Through Aetna health insurance, individuals may be able to obtain detoxification and rehabilitation services for alcohol and drug addictions. This may include treatment for opioid addiction, such as that caused by heroin or prescription painkillers.
Roughly 37.9 million Americans turn to Aetna for their health insurance needs. These services are provided by a network comprised of approximately 1.2 million health care professionals, 690,000 primary care doctors and specialists, and 5,700 hospitals.
Aetna provides health insurance plans and services which include Medicare, Medicaid, and behavioral health programs. Aetna’s behavioral health care coverage may help a person pursue treatment for a substance use disorder.
Does Aetna Provide Services For Substance Abuse Treatment?
Yes. Aetna asserts that “Aetna’s network programs have been carefully screened for quality of care, adherence to modern principles of treatment, and excellent follow-up.” The exact benefits and specifications of any substance abuse treatment coverage will vary plan to plan. Our representatives can contact Aetna directly to determine any copays (or coinsurance), deductibles, or out-of-pocket maximums which may influence a person’s out-of-pocket treatment costs.
In order to obtain coverage, Aetna may require documentation confirming the diagnosis of the addiction. This documentation should also portray that substance abuse treatment is medically necessary. This may include correspondence from doctors who are familiar with a person’s case, medical records, and the results of a clinical assessment.
A clinical assessment is important because it does two things: first, it confirms that addiction treatment is medically necessary, and secondly it outlines which treatments are appropriate for a person’s unique circumstances.
During the assessment, the assessor will take note of:
- the drug of abuse
- the length of abuse
- the frequency of abuse
- the effects of the abuse on a person’s life and health
- health and medical history
- the existence of any co-occurring mental health disorders
- any previous addiction treatment history
This information will also help craft an individualized treatment plan which best serves each person’s unique needs.
Aetna notes that programs in their network provide Continuing Care support, or weekly support or “alumni” groups. These peer-support groups help individuals maintain and nurture important recovery principles.
Does Aetna Cover The Cost of Outpatient Substance Abuse Treatment?
It’s important to consider the severity of the addiction when contemplating outpatient care. Outpatient treatment holds a valuable role in addiction medicine, however, it’s not a format that works for everyone.
While outpatient treatment is flexible, it permits a person to still be exposed to harmful triggers for substance abuse. Because of this, many individuals are better off in inpatient rehabilitation programs. These programs provide more protection and a greater opportunity for healing.
Outpatient programs can be great options for individuals who are in transition from inpatient residential programs to sober living in their home or community. These programs enforce important recovery principles while holding a person accountable to their sobriety goals.
Aetna lists both partial hospital treatment and intensive outpatient treatment programs as options in their publication concerning alcohol and drug treatment.
Does Aetna Cover The Cost Of Treatment At An Inpatient Rehab Center?
Inpatient drug rehab programs offer the greatest measure of stability and security during treatment. Additionally, these programs give a person more resources to build a stable recovery with.
Aetna literature notes that inpatient and residential treatment is offered in the following settings:
- general medical hospitals
- psychiatric hospitals
- alcohol and drug treatment facilities
Healing takes both time and access to a variety of researched-based treatment methods. Inpatient programs give a person the greatest opportunity for these elements so that their body and mind have the best chance of healing from addiction.
People who are working to overcome moderate to severe addictions are typically best served in inpatient programs. This is especially true for those who require a medically-supervised detoxification prior to entering treatment. This is often the case for alcohol, benzodiazepine, and opioid addictions.
Does Aetna Cover the Cost of Suboxone?
Suboxone is an evidenced-based medication used to treat opioid use disorders. It’s best utilized as part of medication-assisted treatment, a combination of medications, behavioral therapies, and social support programs.
Aetna benefits may provide coverage for Suboxone. In March of 2017, Aetna ended the prior authorization requirement for any buprenorphine-containing medications for the treatment of opioid addiction. This means that prescribing doctors are able to get these medications to patients quicker.
Suboxone is a combination of two medications, buprenorphine, and naloxone. The buprenorphine diminishes cravings and withdrawal symptoms, while the naloxone guards against drug misuse and diversion.
When supported by a comprehensive treatment program, Suboxone is used during detoxification to help a person taper off the opioid drug of abuse.
Does Aetna Cover the Cost of Methadone Maintenance?
Methadone is also used within medication-assisted treatment programs. Methadone can reduce cravings and symptoms of withdrawal during detoxification, then later be used as a maintenance medication. When used for maintenance, methadone helps a person reduce or stop using opioid drugs like heroin or prescription painkillers.
Aetna notes that methadone is covered by a medical plan, not by pharmacy coverage, due to the fact it’s dispensed by a methadone clinic.
Will My Insurance Pay For
Finding A Rehab Center That Accepts Aetna
Choosing treatment is no small task, but understanding how to use Aetna health insurance can help a person to obtain the best services available for their treatment needs. Even if Aetna doesn’t cover the complete cost of treatment, there are still other options which can help to supplement these insurance benefits.
Today, a person may be able to access a variety of scholarships and grants which round out this cost. Additionally, many facilities offer sliding-fee scales based on income or financing options which provide even greater flexibility.
Contact InpatientDrugRehab.org to learn more about insurance options for addiction treatment.