Cornerstone

Understanding Aetna Drug Treatment Coverage

Learn about using your Aetna insurance policy to cover substance abuse treatment

Alcohol and Drug Treatment Coverage with Aetna

When you’re struggling with alcohol or drug addiction, the last thing you want to worry about is whether your insurance will cover the treatment you need. Aetna, one of the nation’s leading health insurance providers, offers coverage for substance abuse treatment to help you get back on track. In this guide, we’ll dive into the various aspects of Aetna’s drug treatment coverage so you can focus on what matters most: your recovery.

We’ll explore topics such as in-network and out-of-network coverage, the claims approval process, the types of plans available, deductibles, and how to navigate hardships. By the end of this page, you’ll understand how Aetna can support you on your journey to a healthier, substance-free life.¹

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Aetna drug treatment coverage

When you choose an in-network treatment center for your drug rehabilitation, you’re opting for a facility that has a pre-existing agreement with Aetna. The main advantage of this choice is that you’ll typically pay lower out-of-pocket costs, as Aetna has negotiated discounted rates with these providers. Additionally, in-network centers handle most of the paperwork and claims process for you, reducing the administrative burden during an already challenging time.

However, it’s important to note that staying in-network may limit your choice of treatment centers, and you might need to travel further to find a covered facility that meets your specific needs. ³

Opting for an out-of-network treatment center using your Aetna policy comes with its own set of pros and cons. On the positive side, you’ll have a wider selection of facilities, increasing your chances of finding a center that offers specialized programs tailored to your unique situation. This can be particularly beneficial if you’re seeking a specific type of therapy or a facility with a particular focus.

However, the downside is that out-of-network centers often incur higher out-of-pocket costs, as Aetna hasn’t negotiated discounted rates with these providers. Moreover, you may need to handle more of the paperwork and claims process yourself, which can be daunting when you’re already dealing with the challenges of addiction and recovery.

Information about Aetna Plan Types

Aetna offers HMO plans that require you to choose a primary care physician (PCP) who will coordinate your care and provide referrals to in-network specialists, including drug treatment centers.

With Aetna’s HMO plans, you’ll typically have lower out-of-pocket costs for covered services, but your choice of treatment facilities may be limited to those within the Aetna network.

Aetna’s Traditional Choice plans are PPO plans that provide more flexibility in selecting a drug treatment center.

You can visit in-network or out-of-network providers, although out-of-network care typically comes with higher out-of-pocket costs.

Aetna’s Traditional Choice plans do not require referrals from a PCP to see a specialist, making it easier to access drug rehabilitation services when needed.

Aetna’s EPO plans balance cost and flexibility for drug treatment coverage. With an EPO plan, you’ll have access to a network of rehab facilities that provide services at a discounted rate, resulting in lower out-of-pocket costs.

However, EPO plans generally do not cover out-of-network care except in emergencies. When considering an Aetna EPO plan, research the in-network rehab facilities to ensure they meet your needs.

EPO plans can be a good choice if you prioritize lower costs and are comfortable receiving care from in-network providers.

Aetna’s Open Access Managed Choice plans are a type of POS plan that combines features of HMO and PPO plans.

These plans allow you to choose between in-network and out-of-network care for drug treatment, but you’ll generally pay more for out-of-network services.

With Aetna’s Open Access Managed Choice plans, depending on your specific plan, you may need a referral from your PCP to see a specialist.

Aetna offers HDHPs that can be paired with an HSA to help cover the cost of drug treatment.

These plans have lower monthly premiums but higher deductibles than other Aetna plans.

By contributing to an HSA, you can save money on a pre-tax basis to pay for qualified medical expenses, including drug rehabilitation services.⁶

Aetna provides Medicare Advantage plans, also known as Medicare Part C, which can include drug treatment coverage.

These plans bundle Original Medicare (Part A and Part B) coverage with additional benefits, such as prescription drug coverage and potentially more comprehensive substance abuse treatment services.

The specific coverage for drug rehabilitation may vary depending on your Aetna Medicare Advantage plan and location.

Understanding Policy Terminology

Regarding your Aetna drug treatment coverage, the Deductible is the amount you’ll need to pay out-of-pocket before your insurance kicks in.

For example, if your plan has a $1,000 deductible, you’ll be responsible for covering the first $1,000 of your treatment costs. Once you’ve met your deductible, Aetna will start sharing the cost of your rehab services according to your plan’s coverage.⁴

It’s important to note that some Aetna plans may have separate deductibles for in-network and out-of-network providers.

After you’ve met your deductible, Aetna will start sharing the cost of your drug treatment through co-insurance.

Co-insurance is the percentage of your treatment cost, while Aetna covers the rest. For instance, if your plan has an 80/20 co-insurance and your treatment costs $1,000, you’ll pay $200 (20%), and Aetna will cover $800 (80%). Remember that co-insurance percentages may vary depending on whether you choose an in-network or out-of-network provider.

The Out-of-Pocket Max is the most you’ll have to pay for covered drug treatment services in a given plan year. This limit includes your deductible, co-insurance, and copayments (if applicable).

Once you’ve reached your out-of-pocket max, Aetna will cover 100% of your eligible treatment costs for the remainder of the plan year. This financial safeguard helps protect you from overwhelming medical expenses related to your drug rehabilitation. As with deductibles and co-insurance, your out-of-pocket max may differ for in-network and out-of-network care.

