Aetna

aetna insurance

Does Your Insurance Policy Cover Rehab?

If you have an Aetna insurance policy, addiction treatment can be covered. The process of getting insurance approval can be stressful, however, our highly trained staff at Granite Mountain Behavioral Healthcare will help you find the right addiction treatment and assist with getting it approved.

Aetna insurance works with an individual’s needs to find nearby addiction treatment for drug or alcohol addictions. Aetna insurance policies have different options for inpatient and outpatient addiction treatment, as well as other services to help on your path to recovery.

Many insurance policies set a predetermined limit on addiction treatment rather than looking at the individual as a whole. Recognizing there are no one-size-fits-all plans for addiction treatment, Aetna insurance works with an individual’s needs to find an addiction treatment solution.

If you are covered by Aetna insurance, then you should have several options for a successful and healthy recovery from addiction through treatment.

 

Aetna Insurance Addiction Treatment Resources

Aetna insurance is committed to patient follow-up with their Continuing Care addiction treatment programs. Members meet weekly and offer support for the “alumni” of various addiction 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’s customer service center provides recovery resources anytime, day or night. It helps find addiction treatment options and counselors nearby.

 

Aetna Insurance Policy Coverage for Addiction Rehab

Aetna insurance is generally accepted by most addiction treatment centers. However, the levels of care may vary. It is good to keep in mind that insurance coverage varies greatly from state to state. It is not unheard of for someone with an insurance policy in one location to have their claims approved and in another location (state) have all of their claims denied.

There have been cases, where we see extremely strong guidelines on an insurance policy, such as treatment must be given in a hospital setting, or no recovery treatment or mental health insurance benefits whatsoever. 

Due to the complex nature of Aetna insurance from state to state, Granite Mountain Behavioral Healthcare can help you find the best possible treatment options with your Aetna insurance plan.

Contacting Aetna insurance directly may not result in the best option for you. Our expertise is from experiencing what has ultimately been successful for actual clients. Let us help you find the addiction treatment or mental health programs that work best for you.

As an Aetna insurance prescriber, individuals can be covered for the following types of treatments:

  • Detox
  • Residential rehab
  • PHP (known as partial hospitalization program)
  • IOP (known as intensive outpatient program)
  • Aftercare programs

 

Does a Rehab Center Need to be In-Network?

You do not need to seek treatment at an in-network facility. However, you do run the risk of incurring more cost my choosing a treatment option that is not in-network. This could lead to higher co-payments. Also, rehab options that are not in Aetna’s network have not gone through the diligent screening process that is done by Aetna. 

“Aetna’s insurance in-network addiction treatment programs are all screened for quality care and adherence to modern principles”. –Aetna’s Website

In some instances, a pre-authorization of a treatment program will be required  

Examples of treatment may include:

 

  • Inpatient Program
  • Detoxification (Detox)
  • Intensive Outpatient Addiction Treatment Programs
  • Partial Hospitalization Addiction Treatment Programs

 

Pre-certification involves a process of reviewing the requested service for meeting the required criteria. Aetna has very high clinical standards and we value your recovery. If you find a treatment program that you are interested in outside of the in-network options, you should begin the pre-certification process immediately so there are no delays in starting your addiction treatment program. 

 

Aetna Insurance Coverage for Inpatient Addiction Treatment

Depending on where you are located and your own Aetna insurance policy coverage, the costs of treatment may vary.

 

Inpatient Addiction Treatment Rehab Service and Costs

For many of our in-network inpatient addiction treatment services,  Aetna insurance plans have 0 percent coinsurance – insurance that kicks in once you pay your full deductible. Other insurance plans could require a copay for admission of other services.

For any out-of-network addiction treatment providers, insurance coverage varies. Factors like location and the type of plan will affect the cost. There are some insurance plans that do not cover any form of addiction treatment that’s out-of-network. But, there are others that have 30 to 50 percent coinsurance. As stated earlier, out-of-network insurance programs generally need to adhere to a pre-certification process. If that process is not followed, there could be a penalty. The best way to find a treatment option that works for you is to discuss treatment with your Aetna insurance provider and find a plan that suits you. 

Here are some definitions of common terms regarding health plan coverage:

  • Premium – This is a monthly amount made to a health insurance company by the policyholder to maintain coverage. Many times, individuals are fortunate enough to have employer-provided insurance, meaning that the company picks up all or part of the monthly premium cost.
  • Coinsurance – Coinsurance, like a copayment, is a form of cost-sharing for services involving healthcare and prescription medications. It is never a flat fee and is always a percentage of the cost for a health service or Rx paid by a member once they have reached their deductible.
  • Deductible – This is the amount you will need to pay before your health insurance starts to cover a larger portion of your bills. As an example, if your deductible is $1,000, you must pay $1,000 for your own care “out-of-pocket” before the insurance kicks in and pays a higher percentage of the costs- the deductible resets yearly.
  • Out-of-pocket Maximum – This is the most amount of money you may have to pay in one year out of your own pocket for healthcare services you receive before your coinsurance covers 100 percent of the bill.

