prior Authorization for Rehab?

No precertification rules, authorization phone line or medical necessity criteria are published for any OptiMed product. That is not the same as there being none, since level funded plans are administered against an employer plan document that can require precertification for inpatient and residential admissions. Ask before the admission date rather than after.

No behavioral health vendor or carve-out is named by OptiMed or by CarynHealth, so there is no separate behavioral number to call. General questions go to 800-836-6036, claims to the United Group Programs claims department on 800-810-9892, and post-acquisition member support runs through CarynHealth on 800-915-9497 or customersupport@carynhealthms.com. Member benefit detail sits behind the MediConnx member login.

Ask before admission

Which OptiMed product is this, and is substance use treatment a covered benefit under the plan document?

Does detox, residential, PHP or IOP need precertification, and who issues it?

Which network logo is on the card, and does this program hold a contract in that network?

Is this plan a reference based reimbursement design, and what happens if the program bills above the reference price?

How Much Does Rehab Cost With OptiMed Health Plans?

The published figures are plan-level rather than treatment-level. Deductibles on the OptiMed Level Funded Major Medical Program run from $500 to $8,150, with copay, coinsurance and HSA-compatible designs. MEC Edge charges $20 for a primary care visit and $50 for a specialist, urgent care or diagnostic visit, within annual visit limits. Employers may contribute anywhere from 0 to 100 percent toward GAP.

OptiMed Level Funded Health Plans with RBR work differently again. Reference based reimbursement pays providers against a reference price instead of a negotiated network rate, and OptiMed offers tools to find RBR-friendly practitioners and support with balance billing disputes. A program that declines the reference price can bill the balance, which is the single largest cost risk on a long residential stay.

Typical US market rates before insurance
Level of care	Monthly	Daily
Medical detox (7–14 days)	$1,500 – $5,200 per week	$215 – $745
Residential inpatient	$6,200 – $26,000	$205 – $865
PHP	$7,200 – $14,000	$240 – $465
IOP	$2,700 – $9,200	$90 – $305
Outpatient	$1,300 – $5,200	$45 – $175

Those are billed rates before any plan payment. Where a limited medical or MEC design turns out to pay only a fixed daily amount, the remainder is a private balance, and a self pay or sliding scale arrangement with the admissions team is worth pricing alongside the plan benefit rather than after it.

Does OptiMed Cover Suboxone, Methadone and Other Addiction Medication?

No formulary or authorization information is published for buprenorphine, naltrexone or methadone, so the drug list for the specific plan is the only reliable answer. Level funded plans use a Cigna or US-Rx pharmacy benefit, and the OptiMed provider network page also lists Broadreach and CVS Caremark under prescription drug management.

Where the Prescription Is Filled

Ask which pharmacy vendor administers the plan, then ask that vendor for the tier and any step requirements on the exact formulation. Suboxone and buprenorphine are retail pharmacy fills, while methadone for opioid use disorder is dispensed inside a licensed opioid treatment program and is usually billed as a program service rather than a pharmacy claim, which puts it under the medical side of the plan.

Limited Medical and GAP Drug Benefits

OptiMed Limited Medical includes an indemnity outpatient prescription drug benefit, meaning a fixed payment rather than a percentage. OptiMed GAP offers an optional rider covering generics only, or generics plus brand. Neither is a substitute for a full pharmacy benefit, so the long-term cost of medication assisted treatment should be priced before a maintenance plan is started.

Which Rehab Centers Are In-Network With OptiMed Health Plans?

OptiMed does not own a provider network. A program is in-network when it holds a contract with the rented network printed on the medical ID card, which is Cigna shared administration, First Health, or one of the PHCS/MultiPlan options. OptiMed’s find a provider page tells members to match the card logo to the matching directory, and that directory settles network status.

Read the network name closely. PHCS Practitioner & Ancillary Only and the PHCS and MultiPlan Limited Benefit Plan directories are narrower than PHCS Primary PPO in its major medical version, and a narrow practitioner network may not include hospital or residential facility access at all. Programs that accept OptiMed Health Plans are gathered on the OptiMed Health Plans page, where each listing shows the payments the program says it accepts, its licensing and accreditation, and the distance to the nearest airport, so a shortlist can be drawn up before the call that settles contracts and precertification.

How Do I Find a Rehab That Takes OptiMed Health Plans?

Start with the card. Identify the OptiMed product and the network logo, search that network’s directory for substance use treatment, then call the program with the product name, the network name and the group number. Ask the admissions team whether it holds a contract in that specific network and whether it has billed an OptiMed plan before.

Keep the employer in the loop. Because these are employer group products, the human resources or benefits contact can produce the plan document faster than anyone else, and on a level funded plan that document is the final word on what is covered. Claims are filed to OptiMedHealth in Norcross, Georgia, or electronically through the Optum clearinghouse, which the billing office will want to know in advance.

Is OptiMed Health Plans the Same as OptiMed Health Partners?

No. OptiMed Health Partners of Kalamazoo, Michigan is a separate, independently owned specialty medication and infusion organization that appears in some employer plan materials as a preferred provider. It is not the employer health plan company described here, and neither is Optima Health in Virginia, now Sentara Health Plans. Names overlap; the companies do not.

Before you call a program: have the OptiMed product name, the network logo from the card, the group number and the plan document or summary of benefits to hand. Those four items let an admissions team quote a real number instead of an estimate, and they tell you within one call whether the plan is major medical coverage or a fixed-payment design.

References and Citations

Optimed Health, Inc. — product pages for level funded major medical, RBR, GAP group supplemental, limited medical, MEC and MEC Edge, provider networks page, find a provider page, contact and claims pages, and state notices.
CarynHealth — company profile, group solutions and member support pages, and the acquisition banner dated September 30, 2025.
United Group Programs, Inc. — claims department details named on OptiMed state notices; Gemspring Capital announcement of its investment in United Group Programs, December 2016.
RehabSeekers directory listings and market rate research, United States, 2026. Ranges are indicative and vary by facility, length of stay and coverage.