Aetna Approval Process for Treatment

The first step is to verify your Aetna insurance coverage. Our center will contact Aetna to confirm that you have an active policy and determine the details of your coverage, such as your deductible, co-insurance, and out-of-pocket maximum. We will also inquire about any limitations or exclusions related to drug rehabilitation services under your specific plan. ²

Once the verification process is complete, our center will inform you of your financial responsibility for the recommended treatment, if any.

To simplify this process, you can use our verified insurance tool, which helps you quickly determine your coverage.

After you begin treatment, our center will handle the claims process on your behalf. Our billing department will gather all necessary information, including treatment details and associated costs, and submit the claims to Aetna.

This means you won’t have to worry about complicated paperwork or communicating directly with the insurance company. Our experienced staff here at Cornerstone will submit claims for your services.

Once Aetna receives the submitted claims from our center, they will review them during adjudication. Aetna will assess the claims to determine whether the services provided are covered under your specific plan and if our treatment center has supplied all the required information.

They will also calculate the portion of the costs they will pay to our center and the amount you will be responsible for based on your plan’s deductible, co-insurance, and out-of-pocket maximum.⁵

The payment part of the process refers to when Aetna issues payment to our center for the services you received. After our treatment center submits your claims and Aetna adjudicates them, Aetna will determine the portion of the costs they are responsible for covering based on your plan’s benefits, deductible, co-insurance, and out-of-pocket maximum.

Once this is determined, Aetna will send payment directly to our treatment center on your behalf. This payment represents Aetna’s financial responsibility for your covered drug rehabilitation services.

As your specific Aetna plan outlines, you will be responsible for paying any remaining balance, such as your deductible or co-insurance.

In the uncommon event that your claim is denied, our treatment center’s billing department will typically file an appeal with Aetna on your behalf.

Our staff here at Cornerstone Healing Center has extensive experience handling such situations and will work diligently to provide additional information or justification to Aetna to overturn the denial. Our center aims to ensure that you only receive services covered by your insurance, so denials are rare.

However, if a denial does occur, rest assured that our billing department will do its utmost to resolve the issue and secure payment for the services you’ve received.

Get Help Paying Your Deductible

File a Hardship With Aetna

If you’re struggling to pay your deductible for drug treatment, one option is to file a hardship with Aetna. A hardship is a situation that prevents you from being able to afford your medical expenses, such as a job loss, family crisis, or unexpected financial. To file a hardship, you must contact Aetna directly and provide documentation of your financial situation. If approved, Aetna may waive or reduce your deductible, making accessing the necessary treatment easier. Remember that the success of your hardship application depends on your specific circumstances and Aetna’s assessment.

Assistance Programs & Payment Plans

Many drug treatment centers offer assistance programs and payment plans to help make treatment more accessible and affordable. These programs can help you manage out-of-pocket expenses, such as deductibles and co-insurance. Some centers offer sliding-scale fees based on your income, while others may provide scholarships or grants to eligible individuals. Treatment centers may allow you to spread your payments over time through a payment plan, making it more manageable to cover your share of the costs.When selecting our treatment center, inquire about available assistance programs and payment plans.

Community Resources & Charitable Organizations

In some cases, community resources and charitable organizations may be able to help you cover your drug treatment deductible. These organizations recognize the importance of accessible and affordable addiction treatment and may provide financial assistance to those in need. Some examples include faith-based organizations, local non-profits focused on addiction recovery, and national charities dedicated to helping individuals overcome substance abuse. Research the organizations in your area and contact them to learn more about their assistance programs.

FAQs About Using Aetna Benefits to Pay for Alcohol and Drug Treatment

Does Aetna cover inpatient and outpatient drug treatment programs?

Yes, Aetna provides coverage for both inpatient and outpatient drug treatment programs. Inpatient treatment involves staying at a rehab facility for an extended period, while outpatient treatment allows you to live at home and attend scheduled therapy sessions.

Your Aetna plan will determine the specific coverage and out-of-pocket costs for these programs, so it is essential to verify your benefits with Aetna or your chosen treatment center.

How can I find an in-network drug treatment center that accepts Aetna insurance?

To find an in-network drug treatment center that accepts Aetna insurance, you can use Aetna’s online “Find a Doctor” tool or call their customer service helpline. You can also work with a rehab referral service or contact treatment centers directly to inquire about their Aetna acceptance.

Choosing an in-network provider will typically result in lower out-of-pocket costs and a more streamlined claims process.

What if I can't afford my deductible or out-of-pocket expenses for drug treatment?

If you’re struggling to afford your deductible or out-of-pocket expenses for drug treatment, there are several options available. You can file a hardship with Aetna to request a reduction or waiver of your deductible, explore assistance programs and payment plans offered by treatment centers, or seek help from community resources and charitable organizations.

Don’t let financial concerns prevent you from getting the help you need. Contact your chosen treatment center or Aetna to discuss your options and find a solution that works for you.

Sources

[1] About Us & Company Information | Aetna

[2] Substance Use Disorder Screening Tools & Resources | Aetna

[3] How Aetna Can Help You With Substance Use Disorder

[4] Member Login & Register | Aetna

[5] Medical Clinical Policy Bulletins | Aetna

[6] What Is An HSA & What Can It Be Used For? | Aetna

CLINICALLY REVIEWED

Lionel Estrada, LISAC

CLINICAL DIRECTOR

Lionel, our Clinical Director is a Licensed Independent Substance Abuse Counselor (LISAC) with over 4 years at Cornerstone, specializes in addiction and mental health. Trained in EMDR therapy, he employs a trauma-informed, empathetic approach to address the underlying causes of these issues.

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