 

Aetna Coverage for Outpatient Addiction Treatment

Outpatient addiction treatment coverage through Aetna insurance is different for everyone. 

Various costs associated with addiction treatment services are compiled below.

 

Outpatient Addiction Treatment Services and Costs

Certain Aetna insurance policies may not have an option for any outpatient addiction treatment services or may involve a fixed coinsurance percentage. Several other insurance plans have a set copay per visit. The largest factors of coinsurance or copays are the location and type of insurance coverage.

Speak with your Aetna insurance provider to determine what will work best for you. Aetna’s 24-hour phone line allows insurance customers to connect with a member services professional who can provide the answers you need about your policy’s addiction treatment coverage.

About Insurance Coverage for Detoxification

In many instances, those who are seeking addiction treatment for an addiction problem must first go through a medical detox process. This isn’t the case for everyone, but for those who are suffering from certain types of addiction, such as benzodiazepine dependence or alcoholism, a detox may be in order.

Detoxing from excessive use of benzos, alcohol, or opiates can be very difficult and even dangerous if individuals do not go through a medical detox process. So, in cases like these where detox is necessary, it’s important to have information about Aetna’s insurance policy on drug and alcohol detox.

Your Aetna insurance may cover inpatient detox or outpatient detox. But, like with many insurance policies, just a portion of the detox process will be covered. Again, insurance coverage mainly depends on the type of insurance plan you have and the kind of addiction treatment facility you are considering. If you have an HMO insurance plan, you may only be covered if you attend an HMO-contracted detox center. A PPO insurance plan may enable you to choose from a broader variety of detox facilities. 

Aetna insurance offers a little more flexibility on detox and addiction treatment options than some other insurance companies. Individuals who are looking for medical detox centers that are covered by Aetna insurance can likely find a facility with little difficulty. But, the best way to know for sure which detox facilities are included in your options, it may be best to call the insurance company to get more details about insurance coverage.

Aetna Insurance Coverage for Mental Health Treatment

For those living with a mental illness, Aetna insurance can help to cover the costs of treatment. It is common for a behavioral or mental health disorders to co-occur with a substance use disorder. This is commonly referred to as dual diagnosis. In these instances, both addiction treatment and mental health treatment are considered necessary to help people who are suffering. Sometimes, finding care for dual-diagnosis can sometimes be difficult. It’s best to find out what resources you need and what options are available with your Aetna insurance policy. 

Physical health is just as important as mental health. Your insurance policy should offer the same type of comprehensive coverage. Another way to think of it is, an insurance plan provides a certain amount of coverage for treatment for a physical ailment or concern must also provide that same comprehensive care for the treatment of behavioral health. 

Common mental illnesses and behavioral health disorders can include:

 

  • Depression
  • Anxiety
  • Eating disorders
  • Bipolar disorder
  • PTSD (known as post-traumatic stress disorder)

 

People who suffer from these issues in addition to substance use disorders can find many options for rehab that will cater to their personal needs. Aetna insurance can help to provide insurance coverage for this treatment. Again, however, it’s important to speak with our team of professionals to discuss the mental health coverage of your insurance policy. 

Helping You Understand Your Aetna Insurance Benefits

As an Aetna insurance prescriber, getting the help of Granite Mountain Behavioral Healthcare call help you answer many questions. Here is a list of several benefits we provide:

 

  • Our team will thoroughly examine your Aetna health insurance plan.
  • Our team will help decide if you are covered for your preferred treatment.
  • Our team help decide what kind of treatment or rehab, and how much will be covered by Aetna.
  • Aetna health insurance is accepted by almost every rehab or clinic in the U.S., so we’ll help choose which ones will work best with your individual policy.

 

We know the specifics of insurance can be extremely confusing. Granite Mountain Behavioral Healthcare will give you a better understanding of what your insurance will cover and what may or may not come out of pocket. 

Understanding your options for treatment of substance use disorder or mental illness is important for both your long-term recovery and overall health. Granite Mountain Behavioral Healthcare does a thorough job of explaining what your insurance covers and which addiction treatment centers are available in light of your policy.

Article Reviewed by Rob Heinrich, LPC

Rob Heinrich, LPCRob is our Clinical Director and brings years of various expertise to Granite Mountain Behavioral Healthcare. He graduated with a Masters in Counseling in 1992 from Denver Seminary and has decades of hands-on experience with providing treatment for substance abuse and eating disorders. Rob oversees the entire clinical team and treatment programming for our clients. He is also an active group therapist in our outpatient program.