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Does Aetna Insurance Cover Addiction Treatment?

Substance use disorders are legitimate mental health conditions that require professional treatment. No matter what drug a person is addicted to, once a substance use disorder has developed the consequences tend to become progressively more dangerous over time. Few people can manage a substance abuse problem without outside help. Fortunately, Aetna insurance offers broad coverage for substance abuse treatment.

Aetna insurance makes it its mission to get clients with drug or alcohol addictions the help they need. The insurance plans that Aetna offers differ from each other considerably. While all of them offer addiction treatment, policyholders with distinct insurance plans have different options and benefits at their disposal. Understanding what your Aetna insurance policy offers and what out-of-pocket expenses you will be expected to pay is essential for anyone hoping to begin their recovery journey.

Aetna Insurance

Aetna Inc. is an insurance company based in Connecticut that offers health insurance plans to over 22.1 million people. Founded in 1853, it is also one of the oldest health insurance companies. Today, Aetna Inc. is a subsidiary of CVS Health.

It is common for many health insurance companies to provide only limited substance abuse treatment. The vast majority of health plans set a predetermined limit on the quantity of substance abuse treatment a person can receive. Aetna, in contrast, rejects the one-size-fits-all approach to addiction treatment. Instead, Aetna works with people on an individual basis to ensure that they get the treatment they need.

Aetna and Addiction Treatment

Aetna works with clients to get them connected to a wide range of different facilities that the insurance company has relationships with. These include outpatient rehabs, therapists, physicians, and other professionals. In addition, Aetna itself works hard to provide an array of resources to policyholders who suffer from substance use disorders.

Aetna runs Continuing Care programs that are designed to support policyholders on their recovery journeys. These programs offer support to people while they are attending treatment centers. They also keep in touch with people who have graduated from rehabs by holding weekly follow-up meetings with alumni. Peer support is an essential component of addiction recovery, and Aetna helps people — including people who went to different treatment programs — connect with each other and lift each other up.

Substance Abuse Coverage with Aetna

Aetna offers a diverse array of health insurance plans. While all of their plans offer substance addiction treatment, no plan is the same. The quantity of out-of-pocket expenses, out-of-network coverage, and the specific services covered differ from plan to plan. In general, however, it should be noted that Aetna is willing to cover any form of substance addiction, no matter how severe. They also provide coverage no matter what substance a person is struggling with. Addictions covered by Aetna health insurance plans include:

  • Alcohol addiction
  • Cocaine addiction
  • Heroin addiction
  • Prescription opioid addiction (including oxycodone and fentanyl)
  • Benzodiazepine addiction (including Xanax and Valium)
  • Marijuana addiction
  • Prescription stimulant addiction
  • Methamphetamine addiction

What Will Aetna Pay For?

Aetna provides coverage for a wide range of treatment programs and recovery resources for people who are struggling with drug addiction and alcoholism. Aetna works with policyholders to evaluate their individual needs. Aetna recognizes that addiction recovery is often a long term ongoing process, and that clients’ needs tend to change over time as they become more confident in their sobriety. Common elements of an addiction treatment program that Aetna covers include:

  • Drug and alcohol addiction screenings
  • “Brief intervention” treatments
  • Inpatient rehabs
  • Outpatient rehabs
  • Group and individual therapy

Outpatient Addiction Treatment with Aetna

A variety of outpatient rehab programs are covered by the majority of Aetna’s health insurance plans. Outpatient programs are considered an essential aspect of addiction treatment by many health insurance companies. Outpatient programs are evidence-based and widely regarded as just as effective as inpatient rehabs. Moreover, since they do not require clients to live on-site, they are not only more flexible for clients, but they are more cost effective for insurance companies. As a result, Aetna and other health insurance companies are often able to cover outpatient treatment for extended periods of time.

Outpatient rehabs covered by Aetna include an assortment of treatment programs that address addictions of all severity levels. This programs, ordered from most acute to least, include:

  • Partial hospitalization programs (PHPs)
  • Intensive outpatient programs (IOPs)
  • Outpatient programs (OPs)
  • Aftercare planning

In most cases, Aetna works with policyholders as they progress from one level of care to another. Outpatient programs are generally recommended for recent graduates of residential treatment programs. Moving from an acute level of care to a more flexible rehab can help people get the support they need as they gradually rebuild their lives. Similarly, Aetna supports policyholders who transition from PHPs to IOPs, or from OPs to aftercare services. This kind of long term care results in lower rates of relapses down the line, which makes it in the best interests of Aetna to cover long term outpatient treatment.

Types of Aetna Insurance

Aetna offers a variety of plans, each with different benefits and out-of-pocket expenses for policyholders. While Aetna has countless plans, they can broadly be divided into three distinct types.

Open-Access Plan

These plans do not require policyholders to have a primary care physician. Clients are free to choose their own doctors and facilities without needing to get a referral.

Copay-only Plan

Copay-only plans cover visits to primary care physicians and even the cost of generic drugs without requiring policyholders to meet a deductible. After the deductible is met, other services only require clients to pay their copay. These plans guarantee that there will be no additional out-of-pocket expenses.

High-deductible plan

Aetna’s high-deductible plan ensures that policyholders have access to preventative care services without requiring them to meet their deductible. This can sometimes include coverage for seeing a primary care physician, though a copay is usually required.

Out-of-Network Rehabs Through Aetna

In general, facilities and providers that are out of Aetna’s network cost more than facilities and providers within Aetna’s network. Some health insurance plans through Aetna will only pay for services that are in-network, while others will cover a portion of the cost of out-of-network services. In general, however, out-of-pocket expenses are significantly higher for out-of-network care. Part of why Aetna encourages people to see in-network providers is that they have been screened for quality treatment. Enrolling in an outpatient rehab that is in Aetna’s network guarantees that the program meets contemporary standards for quality addiction treatment.

