Does Aetna Insurance Coverage Cover Drug or Alcohol Rehab?

If you struggle with substance use disorder and are looking to enter into a drug and alcohol recovery program, you have probably already begun looking into how you can pay for your treatment. There are many different types of insurance companies, and insurance plans out there for you to choose from and be covered by. Of course, not every insurance company or policy is the same, and depending what type of plan you have, or even what state in the U.S. you live in, can affect what types of services your personal insurance policy can and will cover for you.

At this point, if you have a policy under Aetna insurance, you may be wondering if your personal plan is enough to cover your drug and alcohol treatment costs, or if you will need to start finding other means of paying for your treatment.

At St John’s Recovery Place (SJRP), we work hard to provide our clients with a quality basis of care and understanding, throughout the many different levels of recovery and treatment. As a part of that care, SJRP works hard to provide clients with the opportunity to work with their insurance through us, in order to pay for their treatment. Here at SJRP, we work with many different insurances, so ultimately it will come down to whether or not your personal policy covers the cost of drug and alcohol rehab.

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Brief History of Aetna Insurance

Originally founded in 1853, the insurance company Aetna had its start in Hartford, CT. Like many other insurance companies, Aetna works hard to serve a broad community of people from all different walks of life, professions, and places.

Aetna first and foremost claims to be a company that is all about the people and advancing healthy communities. And as the world has changed and evolved from 1853 to now, Aetna continues to work to serve their clients, now more than ever working to build a new consumer healthcare experience, for everyone who has an insurance policy with the company.

What Does My Aetna Insurance Policy Cover?

Aetna’s dedication to providing consumers with quality care is great, but what exactly is covered under their insurance policy? It depends on what type of policy you are personally enrolled in. Aetna has many different types of insurance policies, all of which come with different levels of coverage and care. So, if you already have a policy with the company, you’ll want to be sure to check what kind of coverage your plan provides you with.

If you aren’t sure what type of coverage your personal Aetna plan will cover, it is important that you get in contact with the company to find out, especially if you are looking into enrolling in a drug and alcohol treatment program soon. Depending on your specific policy, your addiction treatment may be covered in either full or partial amounts. If you are unsure where to start looking for specific information on your plan, you can either call the company or try visiting their member login website. Otherwise, Aetna insurance plans typically include:

HMO plans

Extremely affordable, but limiting. Clients can only work with physicians in the network of this plan, and typically do not suffer from any chronic or severe conditions.

POS plans

Are also affordable, but allow clients the chance to work with healthcare physicians that are out of the network’s coverage. This type of coverage is a little more expensive than the first, but also allows clients the opportunity to work with specific specialists they may need for some chronic conditions.

EPO plans

A less commonly known insurance type that limits clients to working with in-network care systems only, but has a larger network available to clients than an HMO plan. Has a larger national network for clients to work with, especially if they need to see a specialist for a specific condition they have.

PPO plans

Also known as “the plan with the most freedom”, this plan is pricier than the previous ones mentioned, but always clients to work with both in-network and out-of-network providers.

HDHP with HSA plans

These types of plans can operate in a multitude of ways, but typically involve lower premium costs, but have higher out-of-pocket expenses for clients to work around. This kind of plan works best for an individual who is managing a chronic health condition but cannot afford high monthly premiums.

Policies Vary

Many Aetna insurance policies and their affiliates are primarily Medicare developed plans (that also offer Medicaid policy options) that work to provide individuals, companies, and providers with a well-rounded network of quality care professionals. Each policy plan varies a bit from each other in terms of which types of treatments they cover, and if you have more questions, you can always call Aetna, or visit their webpage to obtain more information about their policies and your personal coverage. But overall, if you have an insurance policy with Aetna, you can expect:

  • Prescription drug coverage
  • 24/7 access to your personal plan and coverage through the Aetna website
  • Assistance with your personal concerns and questions
  • Patient confidentiality on both state and federal levels
  • Access to participating, in-network providers and services
  • Treatment coordination
  • National coverage
  • Management of your personal healthcare case

Does Aetna Cover Rehab?

