Does Aetna Cover the Cost of Alcohol or Drug Rehab?

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July 16, 2021 by
Does Aetna Cover the Cost of Alcohol or Drug Rehab?

What Benefits Does Aetna Offer For Treating Alcohol & Drug Rehab?

Making the very important realization that you or a loved one needs professional help with a substance use disorder is definitely a step in the right direction for leading a healthier, more rewarding lifestyle. Reaching out for help with an addiction issue will help ensure that you receive the proper treatment leading to long-lasting sobriety.

You may be concerned about how your drug rehab treatment will be paid for and if your Aetna health insurance will cover its cost.

If your health insurance carrier is Aetna, you will want to know which benefits they offer for treating alcohol and drug rehab.

Aetna does offer screenings, brief interventions, and treatment referrals (SBIRT) to evidence-based providers for at-risk substance and alcohol users. Aetna’s SBIRT benefits work well in primary care settings when clinicians need to screen and advise individuals who aren’t yet seeking help with a substance use disorder.

If you or a loved one are struggling with addiction, call WhiteSands Alcohol and Drug Rehab today at 877.969.1993 to learn how we can help.

For patients who do need professional assistance for overcoming the addiction because their substance abuse is interfering with different aspects of their life and health, Aetna’s SBIRT program can help with a referral to and a stay in a professional treatment program to the extent that their medical benefits cover such services. All of your conversations and information about your condition are kept completely confidential.

Aetna’s customer service representatives are available anytime, day or night, to work with their members to find a rehab solution that will fit their individual needs rather than prescribing a one-size-fits-all plan for everyone. The Aetna Healthcare Continuing Care programs help patients in recovery receive the ongoing support they need after treatment, while they’re in recovery, to help prevent a relapse from occurring.

Does Aetna Cover The Cost of Rehab?

Aetna does cover either all or a portion of the cost of rehab when it’s performed in a treatment center that’s been screened for consistency with the current standards of practice in the field for quality care and adherence to modern scientific principles.

Not every Aetna health plan demands that the rehab treatment center you use must be in-network, but when you decide to get treatment at an out-of-network provider, the cost will usually be higher for you. Also, Aetna’s in-network providers for rehab have been carefully screened while out-of-network providers for the most part have not been screened.

Some patients may need to be pre-certified or get authorization from Aetna before rehab treatment can begin. This can be true for inpatient admissions, outpatient detox programs, intensive outpatient programs, and partial hospitalization programs.

If your Aetna plan was purchased through the ACA marketplace, some type of coverage is available to you through your policy for alcohol and drug treatment. Mental health inpatient services and behavioral health treatment are also covered.

With any of these plans, you may have some financial responsibility for your treatment depending on the state in which you live, your specific insurance plan, the type(s) of treatment you need, and whether you use in-network or out-of-network providers.

How To Verify Your Aetna Insurance Benefits For Addiction Coverage

Before you begin rehab treatment for alcohol or drug addiction, you’ll want to check your Aetna coverage and benefits to find out what will and won’t be paid by insurance. Some of the costs for rehab may have to be out-of-pocket costs for you, so it’s best to know beforehand what to expect.

The intake coordinators at WhiteSands are happy to help you verify your benefits when you call (877)640-7820. We will help you determine approximately what your out-of-pocket cost will be.

You can also call the phone number listed on the back of your Aetna card and speak to an insurance representative to ask for details on your benefits for addiction coverage. You can also log onto the Aetna website to discover more about your specific plan what is covered.

Knowing what to expect from Aetna in advance will give you some peace of mind while you or the person you care about is being treated for addiction. Being relieved of the stress and anxiety about treatment costs that are unexpected will help you better focus on achieving a successful recovery.

Does Aetna Cover the Cost of Attending Rehab For Spouses or Children?

If you have an Aetna family or couples policy, your spouse and children will likely be eligible for some coverage for alcohol or drug rehab treatment. Check with your Aetna representative, the website, your policy, or our staff at WhiteSands, who can help you determine your family’s coverage benefits.

