Using Aetna Insurance for Drug Rehab

Can I use Aetna Insurance to pay for drug rehab?

Aetna Insurance offers a range of health insurance and employee benefits plans. Your behavioral health benefits can help you to pay for drug rehab, but the coverage options and costs involved will vary from plan to plan. You can use Aetna Navigator, their online portal, to view specific coverage, and contact customer support online to make sure that the treatment program you would like to use is covered under your insurance plan.

Aetna is not offering individual plans for 2018. However, you can visit eHealth or healthcare.gov for options including Aetna open-access plans, copay only plans, and high-deductible plans. Open-access plans allow you to choose your doctor; they do not require referrals, and they do not require a primary care doctor. Copay-only plans guarantee that you are only responsible for copays, with primary care physician visits and generic drugs covered before you reach your deductible. High-deductible plans offer preventative care before the deductible is met, coverage through a primary care physician before the deductible is met, and the option of a health savings account. To view your Aetna Insurance plan’s details, you can log into Aetna Navigator.

Aetna Insurance Coverage for Drug and Alcohol Rehab

For behavioral health concerns, Aetna Insurance gives you access to psychiatrists, psychologists, counselors, therapists, social workers, psychiatric nurse practitioners, and primary care doctors. Because behavioral health issuers often go hand in hand with substance abuse, it is important to address behavioral health problems if you are seeking care for substance abuse issues. Check your Aetna plan for alcohol and drug rehab coverage.

Length of Addiction Treatment Aetna Will Cover

Not everyone recovers from addiction at the same pace, which is why Aetna Insurance providers may consider other factors in terms of private addiction treatment. Instead of providing you with a pre-determined length of stay such as three days, Aetna will cover a portion of the addiction rehab stay based on deductible and amount of coverage. If you have any additional coverage through your employer or choose a more affordable treatment facility, you might have a longer stay. The treatment center and your insurance will keep your information discreet regardless of the duration of your stay.

The majority of patients treated in a primary care setting have a physical issue that is affected by stress, difficulty maintaining a healthy lifestyle or a psychological disorder.

Types of Drug & Alcohol Rehab Available With Aetna Insurance

Drug and alcohol rehab has evolved and improved over the past few decades. Historically the usual approach was a referral to a 28-day inpatient or residential program. Currently, there are a number of treatment models and environments allowing patients to integrate their treatment as they are ready.

The following are the types of rehab available to support you in you recovery:

Detoxification: Alcohol and some drugs can cause physical dependency and withdrawal symptoms. Some alcohol and drug dependent individuals can have a safe detox in an outpatient setting. The need for admission to inpatient treatment for detox depends upon the amount of alcohol and/or the type of drug being ingested, the severity and length of use and current mental and physical condition of the individual. Medical risk factors relating to the patient’s other illnesses are also considered.

Rehabilitation (Residential and Inpatient): These rehab programs are offered in Hospitals and Alcohol and Drug Treatment Facilities. Patients receive 24-hour supervision with oversight of psychiatric and medical conditions while working on their recovery from addiction. Once the individual is stable they can typically move to an outpatient level of care for their ongoing treatment.

Partial Hospital Treatment (PHP): PHP programs typically provide four to eight hrs of programming during the day, allowing individuals to go home at night. Typically, an evening self-help group such as AA or NA may be an addition to the treatment program. The advantage for the patient in these approaches is that they can be in a supportive environment while experiencing some of their stressors or triggers.

Intensive Outpatient Treatment (IOP): Intensive outpatient programs typically meet for three to four hours at a time, often in the evenings. They may meet three to four days per week. Self-help group participation is usually expected when participating in IOP. As with the PHP, individuals can experience stressors and triggers while having the ongoing support of their team. Another important consideration is that individuals can return to work while attending an evening program.

Continuing Care Programs: Drug and alcohol treatment programs in Aetna’s network offer Continuing Care support programs. Usually these support or “alumni” groups meet weekly. Occasionally former clients organize their own social events to celebrate and strengthen recovery. Some people benefit from seeing an individual counselor for addiction therapies after completing a treatment program.

Treatment of alcohol and drug abuse is a process that occurs over time. A person’s need for each particular type of treatment is determined by their own condition, not by pre-determined program duration like “28-days”, etc. The best results occur when the individual stays affiliated with a treatment program in their own community and participates in some form of a self-help group.

Aetna’s Requirements for Substance Abuse Treatment

In qualifying you for a rehab program, Aetna Insurance considers a number of factors for rehab coverage in its plans. They look at the type and severity of the addiction, the cost-effectiveness of the program, and whether or not the specific treatment type meets their requirements for your specific rehab needs. Once accepted into a treatment program, the professionals at the facility will work with Aetna to ensure that you receive appropriate treatment for drug or alcohol dependence.

For more details on your specific coverage through Aetna, you can also call the Member Services telephone number on the back of your insurance identification card. They give you access to a web portal that can help you with finding addiction and behavioral health resources in your area. Because they have a large network of providers, you can certainly find recovery services that accept Aetna health insurance. In order to find a provider for addiction treatment near you, you can search the directory of Aetna’s providers online.

Some helpful questions to ask regarding substance abuse therapies include:

  • How do you decide that I need treatment?
  • What coverage is available for addiction treatment?
  • Will there be a copay or deductible for treatment services?
  • Is there an out-of-pocket expense maximum for treatment?
  • How can I find local rehab providers and whom do you recommend?

Once you are approved for rehabilitation services, you and your treatment team will need to check in regularly throughout rehab, to make sure each of the services you’re provided is covered. If those therapies aren’t included, you and your team can determine what you are expected to pay out of pocket.

Utilizing Your Aetna Insurance for Addiction Treatment

We strive to provide the highest-quality treatment to any individual seeking help for themselves or their loved ones. Through utilization of our patients’ health insurance coverage options, maximization of insurance benefits available on their existing individual policies and affordable self-pay treatment rates, we will assist you to explore all your financial options.

Call us today at 203-293-1723. We will work with you and with Aetna to determine the best financial plan for you. In addition, our financial case managers will determine if patient aid is available to be used in combination with your insurance benefits.

At Clearpoint, the insurance verification process can take from a few minutes to several hours. Other addiction providers may require more or less time to verify benefits, and results can vary.

Call us at: 1-203-293-1723

HAVE A QUESTION? WE’RE HERE FOR YOU