Understanding the ins and outs of insurance policies can be difficult, confusing, and frustrating. Typically, Aetna insurance policies that have lower premium costs only allow clients to work with specific in-network providers and care services, but there are some plans available to consumers that can also cover out-of-network costs and services.

Aetna healthcare works to care for their clients no matter what their circumstances may be. As a result, most insurance policies with the company cover the alcohol and drug addiction treatment process from the very beginning to the very end, involving the screening process to determine the disorder, all the way through in-network after care programs. As an in-network Aetna care provider, Saint John’s Recovery Place (SJRP) helps clients who struggle with substance use disorders to enter into their drug and alcohol rehab programs with a little more peace of mind.

As an in-network care provider, clients who hold even less expensive Aetna insurance policies can have at least part of their treatment covered by the healthcare company at a lower cost. Insurance and addiction recovery can be frustrating to try and understand, and often hard to work through, but it does not have to be impossible or limit the amount or type of treatment a client can receive. The most common drug and alcohol addiction treatments that are covered by Aetna insurance include:

Does Aetna Cover Methadone Maintenance Treatment?

Substance abuse recovery can be long, complex, and involves a lot of steps. In order to even begin your addiction recovery process, you must first begin by visiting your primary care physician, and undergo an evaluation to determine the scope of your disorder, and allow your doctor the chance to come up with a preliminary treatment plan and recommendations for your next step. Depending on the severity of your condition, the manner in which your plan is executed can look very different. Of course, addiction is a chronic disease, but everyone handles and experiences it differently, which means no one’s recovery plan and treatment will look the same.

Aetna insurance plans can look very similar, and depending on your personal policy, your needs, and the types of physicians and care services you choose, your Aetna insurance plan can look very different from another client’s and can involve different kinds of treatment. Methadone maintenance treatment is a type of medication-assisted substance abuse recovery treatment, that aids clients in managing their chronic pain and withdrawal symptoms and cravings that are normally associated with opioid addiction and recovery. Over 10.3 million people misused prescription opioids in 2018, and the epidemic’s numbers have only continued to grow, as opiate abuse remains the most common form of substance abuse in the U.S.

Whether or not Aetna insurance covers the use of methadone maintenance treatment in substance abuse recovery, completely depends on you, your personal policy with the company, and whether or not you can locate a doctor or drug and alcohol treatment facility near you, that offers the treatment and is within Aetna’s in-network treatment services. Aetna insurance policies typically work very well, and cover much of what an individual needs to pursue recovery and the maintenance of their overall health, and there are a multitude of services and resources available to clients through the company’s treatment network. Typically, methadone maintenance treatment is covered under Aetna insurance in a medical care plan, and not under a pharmacy care plan, as the addiction treatment is normally given in a clinic setting.

Does Aetna Insurance Cover Suboxone Treatment?

So, does your Aetna insurance cover the cost of your suboxone prescription? Typically, yes, according to your personal policy and plan, suboxone is covered by Aetna insurance. With an Aetna Speciality Pharmacy policy plan, all of your pharmacy needs can be filled with ease, from your lowest general cost medications, to your special, high cost, drug needs. The amount you pay for your specialty drug–like suboxone–directly relates to the type of drug your doctor prescribes you with. With your insurance plan, you will only have to pay either a flat rate for the medication, or a percentage of the drug’s original cost, but you can get it with your Aetna insurance policy.

Suboxone is a medication that contains both buprenorphine and naloxone, both drugs that are also covered for everyone registered to an Aetna policy through their employer. Suboxone helps to block the effects of opioids on the brain, helping to prevent usage, reduce cravings, and aid clients in slowly weaning off of their drug use. In order to use suboxone and have the cost of the drug covered by your Aetna insurance policy, you have to obtain a prescription by your in-network primary care physician in order to use the drug.

Does Aetna Cover Alcohol Recovery Rehab?

So, what about alcohol use disorders and rehab? Does Aetna insurance cover alcohol rehab and treatment? If you or your loved one struggle with alcohol addiction, and you have Aetna insurance, you may be wondering if alcohol rehab can be an option for you to utilize with financial help from your insurance policy. In order to learn exactly what your Aetna insurance policy does and does not cover, it is important for you to visit your own client portal on the company’s website. Logging in to this portal will provide you with a multitude of resources and information about your policy plan, coverage, and the in-network services and providers you can choose from.

