When looking for treatment for substance abuse and mental health conditions, figuring out your insurance coverage is often the first step in determining how you’ll attend treatment. Wading through confusing insurance jargon can be overwhelming and confusing. This can often lead to individuals deferring going to treatment because they don’t understand their insurance coverage.
Westwind is an in-network treatment provider for Aetna Health Insurance, so getting covered can be much easier than you think.
If You Have Insurance, You Have Coverage
The Affordable Care Act (ACA), also known as Obamacare, is a health insurance reform that was passed in 2010. The ACA requires all U.S. citizens and legal residents to have health insurance coverage. In order to make this possible, the ACA created Health Insurance Marketplaces where people can shop for and compare health insurance plans. The ACA mandates that all treatment plans offer some sort of coverage for substance abuse and mental health conditions. So regardless of your insurance plan, you have some sort of coverage.
What is Aetna Insurance?
Aetna has a wide insurance network with over 46 million treatment subscribers throughout its many types of insurance plans. These include regular insurance, vision, and dental. Aetna offers plans in all 50 states of The United States and includes 1.2 million medical professionals. These include primary care physicians and specialists throughout over 5,700 healthcare facilities.
Aetna was acquired by CVS Health in 2018 and is now a subsidiary of CVS Health.
Does Aetna Cover Rehab for Substance Abuse?
To qualify for substance abuse treatment through Aetna you will need to be evaluated by an addiction treatment specialist to determine what type of care your plan will cover. In general, a treatment specialist will use biological factors as well as answers for the following items:
- How long have you been suffering from addiction?
- Have you been through a treatment program previously?
- What types of substance(s) have you been abusing?
- Do you have any co-occurring mental health or co-morbid disorders?
- Is your home environment a safe and supportive environment for treatment?
This is not an exhaustive list of all the questions a treatment provider may ask. However, you should expect these questions in order to get an accurate diagnosis of what’s needed for your own individual care.
Types of Substances Aetna Insurance Covers
Aetna insurance typically covers treatment for most types of addiction that include:
- Alcohol
- Heroin
- Cocaine/Crack
- Meth
- Prescription drugs
- Fentanyl
- Club drugs (ecstasy, MDMA)
Aetna Coverage for Detox
In order to be approved for detox treatment through Aetna your treatment specialists will need to determine the severity and length of substance abuse. They will also need to consider if there is another co-occurring illness present. Once this has been understood you can qualify for an inpatient or outpatient detox program. Detox options also include abstinence-based detox and medical detox programs.
Treatment providers will determine which ones will work best for you. In many cases, individuals will need to attend medical detox in order to withdraw safely from drugs or alcohol. Medical detox programs prescribe individuals medications to ensure they detox safely and comfortably. These programs are also monitored 24/7 to make sure that the detox protocol is working and withdrawal symptoms are being managed.
Aetna Coverage for Inpatient Treatment
To qualify for inpatient treatment using your Aetna insurance you will need to demonstrate the need to get treatment at the facility. Individuals with serious addiction issues or co-occurring disorders will often be required to attend this form of treatment, and then they can transition to an outpatient care facility.
Inpatient treatment is a form of addiction treatment program where you undergo treatment at the facility and live at the facility. Inpatient treatment can also be referred to as residential treatment. Inpatient programs are the most intensive form of addiction treatment as you live at the facility and undergo treatment therapy around the clock. Therapy typically includes individual, group, and family therapy.
Aetna Coverage for Outpatient Treatment
Aetna typically covers two forms of outpatient care, intensive outpatient and partial hospital treatment depending on your individual treatment plan and coverage. Both forms are considered outpatient care as you attend treatment at the facility but then stay at your own home in the evenings.
Partial Hospital Care
Partial hospital programs or PHPs usually include 4-8 hours of treatment during the day (also sometimes referred to as day programs), and may also include attending support groups like NA or AA. PHPs are essentially as intensive as many inpatient rehab programs but you stay at home in the evenings. In many cases, if you can’t attend a residential program, a PHP will be recommended. These are the most intensive outpatient programs.
Intensive Outpatient Care
Intensive outpatient programs (IOPs) usually involve 3-5 hours of treatment a few days a week. Treatment is much less intense than in a partial hospital program or a residential program, but more intense than standard outpatient care, as with partial hospital programs those attending may also need to attend support groups outside of treatment.
