Ah, insurance…it can be the best of things but also the most confusing of things. Whether you have insurance through your workplace, a family member or an independent plan with a coverage company, your individual coverage can change based on a number of different factors, including:

  • Your location
  • Your age
  • Your individual policy plan
  • The services you wish to receive
  • And your personal health history

Even though insurance companies typically offer their client’s a choice from a number of different coverage plans, the treatment options, facilities and conditions covered can vary widely, resulting in an almost individualistic kind of coverage for each person.

Not every insurance company is created equal, not every insurance plan will cover everything that you need and not every drug and rehab center will accept the same insurance policies. If you or a loved one struggles with a substance use disorder (SUD), addiction or co-occurring disorder, you may be wondering about what the best insurance for rehab is, does insurance cover rehabs, and if you have a health coverage policy with Aetna, you may also wonder whether or not there are drug rehabs that accept Aetna insurance near you.

Does Aetna Insurance Cover Drug and Alcohol Rehab?

Aetna insurance is a large company, originally founded in 1853, that is dedicated to providing the people they serve with an insurance policy and care coverage that is filled with excellence, integrity, inspiration and caring. The company works to provide a wide range of healthcare services to over 39 million people in the U.S.

Since Aetna is such a large company that provides essential service coverage to clients in nearly every single state of the country, the healthcare provider network has worked hard to be able to provide their clients with access to most drug rehab centers that accept insurance, and addiction treatment. So, yes! Aetna does cover substance abuse treatment, and may even be the best insurance for rehab coverage, based on its large national provider network.

Not every drug and alcohol treatment center accepts the same types of insurance policies or companies, but most rehabs that accept insurance for payment will accept an Aetna policy, although maybe at varying degrees. Every state has a different set of laws that govern the treatment practices and coverage basics of substance abuse rehab. As a result, the rehabs that accept Aetna may not all mirror each other exactly.

For some policies, in some states, you may be able to receive full coverage for your substance abuse treatment, in others, you may only receive coverage for certain services, or only partial coverage. It all depends on you, the state that you live in, the types of coverage you are looking to receive, and your personal insurance policy plan.

How Insurance Coverage Works

So, does insurance cover rehabs? Yes. Are there specific drug rehabs that accept Aetna insurance, and specific rehabs that may not? Yes. Is Aetna one of the best insurances for rehab coverage? Also, yes. This is all great information to know and have handy. But when it comes down to trying to understand your insurance policy, how do you know the way it really works?

Insurance and substance abuse treatment can both be incredibly complex and frustrating / hard to understand. That does not mean it is impossible to gain a better general understanding on how your insurance policy works. Every insurance policy, even Aetna, has a set of different coverage plans, divided into individual user and family user guides. Each of these guides can be further broken down by package plan, typically, the more an individual pays up front in deductibles, the more coverage they have, but it all depends on the policy plan they have chosen to enroll in. Some of the most well-known and highly utilized insurance policies include:

  • Point of Service (POS) Plans: Where clients can pay less for services, as long as they use doctors and facilities that belong to the insurance company’s personal network of providers, but are not forced to always stay within the network if they truly need (although they will pay more for out-of-network services). In this plan, clients will need to receive referrals to see specialists and receive specific types of treatments.
  • Exclusive Provider Organization (EPO) Plans: Where clients enroll in a specific managed care plan that only allows for treatment coverage when using the company’s personal network of providers, except in the case of emergency treatment.
  • Preferred Provider Organization (PPO) Plans: Where clients pay less for treatment services when they stick to using their company’s in-network providers, but can also use out-of-network services without a referral, but at an additional cost.
  • Health Maintenance Organization (HMO) Plans: Where clients are limited to receiving care from only doctors who work with, or are contracted by the HMO itself. This type of coverage may require clients to live in specific serviceable areas in order to be eligible / receive coverage and are often integrated into a client’s care to focus on illness prevention and overall wellness.

Along with each of these different plans, comes with the opportunity to vary your payments for services. Not month by month of course, but when you enroll in an insurance policy with a specific company, you have the opportunity to select the type of plan you will be paying into, and then the amount of coverage you would like to receive from such a plan, broken up into bronze, silver, gold and platinum settings, where in bronze you pay the lowest monthly premium, but the highest when you need care, and in platinum where you pay the highest monthly premium, but the lowest costs when you need care–with silver and gold measuring on different sides of in-between.

