How UMR Mental-Health Coverage Works
Because UMR is a third-party administrator for self-funded employer health plans, your exact benefits depend on what your employer chose. Still, most UMR plans follow a similar structure.
If you’re in a PPO or open-access plan (the most common design), therapy and psychiatry visits usually cost $0–$40 per session, or 20% after deductible if you’re on a high-deductible version. Mental health care is fully integrated with your medical benefits, so there’s no separate deductible.
On a high-deductible HSA plan, coverage works the same way, but you’ll pay the contracted rate until your deductible is met. After that, coinsurance kicks in (around 20%) before you settle into the same $0–$40 copay structure as PPOs.
In states where UMR administers Medicaid, mental health services are generally $0 per visit, with unlimited medically necessary sessions included.
For retirees or those on COBRA using the UHC Choice Plus network, the design usually mirrors active-employee plans, though it’s always best to check your Summary of Benefits for the exact breakdown.
Coverage fast facts
- Unlimited visits. UMR does not cap medically necessary therapy or psychiatry sessions.
- No referral needed. Most UMR benefit summaries list “No” under referral requirements for specialists, including mental health.
- Telehealth parity. Many employers waive copays for virtual therapy and psychiatry, especially when delivered through Optum or another preferred partner.
- Pre-authorization may apply. Some plan designs still ask for a quick authorization before starting therapy, so always confirm first.
UMR Mental-Health Providers Types
UMR contracts with a range of licensed providers, including:
- Therapists and counselors (LCSWs, LMFTs, LPCs) for weekly talk therapy, coping skills, and family sessions.
- Psychologists (PhD or PsyD) for therapy plus psychological testing and trauma-focused treatments.
- Psychiatrists (MD/DO) for diagnosis, prescribing, and managing complex mental health conditions.
Many members find the best results come from combining services—for example, weekly therapy with a counselor plus periodic medication check-ins with a psychiatrist.
Real-Life Use Case: How Rosa Found a Therapist That Takes UMR
Profile: Rosa, 29, graphic designer in Atlanta, covered by a UMR-administered PPO. She’s felt persistent sadness for three months.
- Day 1 – Portal Login
Rosa opens UMR.com → “Find a Provider.” The tool lists behavioral-health clinicians in the Choice Plus network
- Day 1 – Smart Filters
She selects “Telehealth,” “evening hours,” and “CBT,” which returns four therapists that take UMR within 10 miles—each marked “Accepting patients.”
- Day 2 – Cost Check
Her cost-estimator tile shows $25 for office visits or $0 for network tele-therapy.
- Day 3 – First Video Visit
She books a Thursday session with Dana Lopez, LCSW—an UMR in-network therapist experienced in depression care.
- Day 10 – Medication Consult
Dana recommends that Rosa try medications in addition to therapy. Rosa schedules a 30-minute virtual check-in with an UMR psychiatrist the next afternoon (also $0).
Time from search to therapy: three days. Out-of-pocket cost: $0.
Step-by-Step: Booking Therapy Through UMR
- Sign in to UMR.com or call the toll-free number on your card.
- Choose Find a Provider → Behavioral Health (no referral needed for most plans)
- Filter the directory: Narrow by zip code, specialty (trauma, couples, ADHD), language, telehealth, or evening hours.
- Verify in-network status: Look for the green check or the phrase “In Network – UnitedHealthcare Choice Plus.” If in doubt, phone the office—UMR recommends double-checking before every appointment.
- Check the cost: Use the cost-estimator link or ask the office to run an eligibility check. Expect $0–$40 per visit once any deductible is met.
- Confirm pre-authorization (if required): A minority of plans still need a quick approval code before the first session
- Book, complete intake forms, and add the appointment to your calendar.
In-Network vs. Out-of-Network: What Changes?
With UMR, it’s almost always best to stay in-network. When you do, your costs are predictable—usually $0–$40 per visit or 20% after your deductible if you’re on a high-deductible plan. Your provider handles all the claims paperwork, and your mental-health records stay seamlessly integrated with your medical benefits. In some plans, you may need a quick pre-authorization before starting, but the process is generally straightforward.