Tiers of Aetna and Benefits of Each Package

Aetna’s healthcare insurance plans consist of basically three different levels. There are Open-Access plans, which let you choose your own physicians. You don’t need to get a referral for doctors’ services and don’t require to list a primary care physician.

The Copay-Only plans ensure that you only need to pay out copays once your deductible is met. Visits with your primary care physician and payment for generic drugs are covered before you meet your deductible.

High-Deductible plans provide you with preventative care services before you meet your deductible. You might also have an option to open a health savings account.

Does Aetna Cover the Cost of Inpatient Rehab?

If you use an in-network provider for inpatient rehab, some of Aetna’s plans have 0 co-insurance fees, while other plans charge a copay for each admission and for different services. Co-insurance fees are what you owe after your full deductible has been paid.

If you opt for inpatient rehab with an out-of-network provider, Aetna’s benefits will differ depending upon where the facility is located and what your specific plan will cover. As noted earlier, some Aetna plans do not cover any non-network providers, while others require a 30%-50% coinsurance payment. Keep in mind that out-of-network treatment programs usually require that you get pre-certified from Aetna or a penalty will be levied.

It’s best to speak frankly with an Aetna representative or your intake counselor at WhiteSands about the type of inpatient rehab treatment your policy will cover.

Aetna also offers certain Medicare and Medicaid insurance plans to older individuals and those who are struggling financially. These plans can also help meet or supplement your rehab expenses.

In general, Aetna’s coverage for inpatient rehab will depend upon your particular benefit package.

Does Aetna Cover Substance Abuse & Mental Health Residential Stays?

If you are dealing with a co-occurring mental health disorder in addition to substance use disorder, you need help with both issues at the same time. Individuals suffering from addiction may have a co-existing condition, such as PTSD, depression, or anxiety that either contributed to addictive behaviors or caused these psychological issues to become more problematic.

Aetna insurance policies do cover mental and behavioral health treatment, although the benefits differ for each patient. Call the number on the back of your insurance card and ask about your coverage for mental health conditions and dual diagnosis.

Does Aetna Pay For Outpatient Rehab?

Outpatient rehab benefits with Aetna are different for everyone. Some insurance policies may not cover outpatient rehab at all, while others will have a fixed co-insurance percentage you need to pay for the services. Still, other Aetna plans may charge a set copay for each outpatient visit to your rehab facility for services. Your outpatient rehab costs with Aetna will depend on your location and the type of insurance plan you carry.

How Long Will Aetna Cover the Rehab Stay For?

Your duration of stay in an alcohol or drug rehab program will depend on your type of coverage with Aetna. When you contact the Aetna representatives, be sure to ask how many days in rehab you’d be covered for if needed, in addition to asking how many outpatient treatment days are covered.

Call Us Now To Verify Your Insurance Benefits

Patients come to us from Tampa, Fort Myers, Orlando, Sarasota, Brandon, Gainesville, Naples, and more. The expert treatment you’ll receive for alcohol or drug addiction at WhiteSands will be well worth the time it might take to carefully look into your insurance benefits with Aetna. Call one of our intake coordinators now and we’ll help you verify what your Aetna benefits will cover for your condition and determine which other providers we accept.

 

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Frequently Asked Questions

We have the answers you're looking for

Aetna provides coverage for drug and alcohol rehab under most of its health plans, particularly those purchased through the ACA marketplace. Federal mandates like the Affordable Care Act and the Mental Health Parity and Addiction Equity Act require Aetna to treat substance use disorder services as essential health benefits. Your specific coverage depends on your plan type, the level of care required, and whether you choose an in-network or out-of-network facility. Contacting Aetna directly or working with a treatment center that accepts Aetna can help clarify what your benefits include before you begin care.

Aetna may require pre-certification or prior authorization before rehab treatment can start, particularly for inpatient admissions, intensive outpatient programs, and partial hospitalization. This process involves Aetna reviewing the proposed treatment to confirm it is medically necessary under your plan. Failing to obtain prior authorization before beginning treatment can result in coverage being denied for those services. Most in-network treatment centers, including WhiteSands Treatment, can help initiate this process on your behalf.