Aetna and the Affordable Care Act

Health insurance companies like Aetna are legally required to cover addiction treatment under the Affordable Care Act. This legislation ensures that substance abuse treatment be considered an “essential health benefit.” All insurance companies are obligated to provide some degree of coverage for addiction treatment.

Moreover, the Affordable Care Act, or ACA as it is sometimes known, also prevents health insurance companies from denying people coverage on the basis that addiction treatment will be expensive. Substance use disorders cannot be classified as pre-existing conditions. As a result, health insurance companies are legally obligated to accept people with addictions, even when the company can safely predict that they will need to pay for treatment soon.

Dual Diagnosis Treatment with Aetna

The Affordable Care Act also protects people with mental health disorders. Addiction treatment and mental health treatment are both categorized as “essential health benefits” under the Affordable Care Act. The ACA also enforces a policy known as “parity,” which requires health insurance companies to charge the same amount for mental health services as for physical services. For example, if a patient is required to pay a specific copay to see their primary care physician, that copay cannot be any higher if they are seeing their primary care doctor about a mental health concern.

Mental health might seem like an unrelated issue, but in fact it is inseparable from addiction. Not only is substance use disorder a recognized mental health condition, but 50% of people with addictions develop additional mental health disorders, most commonly depression and anxiety. Moreover, 50% of people who suffer from mental illness end up developing substance abuse problems — often as a way to cope with the symptoms of their emotional discomfort. Ultimately, both conditions are mutually reinforcing. As a result, it can be difficult to successfully manage addiction without also treating underlying mental health conditions.

Aetna has extensive addiction and mental health disorder treatment coverage. In fact, quality outpatient programs covered by Aetna insurance plans offer a treatment modality known as integrated treatment. This comprehensive approach entails simultaneous treatment for both substance use disorders and underlying mental health conditions. By enrolling in an outpatient program and taking part in integrated treatment, Aetna dual diagnosis policyholders can achieve long term recovery from comorbid conditions.

What Does Aetna Cover For Me?

Given the sheer number of plans Aetna offers, it is not possible for one article to provide detailed answers about everyone’s individual coverage levels. For people seeking addiction treatment, it can be difficult to determine what benefits they’re entitled to, what out-of-pocket expenses to expect, and where to go for help. By calling your Aetna insurance representative listed on the back of your health insurance plan card, you can get a basic outline of your benefits and coverage.

You can also call NuView Treatment Center, an in-network outpatient rehab in West Los Angeles. Contact us at (323) 307-7997. Even if NuView Treatment Center is ultimately not for you, our staff are available for confidential and free consultations. We can help determine the coverage levels associated with your specific Aetna plan and connect you to the resources you need.

Addiction Treatment at NuView Treatment Center

At NuView Treatment Center, we believe that the recovery process begins with physical sobriety but doesn’t end there. We help clients address underlying issues, including mental health disorders and family conflicts. At the same time, we work with them to take positive steps toward developing new and fulfilling lives in sobriety. Our highly trained staff develop individualized treatment plans for every client. We believe in evidence-based treatment, compassion, and that everyone has a chance to recover from addiction if they reach out for help.

NuView Treatment Center is centrally located in West Los Angeles. Our outpatient treatment programs include every level of care, from partial hospitalization programs to aftercare planning. We are also in network with Aetna health insurance plans, making addiction treatment at NuView Treatment Center both effective and affordable.

If you are ready to make a change, contact NuView Treatment Center today.

Frequently Asked Questions

Aetna Insurance requires preauthorization to ensure that the treatment is medically necessary and covered under your plan. The preauthorization process typically begins by contacting a customer service representative at Aetna and providing them with detailed information about the proposed treatment. This includes information about the type of care, length of stay, expected outcomes, and other details. The Aetna representative will then review the information and decide whether preauthorization is required for treatment to be covered under your plan. If preauthorization is required, they will provide you with a number that must be included when submitting claims related to the services received during treatment. You must remember that different policies, products, and services may require additional preauthorization. Therefore, reviewing your insurance policy or contacting Aetna for more information is essential.

Aetna Insurance members may have some out-of-pocket expenses associated with addiction treatment services and medications. Depending on the specific plan, these may include co-pays, coinsurance, or a deductible. It is essential to review your coverage details to determine better which costs you may be responsible for. Additionally, many plans may cover alternative forms of treatment, such as acupuncture and massage therapy. However, these services often require pre-authorization, so you should check with your plan administrator before using them. Aetna Insurance also offers a variety of discounts for members seeking addiction treatment services, so be sure to inquire about those options.

Aetna Insurance may provide coverage for medications related to addiction treatment, depending on your plan. If you would like to know more about the coverage, please contact Aetna Customer Service. The representatives can provide specific information about your plan and what medications are covered. They can also direct you to resources for additional information about addiction treatment.

Yes, most addiction treatment centers that accept Aetna Insurance have case managers available to help patients understand their insurance coverage and any benefits they may be eligible for. The case manager will review your policy with you and answer any questions you may have. They can explain how the insurance works and what specific services are covered. Additionally, they can provide helpful information about accessing services, filing claims, and other vital details. They can also explain what out-of-pocket expenses may be required. Case managers are a great resource to help maximize your insurance coverage and understand the system better.

At NuView Treatment Center, we accept most major health insurance plans. To find out if your Aetna health plan is accepted, please call our office at 323-307-7997. Additionally, you can fill out this verification of insurance benefits form. Our staff will be more than happy to answer any questions you may have and help determine the best plan for your treatment.

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