Still, even with this knowledge insurance terms and concepts can be difficult to understand. So, here are a few important definitions of insurance terms, that can help make your life and understanding a little easier:

  • Deductibles: Are the amount a client owes / needs to pay for their health care services, before their insurance plan kicks in and begins to pay.
  • Copayments: Are the amount a client pays for their share of the cost of their medical services, item, or doctor visits.
  • Coinsurances: Are when the client’s share for the cost of their covered health care services and treatment are calculated by a percentage, normally around 20% of the total cost, for the allowed amount of the service.
  • Premiums: Are the amount a client pays for their health insurance plan on a monthly basis.
  • Networks: Are the doctors, hospitals, suppliers, and services that the client’s health insurance company has or does not have a contract with. In-network is for those that work with the insurer, out-of-network refers to those who work outside of the insurance company’s contracted community.

About Drug and Alcohol Rehab, Treatment, and Insurance Coverage

So, now you understand more of the terms and practices that go along with your insurance plan, but what about the drug rehab centers that accept insurance? Every drug and alcohol rehab facility operates a little differently, not every rehab center will offer the exact same services or accept the same types of insurances. But luckily, rehab centers generally share the same founding principles, offer the same types of traditional therapies, and most rehabs that accept insurance will work with clients who have coverage policies with bigger insurers like Aetna. There is not one best insurance for rehab that healthcare companies or policies can offer that work across the board.

What will work best for each individual varies, based on the severity of their condition, where they are attending rehab, the policy they hold with an insurer and so on. But Aetna is typically considered one of the best insurance companies to use, in order to receive coverage for a variety of different health conditions and services. There are many drug rehab centers that accept insurance, all of which can decide individually whom they will work with, and whom they will not work with. For a drug and alcohol rehab facility to be covered under most insurance policy plans; the center must be a registered member of the insurance company’s community network.

Some drug and alcohol rehab facilities like St. John’s Recovery Place (SJRP), works diligently to become a part of many different insurance community networks, others choose to focus on only a few providers. It all depends on the individual rehab center and insurance company themselves, and whether or not they decide to work together. Drug and alcohol rehab are normally covered, at least in part, by many different insurance companies, although not all treatment services in a rehab facility may be always covered. Addiction is a complex disease that often involves an extensive treatment program. Drug and alcohol treatment programs for addiction and substance use disorders often include:

  • Medical detox services
  • Inpatient / residential rehab services
  • Partial hospitalization program (PHP) suggestions
  • Outpatient rehab services
  • Intensive outpatient rehab services
  • Aftercare services
  • Support groups
  • Tradition therapies

And, for some special rehab centers, the use of complementary, alternative, and holistic therapies may be added to a client’s treatment regimen. Not every insurance company will cover the use of alternative, holistic therapies, and not every rehab center will offer such services, so if you or a loved one decides to engage in such a treatment option, you may be subjected to paying for the treatment out of your own pocket. Addiction is difficult, rehab and therapy can be frustrating and uncomfortable at times, and insurance can be difficult to understand. But, at the end of the day, if you or a loved one struggles with a substance use disorder or addiction, it is important that you seek out quality professional help, and make sure your insurance company is on board with helping you to receive the treatment you deserve.

If you have an insurance policy with Aetna, you can visit your own personal member portal online, or call the number on the back of your insurance card in order to find out more information about your personal policy plan, and take the opportunity to ask your insurance company about the drug and alcohol rehab centers they may already be connected with, along with the treatments they will cover in full or in part. Don’t wait another day to start your addiction recovery journey, start now by calling your insurance company, or by speaking with your doctor, to figure out your next steps.

References

  • Health Care. How Insurance Companies Set Health Premiums. (Accessed 2020, December 7).
  • Aetna. Company Values. (Accessed 2020, December 7).
  • Aetna. Aetna Facts. (Accessed 2020, December 7).
  • Aetna. Our Corporate Profile. (Accessed 2020, December 7).
  • Aetna. State Specific Information. (Accessed 2020, December 7).
  • Aetna. Screening, Brief Intervention and Referral to Treatment. (Accessed 2020, December 7).
  • Aetna. Individual & Family Health Insurance Plans. (Accessed 2020, December 8).
  • Health Care. Health Insurance Plan & Network Types: HMOs, PPOs, and More. (Accessed 2020, December 8).
  • Health Care. The ‘Metal’ Categories: Bronze, Silver, Gold & Platinum. (Accessed 2020, December 8).
  • Health Care. Understanding Key Health Insurance Terms. (Accessed 2020, December 8).
  • St. John’s Recovery Place (SJRP). Home. (Accessed 2020, December 8).
  • Aetna. Member Log-In. (Accessed 2020, December 8).
  • NIH: National Institute on Drug Abuse: Advancing Addiction Science. Publications: Principles of Drug Addiction Treatment: A Research Based Guide (Third Edition). Types of Treatment Programs. (2018, January). (2020, December 8).