Aetna covers a range of addiction treatment services that may include medical detox, residential inpatient care, partial hospitalization, intensive outpatient programs, standard outpatient therapy, and medication-assisted treatment when deemed medically necessary. Aetna also offers Screenings, Brief Interventions, and Treatment Referrals, known as SBIRT, for individuals who are at risk but not yet engaged in formal addiction treatment. Mental health inpatient services and behavioral health treatment are also covered under most Aetna plans. The specific services covered vary based on your individual policy and the level of care that meets medical necessity criteria.

Choosing an Aetna in-network rehab facility results in significantly lower out-of-pocket costs because these facilities have negotiated a discounted rate directly with Aetna. In-network providers cannot bill you more than the contracted rate, eliminating surprise charges. Out-of-network rehab may still receive some coverage under certain Aetna plans, but you will generally pay a higher percentage of the total cost. WhiteSands Treatment is an Aetna in-network provider in Florida, which means you can access care with reduced financial exposure.

Yes, most Aetna plans include some level of financial responsibility for the member even when rehab is covered. Depending on your specific plan, you may be responsible for meeting a deductible before benefits apply, paying a copay for each outpatient visit, or contributing a co-insurance percentage for services received. ACA marketplace plans are structured in tiers such as Bronze, Silver, Gold, and Platinum, each with different cost-sharing arrangements. Understanding your deductible, copay, and out-of-pocket maximum before beginning treatment helps you plan for these costs.

Aetna covers outpatient rehab services under many of its plans, though the specific benefit structure varies. Some Aetna plans charge a flat copay per outpatient visit, while others apply a co-insurance percentage after the deductible is met. There are also Aetna plans with limited outpatient coverage that require members to pay out of pocket for certain services. Verifying your Aetna outpatient benefits before beginning treatment ensures you understand what will be covered and what your financial responsibility will be.

Aetna generally covers dual diagnosis treatment, which addresses both a substance use disorder and a co-occurring mental health condition such as anxiety, depression, or PTSD. Under the Mental Health Parity and Addiction Equity Act, Aetna is required to provide coverage for behavioral health conditions on par with physical health conditions. This means that if you are struggling with addiction alongside a mental health disorder, both conditions may be treated and covered simultaneously. Facilities like WhiteSands Treatment that specialize in integrated dual diagnosis care can work directly with Aetna to verify your benefits.

Aetna can deny coverage for rehab in certain circumstances, most commonly when a treatment is not deemed medically necessary under your plan's clinical criteria or when prior authorization was not obtained before care began. Claims may also be denied if the facility is out-of-network and your plan does not include out-of-network benefits. If Aetna denies coverage, you have the right to file an internal appeal and may also request an expedited or external review. Working with a treatment center experienced in navigating Aetna's process can help you avoid common denial triggers.

Aetna uses clinical criteria to determine whether a specific level of addiction treatment is medically necessary, evaluating factors such as the severity of the substance use disorder, the presence of co-occurring conditions, previous treatment history, and the risk of harm without care. These criteria are used to decide whether coverage is approved for services like medical detox, inpatient residential treatment, or outpatient programming. Treatment must align with established clinical guidelines to receive coverage approval. Your treatment provider can assist with gathering the documentation Aetna requires to support a medical necessity determination.

The most direct way to verify your Aetna benefits for rehab is to call the member services number on your insurance card or log into the Aetna member portal to review your behavioral health benefits. You can also contact a WhiteSands Treatment admissions advisor, who can verify your Aetna coverage on your behalf at no cost. Verification typically includes confirming your deductible status, copay or co-insurance amounts, covered levels of care, and whether prior authorization is required. Having this information before you begin treatment allows you to make informed decisions about your care.

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.

About the Author

is a proud alumni member of WhiteSands Treatment. After living a life of chaos, destruction and constant let downs, Mark was able to make a complete turnaround that sparked a new way of life. He is serious about his recovery along with helping others. At WhiteSands Treatment, we offer support to you in your homes or when you are out living in your daily lives.

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