Aetna Insurance Coverage For Drug And Alcohol Rehab

Aetna's health insurance plans offer coverage for addiction treatment. Copays and deductibles will differ, depending on the patient's plan and what state they live in.

Aetna Insurance Coverage for Drug and Alcohol Rehab

Aetna is one of the most well-known insurance providers, with more than 20 million customers around the world. Aetna offers behavioral health and mental health benefits, including a variety of substance use disorder treatment programs. Having accurate insurance information on hand is helpful when evaluating a drug and alcohol rehab program.

Does Aetna Cover Drug and Alcohol Detox?

Detox occurs when a person stops using a specific substance. During drug and alcohol detox, a person might experience unpleasant and sometimes dangerous withdrawal symptoms, such as:

  • Nausea
  • Vomiting
  • Dehydration
  • Mood swings
  • Seizures

A professional drug and alcohol detox program provides for the medical management of withdrawal symptoms. Aetna may cover traditional detox programs but not rapid detox. Aetna may require preauthorization to the detox program and a medical referral.

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Does Aetna Cover Inpatient Rehab?

Most Aetna insurance policies will cover inpatient drug and alcohol rehabilitation. Like most health insurance providers, Aetna offers a variety of plans, and they don’t all cover the same level of services. Some will also have different copayment requirements.

Insurance policies from Aetna come in two formats:

  • HMO – Health Maintenance Organization
  • PPO – Preferred Provider Organization

Aetna also offers two other program types in some states:

  • POS – Point of Service
  • EPO – Exclusive Provider Organization

Each plan type will have its own set of rules. Plan details vary by state and deductible level as well.

In some states, Aetna uses the traditional metal level classification for their plans. Platinum is the highest metal level so it will have a lower deductible but a higher monthly premium. The other metal levels include:

  • Gold
  • Silver
  • Bronze

Bronze is the lowest category. Bronze plans tend to have low monthly premiums but high deductibles.

In most cases, however, Aetna creates unique programs designed to fit the needs of each state. For instance, GA HNOnly 2500 80 Select is an insurance plan created just for the state of Georgia.

Aetna HMO Plans

Although Aetna’s HMO plans change from state to state, most of them do not use the metal level system. Aetna’s HMO programs are classified by:

  • State
  • City
  • Deductible
  • Percentage
  • Copay

An example of this would be PA HNOnly Uniontown 5000 100% $30.

Some common coverage details offered in Aetna HMO plans include:

  • $250 copay/day, days one through five
  • 20 percent coinsurance
  • 30 percent coinsurance
  • $1,000 copay/admission
  • 20 percent coinsurance after $250 copay/admission, deductible does not apply
  • $500 copay/admission

Copay refers to the exact dollar amount a patient would pay, such as $250 per day or $1,000 per admission. Coinsurance is a percentage that is paid. If the coinsurance is listed as 20 percent, the patient is responsible for 20 percent of the overall bill and Aetna pays 80 percent.

One similarity from state to state in HMO plans is a lack of coverage for out-of-network providers. Aetna also does not require preauthorization or referrals.

Aetna PPO Plans

Like the HMO policies, Aetna’s PPO plans vary from state to state, and most do not adhere to the metal level category system. PPOs are also grouped by state and deductible, as well as by other aspects like copay amounts.

One main difference between HMO and PPO benefits is most PPO plans cover out-of-network providers. A “100/50” policy means Aetna covers 100 percent in-network minus the copay or coinsurance fee and 50 percent for out-of-network.

Some basic Aetna PPO coverage details for inpatient rehab include:

  • $500 copay per admission, 50 percent coinsurance and out-of-network precertification is required or benefits will be reduced by 50 percent up to $400 per service or supply.
  • 20 percent coinsurance, 50 percent coinsurance and precertification is required for out-of-network care or a $400 penalty applies per occurrence. However, the penalty will not exceed the cost of the benefit. Precertification is not required in an emergency.

Most have either a copay or coinsurance charge, 50 percent out-of-network coverage and a penalty for failure to preauthorize out-of-network care.

POS and EPO plans are similar to PPO policies and require either a copay or coinsurance fee for in-patient facilities. Aetna will pay 50 percent for out-of-network care, but there may be a penalty for failure to preauthorize.

Does Aetna Cover Outpatient Rehab?

Aetna may also cover outpatient services for drug and alcohol rehabilitation. Exact benefits will vary from state to state and policy to policy. Some Aetna HMO coverage details for outpatient care include:

  • Outpatient office visits: $50 copay/visit, deductible does not apply; all other outpatient services are no charge
  • Outpatient office visits: $20 copay/visit, deductible does not apply; all other outpatient services are no charge
  • Outpatient office visits: $40 copay/visit, deductible does not apply; all other outpatient services are $20 copay/visit and deductible does not apply
  • Outpatient office visits: $75 copay/visit, deductible does not apply; all other outpatient services are 20 percent coinsurance
  • Outpatient office visits: $110 copay/visit, deductible does not apply; all other outpatient services are 40 percent coinsurance
  • Outpatient office visits: $50 copay/visit; all other outpatient services are 20 percent coinsurance

Most plans require a copay per office appointment. Some will pay for other outpatient services while other policies require a coinsurance fee. These HMO plans do not cover out-of-network care.

The PPO, POS and EPO programs offer varying coverage for outpatient addiction treatment. Some require a copay or coinsurance fee for office visits. Most will pay some part of out-of-network care, sometimes as much as 50 percent. Aetna also requires preauthorization for out-of-network care to avoid a penalty.

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Does Aetna Cover Medication-Assisted Treatment?

Medication-assisted treatment options like methadone or Suboxone work for opioid addictions. Aetna does cover maintenance therapies like these, but only for those who are recovering from addiction to opioids such as heroin or painkillers.

Does Aetna Cover Sober Living Houses?

Aetna insurance will likely cover at least part of the cost of an aftercare program like a sober living house. It will depend on the policy you have and whether the facility is in-network or out-of-network. Each facility will verify insurance before admission so patients know what to expect.

What is the Difference Between In-Network and Out-of-Network?

Aetna establishes partnerships with individual physicians and treatment centers to gain some control over the cost of care. These partners are called “in-network.”

Any facility or provider that does not have this arrangement with Aetna is out-of-network. Choosing in-network or out-of-network care can influence a patient’s payment responsibilities. Out-of-network addiction treatment facilities can occasionally work out an arrangement with the insurance company, however.

All treatment centers will verify a patient’s of insurance benefits as part of the admission process.

How To Find Drug And Alcohol Rehab Centers That Accept Aetna

  1. Call Addiction Campuses for an immediate verification of benefits. Addiction Campuses can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.
  2. Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.
  3. Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.

Addiction Campuses accepts many forms of insurance. For a free, confidential verification of insurance benefits, call today.


Sources

https://www.aetna.com/sbcsearch/home

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