Alcohol abuse disorder is just another substance use disorder, and as such, your Aetna insurance plan (depending on your individual policy) will likely cover the cost of your rehabilitation treatment in full or part, especially if you choose from the network of providers and services plans that the company already provides you with by default. Alcohol rehab can also utilize detox, inpatient, outpatient, and aftercare services, all of which can be covered in Aetna’s different policy plans, through their in-network treatment centers and care providers.

In-Network Services Vs. Out-of-Network Expenses

So what really is the difference between in-network care, and out-of-network care? Aetna healthcare has worked hard to build a community of quality professional and essential services to build their in-network team. The term in-network refers to just that, a team of providers, care centers, health services, and facilities that work together to provide the same standard of care that Aetna officials expect–with professionalism, understanding, compassion and excellence of treatment in mind.

Of course, depending on the type of insurance policy you get under Aetna, you do not have to be limited to their own providers and practices, you are free to add in additional treatments, see specialists, and other doctors who are outside of the Aetna network to receive treatment, but it will cost you more from the insurance policy to cover this type of care. Out-of-network care expenses can vary highly, depending on what services you are looking into, the cost of that individual provider, and whether or not they will accept your insurance policy under Aetna as well.

Aetna healthcare works hard to provide their consumers with a large in-network basis for treatment. But, if you decide you want to try an out-of-network treatment or specialist, you will be subject to others fees, as well as the potential to have to pay more out-of-pocket costs for your out-network treatments. The cost of out-of-network treatment varies, depending on:

  • The percentage of cost your policy is allowed / subject to cover
  • The methods which your personal policy is set to “allow” or “recognize”
  • The medicare-based rates for service that are determined by the government

Emergency care does not count as out-of-network care. Aetna insurance plans work to cover what are called “reasonable” treatments for substance abuse disorders, and other health issues. You can find out more about Aetna’s in-network services and providers on the company’s website. Types of care that may be seen as “unreasonable” or are out of the Aetna healthcare network may include:

  • Luxury treatment facilities
  • New age treatment methods
  • Holistic treatment methods and therapies
  • Some over-the-counter medications
  • Private treatment facilities

Paying for Drug and Alcohol Rehab

If you or your loved one struggles with a substance use disorder, you are probably feeling very overwhelmed by the amount of information being introduced to you. You are learning more about the disorder, more about yourself, the needs of your loved ones, the steps or treatment, all while trying to figure out how you will pay for treatment, and find help to manage your life after you leave your loved ones to obtain treatment. Here at St John’s Recovery Place we know how stressful and overwhelming this process can be, but we promise you, with persistence and dedication, you can make it through.

Aetna Insurance, and Aetna in-network or participating rehab facilities can do a lot for you, and your loved ones in terms of recovery and paying for your treatment costs. But, if you don’t have Aetna insurance or your personal policy plan does not cover the types of treatment you need, or would like to try, there are other ways to pay for treatment that can help you greatly, including:

  • Scholarships
  • Grants
  • Donations
  • Payment plans

There are many different types of funding options and opportunities available to you if you are looking to pay for drug and alcohol rehab and either do not have the sufficient funds to pay for treatment, your insurance policy won’t cover the treatment in full, or if you want to try an out-of-network service that would normally be too much for you to afford. At the end of the day, rehab facility insurance programs work very hard to make treatment affordable, so that it can be readily available to anyone who needs it. So, if you are looking into drug and alcohol rehab, and you aren’t sure if the facility you are looking into accepts your insurance, or that your insurance policy will cover the cost of your treatment, make sure to call your insurance company (whether it is Aetna or another provider) to determine where you need to be looking for treatment, and do not be afraid to reach out to the treatment center you are interested in to ask questions.

Addiction recovery is already difficult, complex, frustrating and time consuming. Paying for addiction recovery, or at least starting the process can also be difficult, but in the end, treatment is made to be affordable. Don’t put off the start of your recovery journey any longer, start today or call us here at Saint John’s Recovery Place for more information about or services, insurance acceptances, and what your next steps may be.

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