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Aetna Insurance Coverage for Drug and Alcohol Rehab

Up until ten years ago, paying for rehab was a real challenge for a lot of desperate souls. Addiction treatment was not something a lot of healthcare insurance providers were willing to cover. That put a lot of extra pressure on addiction sufferers to come up with the financial resources to cover their treatment costs out-of-pocket. The unfortunate part about what was taking place a decade ago was put a substantial financial barrier in front of people who legitimately wanted help but couldn't afford it.

Change in Insurance Coverage Laws

With the nation facing rising issues related to drug and alcohol abuse, something needed to be done. In 2009, relief came for the addiction treatment community when the laws pertaining to healthcare insurance coverage changed. As a result of these changes, healthcare insurance providers like Aetna Insurance were forced to start covering the costs related to addiction treatment. The new laws made clear that insurance providers were to view addiction treatment in the same way they would consider the treatment of any other disease. It was more than a decade ago that the medical and psychiatric professions concluded that addictions are diseases. 

While the new laws didn't establish the financial extent of coverage that insurance companies were compelled to offer, it did establish there would be individual baseline addiction treatment costs that insurance companies had to cover. As long as insurance companies followed these baseline guidelines, they could determine the percentages of coverage they would offer under each category, using market forces to guide their decisions. These are the laws the healthcare insurance industry is currently operating under.

By the way, the healthcare insurance coverage laws did something else essential for addiction sufferers who are looking for help. Insurance companies were and are no longer allowed to discriminate against people with pre-existing conditions. That is important to addiction sufferers who have been dealing with substance abuse issues for months and even years. 

What Addiction Treatment Costs Aetna Covers

It's important to remember that the primary addiction treatment costs Aetna Insurance covers are statutory, meaning they have been established by law. That doesn't mean Aetna doesn't cover other costs not mentioned in the statutes. Each insurance policy Aetna issues is tailored to the needs of the client, whether it be a large employer or a policy for an individual. 

While it's hard to determine all that Aetna covers, it is possible to speak to the basic categories of addiction treatment that the company does cover. Here are the five basic categories:

  • Detox Programs
  • Addiction Treatment Medications
  • Residential Treatment 
  • Outpatient Treatment
  • Aftercare Programs

The following is a more in-depth discussion about each of these categories.

Detox Programs

Unless a client enters rehab with a mild addiction issue, there's a high likelihood they will need time to deal with their withdrawal symptoms and lingering cravings. For the safety of the client, most addiction treatment facilities will make medically-monitored detox programs readily available. The goal of a detox program is to keep the client comfortable while they pass through withdrawal in preparation for therapy and counseling. Aetna will cover most, if not all, costs related to detox programs. FYI: The average detox program runs $1,000-$1,500 for 5-7 days of treatment.

Addiction Treatment Medications

During the detox process and after release, some addiction treatment clients require certain kinds of medication. Methadone treatment certainly falls in this category. Should a rehab facility's medical staff decide to prescribe certain medications for a client, Aetna will generally cover 100% of said costs. That could run upwards of $1,000 for standard medications and as much as $5,000 for a methadone program.

Residential Treatment

Most of the time, clients require residential care. That means 24/7 confinement in the rehab facility where they will undergo intensive therapy. The living quarters are generally nice with specific amenities to make the overall living environment comfortable for clients who may be there for 30, 60, and even 90 days. If the client has a significant addiction to opiates or alcohol, they might need to extend treatment to upwards of six months. Aetna will generally cover a predetermined percentage of residential care for up to 90 days.

Insurance companies are permitted to place some restrictions on the types of therapy they won't cover. As an example, an insurance company might elect not to cover holistic treatment programs. That's permitted. 

The monthly cost of residential treatment usually falls between $5,000 and $10,000 per month.

Outpatient Treatment

If a client has logistical problems that prevent them from committing to residential treatment, they can probably qualify for an outpatient program. There are three levels of outpatient treatment, with each successive one a little less restriction than the one before it. Partial hospitalization requires the clients to attend treatment sessions 8-10 hours a day, 5-7 a week. At the next level, intensive outpatient treatment requires the client to receive treatment 4-6 hours a day, 3-5 days a week. At the lowest level, standard outpatient care only requires the client to attend therapy sessions 2-3 hours a day, 1-3 days a week.

An entire 90-day outpatient treatment program might run $10,000. Aetna might well cover 100% of these costs for two reasons. It saves them money versus residential care, and it offers motivation for customers to choose this option.

Aftercare Programs

The last thing an insurance company wants to encounter is continuing treatment costs because a customer has difficulty with relapses. For that reason, Aetna does cover some additional counseling after the customer has completed their basic addiction treatment program.

Selecting the Best Rehab Facility Option

When an addiction sufferer is ready to get help, it's incumbent on them to understand a bit about their insurance coverage. If the prospective addiction treatment client has an HMO policy, they will need to go through their primary healthcare provider for a referral to an "in-network" rehab facility. By staying with an in-network treatment facility, the client's costs are much lower than if they would decide to go outside of their HMO network.

If the prospective client has a PPO policy, they'll have more freedom to select any facility that's able to meet their needs. However, they will have to pay a percentage of the final bill out of their pocket. That percentage could be substantial, depending on the insurance policy's parameters. 

The Insurance Verification Process

Before committing to treatment, most insurance companies, Aetna Insurance included, require the customer to verify coverage. While the customer might be able to do this on their own by reading their policy summary or talking to an insurance company representative, most rehab facilities want to verify coverage as final confirmation. It's quite common for an addiction treatment center to employ administrators who work directly with healthcare insurance providers for pre-approval of treatment costs. Treatment begins as soon as the rehab facility has a clear understanding of how they will be getting paid.

Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers.

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An estimated 39 million people rely on Aetna

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