Aetna Insurance Coverage For Drug Rehab

Aetna is a private insurance company that offers addiction treatment and mental health coverage. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Using in-network providers can reduce how much you need to pay out-of-pocket, as most in-network providers will be entirely or mostly covered by your plan. We help you get medically necessary health care services in the most cost-effective way under your health plan.

Find your plan information

This helpline is answered by Treatment X LLC, an addiction treatment provider with treatment facilities in Ohio, Pennsylvania, and California. There are several ways to find a drug and alcohol rehab center that accepts Aetna insurance. Co-pays are flat fees charged for each visit to a regular doctor or specialist. This is a separate charge from a deductible and is usually more expensive for specialized services such as addiction care. Depending on the specifics of your plan, you may need to get a referral from a doctor before insurance coverage will kick in.

Blue Cross Blue Shield Drug and Alcohol Rehab Coverage

To find does aetna drug test out more about available in-network providers, contact Aetna to discuss your options. A PPO plan with an extended service area (ESA) gives you the flexibility to see any provider, in or out of network, at the same cost. They just have to be licensed, eligible to receive Medicare payments and willing to accept your plan. With a PPO plan with ESA, you have the option to choose a primary care physician. But when we know who your doctor is, we can better support your care.

Listed below are some of the addictions that Aetna is required by law to cover under its insurance plans. A deductible is the amount of money paid out-of-pocket for covered services before the health plan kicks in. For example, if the deductible for your plan is $1,500, you will need to pay that amount out of pocket before insurance will start covering services.

You, nor your loved one, are under any obligation to commit to a Treatment X treatment program when calling the helpline. Reach out to AddictionResource.net today for more information about substance use disorder treatment. You should contact the facility before arrival so you don’t waste the time and money to travel to the rehab center only to be denied. Aetna also uses a screening, brief intervention, and referral to treatment (SBIRT) practice that helps identify, reduce, and prevent alcohol and drug use. Luckily, there are several resources that can help you get the recovery services you need.

Check in with your doctor about the status of the requested prior authorizations

Clients may need to seek a referral from their primary care doctor before their Aetna plan will kick in. People with Medicare or Medicaid coverage will likely need prior authorization before they can get approval for a prescription refill. Aetna covers medication-assisted treatment for all members using a list of approved drugs. While Suboxone was removed from the list in 2023, there is a generic form of the drug that Aetna will cover.

Aetna Drug and Alcohol Rehab Coverage

1. Insurance coverage is a major consideration in choosing a drug rehab facility.
2. Review your Evidence of Coverage (EOC) to learn about comprehensive plan details, and your rights and responsibilities.
3. POS plans do have higher premiums than HMOs, but they do cover out-of-network doctors.
4. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
5. Aetna may or may not authorize treatment for the full recommended length of stay.

Day treatment is an intensive program that may occur three to five days a week, up to eight hours a day, for up to 16 weeks. To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. We do not receive any fee or commission dependent upon which treatment or provider a caller chooses.

In addition, Aetna reserves the right to drug test an employee at any time if substance use is suspected or if a workplace accident occurs. If a drug test is required and the result is positive, that can void any worker’s compensation claims and can result in disciplinary action up to and including termination. Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device. The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations.