Does Aetna Insurance Cover Drug Rehab?
As a part of CVS Health, Aetna insurance offers coverage for 39 million people across the country.1, opening para. While the company is best known for its health insurance plans, it also offers dental and pharmacy benefits. Aetna members can take advantage of Medicare plans, Medicaid services, behavioral health programs, and medical management.1, first listLuckily, the Aetna coverage network stretches across the country, meaning members will have access to 1.2 million healthcare professionals and over 5,700 hospitals.1, third list
Are you wondering if you can use your Aetna benefits at drug or alcohol rehab? Aetna does cover this type of treatment, but to know for sure if your benefits will be accepted at a particular facility, you have two options. Rehab centers can check your coverage based on the information provided or you can call the number on the back of your insurance card for more information about your coverage.
What Will Aetna Insurance Cover?
When it comes to Aetna substance abuse treatment, the insurance provider offers coverage for quite a few things. Aetna may offer coverage for the following alcohol and drug treatment options:
- Screening, Brief Intervention, and Referral to Treatment (SBIRT). As an evidence-based practice, SBIRT allows a healthcare provider to screen you for a substance abuse disorder, even if you haven’t sought treatment for one yet. It’s often performed by primary care physicians who think you may be at risk. 2, 2nd para
- Detoxification. In detox, you’ll work on managing your physical dependency. You’ll wean off your substance and get medical help for dealing with withdrawal symptoms. 3, underlined sections
- Inpatient/residential rehab. For this treatment, you’ll live at a facility and receive 24-hour care. This includes alcohol and drug treatment facilities, psychiatric hospitals, and general medical hospitals. 3, underlined sections
- Outpatient rehab/therapy. Outpatient rehab is therapy is when you live at home but attend treatment for a few hours each week. 3, underlined sections
- Intensive outpatient programs (IOP). IOP allows you to start working on rebuilding your life while still receiving intensive care. You’ll live at home but attend programming several times a week. 3, underlined sections
- Partial hospitalization programs (PHP). This is kind of a hybrid of inpatient and outpatient. You’ll spend the majority of your day in treatment, but then you’ll return home at night. 3, underlined sections
- Continuing care. Once you make it through treatment, you still need to watch out for relapse. Continuing care helps you do that by linking you with support groups, providing resources, and more. 3, underlined sections
Does Aetna Insurance Cover Mental Health Care?
Yes, Aetna insurance is legally required to provide coverage for mental health care. The Affordable Care Act stipulates that all individual and small employer health insurance plans must cover mental health and substance use disorder services. This includes rehabilitative and habilitative services that might be recommended by a health professional.4, paragraph
When you have a mental health issue and substance abuse problem at the same time, it’s called a co-occurring disorder. Examples of mental health conditions commonly seen with substance abuse include:5, ix, “Overall Key Messages” 1st para.
- Bipolar disorder.
- Posttraumatic stress disorder.
- Personality disorders.
- Anxiety disorders.
Treating co-occurring disorders at the same time is crucial. Without concurrent treatment, you may experience a domino effect that can reduce your chances of recovery for both disorders.5, pg. ix bottom para.
Some of the Aetna mental health services you might be able to utilize include:6, options for getting treatment
- A behavioral health case manager who arranges your outpatient care, connects you with community resources, and consults with caregivers.
- Behavioral therapy, which is a session with a qualified therapist that helps you talk through the issues behind your mental health problems.
- Medication therapy, which can help manage your symptoms, so you feel better.
How Long Does Aetna Insurance Cover Rehab?
Research shows that a longer treatment duration is most effective. The National Institute on Drug Abuse recommends residential treatment of at least 90 days for maximum effectiveness.7, first para. However, every person’s needs are different, which is why you’ll need to rely on your medical support team to create your personalized plan of care.
Because of this and the wide array of policies and tiers of coverage, Aetna substance abuse treatment coverage can vary. Your coverage will depend on your Aetna plan and your treatment plan will depend on your doctor’s recommendations.
The best way to verify your Aetna drug rehab coverage is to get your specific plan information. You can do this by looking at your insurance card. There should be an Aetna hotline number on the back you can call with questions. Or, you can call the facility you’re considering directly to ask if they’re in the Aetna rehab provider network.
What If my Aetna Policy Does Not Cover Rehab?
Depending on your Aetna plan, it may not offer robust rehab coverage. You may have limits on how long you can stay at a facility or high co-payments (the amount you pay to receive benefits).
Luckily, you may have financing or scholarship options available to supplement your Aetna drug rehab benefits. Many drug treatment facilities offer a sliding-scale fee based on what you can afford. Others may receive government funding to provide free treatment to people with low incomes. Some may also accept payment in installments over time.
Whatever you do, don’t delay treatment because you don’t have the money for it. Getting treatment right now is critical, as the longer you go without help, the harder it will be to eventually get back on track. Addiction is a chronic disease, meaning that it will only get worse without treatment.7, second para.
Aetna In-Network versus Out-of-Network Rehab Centers
Like all insurance companies, Aetna has a network of Aetna-approved providers. These are facilities and professionals that have negotiated their rates with the insurance company. This rate is typically lower than what the service provider would charge to a non-Aetna customer, which helps you save money. Usually, you’ll only have to cover a co-pay (a set amount for a specific service), coinsurance (a set percentage of the bill defined by your insurance plan), or a deductible (a monetary threshold you need to meet before your full benefits kick in).
If you choose to seek care outside of this network, Aetna may not provide full coverage. Depending on your plan, you may be eligible for a limited amount of insurance coverage.8, “save money by staying in network”
Consider the following example, which illustrates the cost savings of receiving care at an in-network versus out-of-network rehab facility. A person enters treatment for 14 days at an in-network facility and has 20% coinsurance. Coinsurance is the amount the person receiving treatment pays; the insurance company pays 80%. For an out-of-network stay, however, the insured person would pay 40% coinsurance and the insurance company would pay 60% of the cost.9, pg. 2, Example 3
At an in-network treatment center, an Aetna member would pay $1,946 for their stay. At an out-of-network facility, the bill for the member would be $8,871. 9, pg. 2, Example 3 As you can see, this is a huge savings, so you should try to stay in-network as much as possible.
Checking to see if a rehab center you’re looking at is in-network or out-of-network is simple. You can use Aetna’s online provider lookup to find a facility that’s in-network in your area. Or, if you have a specific facility already in mind, you can call Aetna to verify benefits. Finally, getting in touch with the facility directly and providing your insurance information can also be an easy way to make sure you’ll be covered.
How to Check Aetna Rehab Coverage
Still have questions about whether your Aetna insurance benefits will cover substance abuse treatment? American Addiction Centers can help. We’re a nationwide network of top-ranked substance abuse and alcohol rehab facilities, and we’re pros at verifying insurance coverage. Just enter your Aetna information into the form below, and we’ll quickly be able to tell you what kind of services are covered.
Want answers even faster? Call our helpline to speak with a knowledgeable American Addiction Centers representative right away. In your confidential call, they’ll be able to check your Aetna benefits while you’re on the phone. That way, you can start making plans for your recovery without delay.
- (n.d.). Aetna facts.
- (n.d.) Screening, Brief Intervention and Referral to Treatment.
- (n.d.). Alcohol and drug treatment.
- S. Department of Health & Human Services. (2019). Does the Affordable Care Act cover individuals with mental health problems?
- Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders.
- (n.d.). Helping you feel your best.
- National Institute on Drug Abuse. (2018). How long does drug addiction treatment usually last?
- (n.d.). Network and out-of-network care.
- (2013). Save money with Aetna’s provider network.