Rather than looking at the individual as a whole, many insurance policies place a fixed limit for substance abuse treatment. Recognizing that there are no one-size-fits-all programs for drug and alcohol misuse, Aetna tailors an addiction treatment solution to an individual’s requirements. Aetna works with an individual’s requirements to identify nearby drug or alcohol addiction treatment. The insurance plans include several alternatives for inpatient and outpatient therapy, as well as additional services to aid in your rehabilitation.

Does Aetna Cover Addiction Treatment?

If you wonder whether Aetna’s health insurance plan covers substance abuse treatment, the short answer is yes. Aetna will pay for at least part of your addiction recovery. Your treatment may be partially or entirely covered, depending on the plan you have.

The Affordable Care Act (ACA) mandates that all insurance carriers provide some kind of coverage for alcohol and drug rehab treatment. It also requires all health insurance plans include behavioral health treatment (e.g., psychotherapy and counseling), mental health inpatient services, and substance use disorder (SUD) treatment.

Your financial responsibility for your treatment will be determined by the state you live in, your healthcare plan, the therapy you require, and whether you pick an in-network or out-of-network institution. You will most likely be responsible for some out-of-pocket fees regardless of whatever drug and alcohol treatment center you choose or what insurance policy you have.

The amount of health coverage you have depends on your state of residency, whether the institution is in-network or out-of-network, the length of your stay, and the quality of your insurance plan. When you have Aetna insurance, drug and alcohol treatment costs may vary from person to person. They will also depend on the addiction center, the type of program attended, and particular services obtained.

Aetna Policy Coverage for Substance Abuse

Aetna’s Continuing Care initiatives are dedicated to patient follow-up. Members gather once a week to provide support to “alumni” of various treatment programs. Social gatherings are sometimes held to celebrate an accomplishment or a recent recovery. The outcomes of initiatives like this are essential — they keep people involved in their community and provide ongoing assistance.

Consult your health insurer to determine what your specific plan covers, including coinsurance, copays, and deductibles. Individuals with Aetna insurance may be covered for the following substance abuse treatments:

  • Detoxification
  • Residential rehabilitation
  • Inpatient rehabilitation
  • Intensive outpatient treatment
  • Partial hospital treatment
  • Continuing care programs

Do the Centers Have to Be In-Network?

Although not all Aetna plans need service providers to be in-network, out-of-network programs may be more expensive. It’s also worth noting that programs that aren’t part of Aetna’s network haven’t been screened for treatment that adheres to current standards of practice.

Pre-certification or authorization of a treatment program may be necessary in some cases. Examples of such cases include:

  • Inpatient admissions
  • Residential Treatment Center admissions
  • Intensive Outpatient Programs
  • Outpatient detoxification
  • Partial Hospitalization Programs

Pre-certification is a procedure that determines if the requested service or program fulfills Aetna’s clinical coverage requirements. Before you begin drug addiction treatment, check with your insurance provider to determine whether pre-certification is required.

Inpatient Treatment Coverage

The costs of inpatient treatment programs may vary depending on your location and Aetna policy coverage. Some Aetna plans provide 0 percent coinsurance for in-network inpatient care — insurance that kicks in after you pay your whole deductible. Other plans may have a copay per admission for various treatments.

Coverage for out-of-network carriers varies according to region and plan type. Some plans may not cover any out-of-network therapy; others may have a 30 to 50 percent coinsurance. Out-of-network programs usually need pre-certification; otherwise, a penalty per occurrence will apply. Consult your provider to find out what kind of therapy your policy will cover.

Outpatient Treatment Coverage

Aetna’s outpatient rehab coverage differs for everyone. The prices of various rehab services are shown below. Certain Aetna policies may not include outpatient treatments or may have a set copay rate. Several additional plans have a per-visit copay. The location and kind of insurance coverage are the two most important factors in coinsurance or copays.

Checking Your Insurance Benefits

Logging in to your online account on the Aetna member website is the easiest method to learn about your specific Aetna insurance treatment coverage. You’ll be able to evaluate your coverage and benefits, print your insurance card, and see if a particular doctor is in the insurance network.

Speak to a treatment provider today for more information on treatment and insurance alternatives.

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