If you choose to go out-of-network—an option usually available only with PPO plans—the experience is different. You’ll likely pay 40–60% of the allowed amount plus any balance the provider bills beyond UMR’s contracted rate. You’ll also be responsible for filing your own claims, and pre-authorization is more commonly required. On top of that, coordination with your overall medical record is limited, which can make care less connected.
Bottom line: Staying in-network keeps your care easier, cheaper, and better coordinated. Out-of-network might be worth it for a niche specialty, but it usually comes with higher costs and more paperwork.
Digital & Telehealth Options
UMR members have multiple ways to access mental health support from home, ranging from live video sessions to self-guided resources.
With Optum Virtual Care, you can connect by video with licensed therapists or psychiatrists. Costs are usually $0–$40 per visit, and many plans now cover these sessions at no cost ($0). This option is available under most UMR PPO and HSA designs.
Many employers also add an Employee Assistance Program (EAP) to their UMR benefits. EAPs typically include 3–8 free counseling sessions per issue, giving you a confidential way to work through stress, relationship concerns, or work-life balance challenges at no cost.
For extra support between visits, all members can access self-guided digital tools through the Optum portal. These include mindfulness practices, CBT-based modules, and mood tracking, all free to use anytime.
Tip: Just like office visits, all telehealth sessions count toward your deductible and out-of-pocket maximum, so you won’t pay more for choosing virtual care—it simply adds convenience and flexibility.
Cost & Coverage
What you’ll pay for therapy or psychiatry through UMR depends on your plan design, but the structure is fairly consistent.
If you’re on a PPO or HMO plan, in-office therapy sessions (around 45 minutes) usually cost $0–$40 per visit, while an initial psychiatric evaluation typically runs $40–$60. Many plans also cover tele-therapy at little to no cost, with virtual sessions often billed the same as in-person—or sometimes waived entirely.
Members on a high-deductible plan follow the same rules, but you’ll pay the full contracted rate until your deductible is met. After that, you’ll usually owe about 20% coinsurance before transitioning to the standard copay range.
If you have Medicare as secondary coverage, costs are generally 20% coinsurance, though a Medigap policy may pay that portion for you—often leaving you with no out-of-pocket expense.
Tip: If the first clinician you see doesn’t feel like the right fit, don’t hesitate to switch. Just reopen the UMR directory and select another in-network provider. It’s penalty-free, quick, and encouraged—because finding the right therapist is part of the process.
What to Do When You Can’t Get an Appointment
If you're running into long wait times, here are steps you can take to speed things up:
- Keep a Log: Write down every call you make—include the date, who you spoke to, and the next available appointment they offered.
- Call for Help Finding a Sooner Spot: Ask UMR to connect you with a Care Coordinator or Optum Behavioral Health representative. They can search for cancellations or other in-network options.
- Request a Timely Access Waiver: If you’re being told to wait too long, ask for a network adequacy or parity exception. Federal law requires UMR to help you access care within a reasonable timeframe.
- File a Complaint: If you're not getting the help you need, log in to your UMR member portal and submit a formal complaint. The plan must respond in writing within 30 days.
Persistence—and keeping detailed notes—can make all the difference in getting care sooner.
Frequently Asked Questions
Does UMR cover therapy?
Yes. Outpatient therapy with licensed, in-network clinicians is an essential benefit; typical cost $0–$40 or 20 % coinsurance after deductible.
How do I find therapists that take UMR near me?
Sign in to UMR.com → Find a Provider → Behavioral Health, enter your ZIP, and filter for “In Network.”
What’s the difference between a UMR therapist and a UMR psychologist?
“Therapist” (LCSW, LMFT, LPC) is a broad counseling designation. “Psychologist” (PhD/PsyD) can also perform testing. Both are covered if in network.
Are UMR psychiatrists accepting new patients?
Many are—especially via Optum Virtual Care. Use the “Accepting patients” filter and consider tele-slots.
Will my virtual session count toward my deductible?
Yes. Telehealth visits apply to the same deductible and out-of-pocket max as office visits.
