Researching and finding a treatment facility is the first step for many people on the road to recovery. But, before selecting a rehab center to attend, it’s important to understand what kind of coverage you may be eligible for when it comes to substance use disorder treatment.
Aetna is a widely popular private insurance carrier that offers comprehensive coverage for drug and alcohol addiction treatment. Depending on the plan you have with Aetna, you can receive coverage for a variety of addiction treatment options.
Using Aetna Insurance For Alcohol Use Disorder Treatment
Aetna Insurance is a well-known insurance company that provides both individual and group insurance plans throughout the United States. The provider offers high-quality and comprehensive care that covers a broad range of medical services and treatment needs.
The 2008 Mental Health Parity and Addiction Equity Act established that insurance companies provide coverage for substance abuse and mental health services that is equal to that of other medical services and treatment covered. This means if your insurance plan will cover a stay at the hospital, it should also cover some or all of a stay at an inpatient alcohol addiction treatment facility.
Plus, the Affordable Care Act ensures that those with pre-existing conditions, such as an alcohol use disorder, can still receive coverage. As a result, even if you are currently struggling with addiction, Aetna cannot deny you health insurance and will provide coverage for treatment depending on the plan you select.
How Much Will Aetna Insurance Cover For Alcohol Addiction Treatment Programs?
To better understand what type of treatment and how much of it will be covered under an Aetna insurance plan, let’s review three basic insurance terms.
- Copay/Coinsurance — This is the amount or percentage that you will be required to pay for each in-network doctor’s office visit or day of a stay at an inpatient rehab facility. For example, your copay for a visit to the doctor or a particular treatment may be $35, with Aetna paying the rest. Or, one day of inpatient treatment may require a copay of $150, and Aetna covers the remaining amount.
- Deductible — A set amount of money that you will be required to pay out-of-pocket each year before Aetna will begin paying. Your deductible will restart each year. For example, your yearly deductible may be $1,500, which means you will need to pay $1,500 in health or treatment costs before Aetna provides coverage.
- Maximum Out-Of-Pocket — Similar to a deductible, a maximum out-of-pocket amount is often set each year. Once the out-of-pocket sum has been met, Aetna will provide coverage for medical services thereafter.
Each Aetna plan is different and will vary in the amount of coverage provided. However, it’s important to know that how much you will pay for alcohol addiction treatment will largely depend on the treatment center you select.
For example, if your Aetna plan will cover 80 percent of inpatient alcohol addiction treatment, and the rehab facility you select costs $12,000, you will be required to pay $2,400. However, if you choose to go to a treatment center that costs $30,000, your out-of-pocket costs will be $6,000.
Aetna insurance plans come in two different forms—HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Additionally, in some states Aetna uses the standard metal level classification for insurance plans that can include gold, silver, and bronze. Each plan will have its own limitations and variations in coverage.
Aetna HMO Plans For Alcohol Addiction Treatment
Common coverage details in an Aetna HMO plan for inpatient drug and alcohol treatment may include:
- Coinsurance: 20 to 30 percent
- Copay for inpatient rehab programs: $250 copay/day, days one through five, or 20 percent coinsurance after $250 copay
- Inpatient rehab admission fees: $500 to $1,000 copay/admission
Aetna PPO Plans
Common coverage details in an Aetna PPO plan for inpatient drug and alcohol treatment may include:
- $500 admissions copay or 20 percent coinsurance
- 100 percent coverage for in-network treatment facilities minus copay or coinsurance
- 50 percent out-of-network coverage and mandatory preauthorization
Aetna Insurance Prior Authorization Requirements
Some forms of treatment for alcohol addiction require prior authorization, or precertification, before they will be covered by Aetna. These include inpatient admissions, residential treatment center admissions, outpatient detox, partial hospitalization programs, and intensive outpatient programs. Prior authorization is required to ensure that only medically necessary treatment is being received and to avoid unexpected fees after receiving treatment.
Do Rehab Centers Need To Be In-Network For Aetna Insurance?
Most Aetna insurance plans require you to seek treatment from providers that are considered in-network. Opting for treatment with an in-network provider or rehab facility will ensure that you receive the most sufficient coverage for alcohol addiction treatment services.
Aetna offers many different types of plans that vary regarding in-network requirements. A few of the plans offered by this insurance provider include:
- Network Only Plans — Individuals receive care from their primary care physician (PCP) who then refers them to specialists in-network.
- Network Option Plans — This type of plan allows individuals to go to any in-network doctor for medical services or treatment.
- Indemnity Plans — These plans allow individuals to see any health care provider regardless of if they are in-network.
Most plans with Aetna require individuals to seek treatment through an in-network provider, while other plans may cover some or all of out-of-network care. It’s important to be familiar with the type of plan you have to better understand your options when it comes to seeking treatment.
Alcohol Addiction Treatment Services Covered With Aetna Insurance
Aetna offers coverage for a number of different alcohol addiction treatment services, from the initial diagnosis to aftercare. Some of the most common forms of treatment include partial hospitalization programs, intensive outpatient programs, and inpatient treatment.
Insurance companies often group treatment into two different categories: emergency and non-emergency treatment. Emergency treatment typically doesn’t require preauthorization, while non-emergency treatment may require precertification for the policyholder to obtain insurance coverage. Treatment is considered emergency when an individual is suffering life-threatening symptoms, is a threat to himself or others, or requires immediate medical attention.
Outpatient Alcohol Treatment Services
A few of the many different types of outpatient treatment covered by Aetna include:
- Diagnosis — Many people begin their journey to recovery from alcohol addiction with a trip to their primary care physician’s office to receive a proper diagnosis. Your PCP can also recommend the most appropriate form of treatment for your condition.
- Intensive Outpatient Programs (IOP) — Intensive outpatient programs are an intensive form of alcohol addiction treatment that requires the individual to attend sessions at the treatment facility several times a week. IOPs may be required before Aetna will cover inpatient alcohol addiction treatment.
- Partial Hospitalization Programs (PHP) — This form of treatment is more intensive than IOP but less intensive than inpatient alcohol addiction treatment. Partial hospitalization programs require individuals attend a program several hours every day and return home in the evenings.
Inpatient Alcohol Treatment Services
In addition to outpatient alcohol addiction treatment, there are also many options available for inpatient treatment. Inpatient treatment is more intensive than outpatient treatment and is recommended for those with a more severe alcohol use disorder.
- Medical Detox — In a medically supervised detox program, the individual stays at a hospital or other facility to withdraw from alcohol. Medically supervised detox programs are the safest way to rid alcohol and other substances from your system and are covered by Aetna.
- Inpatient Alcohol Rehab Programs — Inpatient alcohol addiction treatment is often provided at a rehab facility that is comfortable and supportive. Inpatient treatment allows individuals to receive help for an alcohol use disorder and requires patients live at the facility for an extended period of time, usually around 30 days.
Find Alcohol Rehab Centers That Accept Aetna
To identify and use your insurance plan to the fullest, it’s important to first understand what plan you have and its stipulations. Each plan with Aetna is different, and what is covered and the amount of coverage offered will vary from plan to plan.
The most cost-effective way to use your Aetna insurance is often to stay within network. However, some circumstances may require you to go out-of-network, so it’s always best to familiarize yourself with both in-network and out-of-network coverage offered by your plan.
To learn more about using Aetna insurance for alcohol addiction treatment or receive confidential verification of insurance benefits, call us today.