Many insurance policies set a predetermined limit on substance abuse treatment rather than looking at the individual as a whole. Recognizing there are no one-size-fits-all plans for drug and alcohol abuse, Aetna works with an individual’s needs to find an addiction treatment solution.
Aetna Healthcare Addiction Resources
Aetna is committed to patient follow-up with their Continuing Care programs. Members meet weekly and offer support for the “alumni” of various treatment programs. Sometimes social events are organized to celebrate an achievement or recent recovery. The results from programs like these are significant – they keep individuals affiliated in their community with on-going support.
Aetna Policy Coverage for Substance Abuse
To determine what your individual plan covers – including coinsurance, copays and deductibles – you will need to contact your insurance provider.
With Aetna insurance, individuals may be covered for the following substance abuse treatments:
- Inpatient rehabilitation
- Residential rehabilitation
- Partial hospital treatment
- Intensive outpatient treatment
- Continuing care programs
Do Treatment Centers Need to be In-Network?
Even though not all Aetna plans require service providers to be in-network, programs that are out-of-network may cost more. It’s also important to note that programs not in Aetna’s network have not been screened for treatment that is consistent with current standards of practice.
In some cases, pre-certification or authorization of a treatment program will be required. Such cases may include:
- Inpatient admissions
- Outpatient detoxification
- Residential Treatment Center admissions
- Intensive Outpatient Programs
- Partial Hospitalization Programs
Pre-certification involves a review process to determine whether the requested service or program meets Aetna’s clinical criteria for coverage. Be sure to check with your insurance provider to see if your substance abuse treatment will require pre-certification before you begin the program.
Aetna Coverage for Inpatient Treatment
Depending on your location and Aetna policy coverage, the costs associated with inpatient rehab programs may vary.
Inpatient Rehab Service and Costs
For in-network inpatient services, some Aetna plans have 0 percent coinsurance – insurance that kicks in once you pay your full deductible. Other plans may require a copay per admission for different services.
In regards to out-of-network providers, coverage varies based on location and the type of plan. Some plans may not cover any form of treatment that’s out-of-network; however, others have 30 to 50 percent coinsurance. Out-of-network programs frequently require a pre-certification, otherwise there will be a penalty per occurrence. Talk with your provider to determine the type of treatment your policy will cover.
Aetna Coverage for Outpatient Treatment
Outpatient rehab coverage through Aetna is different for everyone. Various costs associated with rehab services are compiled below.
Outpatient Rehab Services and Costs
Certain Aetna policies may not have an option for any outpatient services or may involve a fixed coinsurance percentage. Several other plans have a set copay per visit. The largest factors of coinsurance or copays are location and type of insurance coverage.
Speak with your insurance provider to determine what will best work for you. Aetna’s 24-hour phone line allows customers to connect with a member services professional who can provide the answers you need about your policy’s coverage.
How Can I Pay the Costs Not Covered By My Aetna Plan?
It’s time to get started on your path to recovery. We’ll find the best treatment option for you and determine any costs you may be responsible for. Regardless of what your insurance provider will cover, there’s a wide range of alternative methods to help cover any expenses.
For help verifying your insurance plan and finding treatment solutions, contact us today.