Outpatient Care
Outpatient care involves visiting a therapist or counselor for a few hours each week. This level of care is generally recommended once you’ve completed a more intensive treatment program and are able to live on your own without 24/7 supervision. Outpatient care is often used as a step down approach from other forms of addiction treatment or used as treatment type in cases of relapse.
Does Aetna Cover Rehab for Mental Health Conditions?
Aetna does cover rehab for mental health conditions, as well as substance abuse disorders. In order to get coverage for mental health treatment, you will need to have a diagnosis from a licensed mental health professional. Aetna also requires that the treatment be deemed “medically necessary” in order for coverage to be provided.
Does Aetna Cover Treatment for Co-Occurring Disorders?
Yes, Aetna does cover treatment for co-occurring disorders. In order to get coverage for the treatment of a co-occurring disorder, you will need to have a diagnosis from a licensed mental health professional. Aetna also requires that the treatment be deemed “medically necessary” in order for this form of coverage to be approved.
If you are approved for treatment for co-occurring disorders you will most likely need to attend an inpatient program or a PHP as these are the most intensive forms of care and are often necessary to treat co-occurring disorders.
Does Aetna Offer Coverage for Therapy?
Aetna offers coverage for a variety of therapy services including individual, group, and family therapy. Aetna also offers coverage for psychiatric evaluations, medication management, and other mental health services.
Therapy is covered through an addiction treatment plan or may be included as part of an aftercare treatment protocol.
Does Aetna Offer Coverage for Aftercare Programs?
Aetna offers coverage for a variety of aftercare programs including sober living houses, alumni support groups, and outpatient therapy. Each person’s approval for aftercare support is determined by their individual condition and not set to a predetermined time. This means that you may undergo several evaluations during aftercare to determine if these programs are helping you remain in recovery.
Aetna recommends that individuals continue aftercare programs with the facility that they utilized for addiction treatment. This is because people see the best results in this scenario. Aftercare programs are a vital part of the recovery process and can help prevent relapse.
100% Coverage is Not Guaranteed
Aetna does not guarantee that 100% of the costs for addiction treatment will be covered. The level of coverage depends on a variety of factors, such as your location, the type of facility you choose, and your individual policy. In general, the more severe your level of addiction, and the better your insurance policy may be, the more likely your costs will be covered.
It is essential to check with your insurance provider or the admissions department at the treatment facility to see what level of coverage you have for addiction treatment.
Aetna Insurance Policies
Aetna offers several types of treatment plans including the following:
- Open-access plans: You choose your own doctors and they need a referral from a primary care doctor.
- Copay-only plans: These plans guarantee that your costs are limited to copays. Generic medications and primary doctor visits are covered before you reach your deductible.
- High deductible plans: These plans offer only preventative medical services before the deductible is met (with a copay), and you’ll also have the option of a health savings account.
To determine which plan you are enrolled in, or to learn more about plan types you can visit the Aetna website to learn more.
How Can I Verify My Coverage?
The best way to find out your coverage is to call the treatment facility of your choice and speak with an admissions specialist. You can provide them with your insurance information and they will determine your type of coverage and associated costs. You can also reach out to facilities by utilizing convenient chatbot functions on their websites to speak with someone privately.
Another way is to call Aetna directly and ask for a list of treatment providers that they are in-network with and to provide an understanding of what your coverage limitations may be.
Westwind Recovery® is an In-Network Treatment Provider
Westwind Recovery® is in-network with Aetna, which means that we will work with you and your insurance company to get you the treatment that you need. We want to make the process of getting help as easy and stress-free as possible for you, which is why we accept a wide range of insurance plans.
When you contact Westwind Recovery®, one of our admissions counselors will discuss with you your insurance information. We’ll work with you to understand your benefits and what your coverage entails. We understand that dealing with addiction is difficult enough – we don’t want you to have to worry about whether or not your insurance will cover treatment. Contact us today to learn more about how your Aetna insurance benefits can cover your treatment!
Dr. Deena is the Chief Clinical Officer of Westwind Recovery®, an award-winning outpatient treatment center in Los Angeles where she oversees the clinical and administrative program and treatment methods. Dr. Deena is a doctor of psychology and licensed clinical social worker since 1993. LCSW #20628. Originally from the East Coast, Dr. Deena has worked running treatment centers, worked as a therapist in psychiatric hospitals as well as school settings and currently has a thriving private practice in the LA area. Dr. Deena has appeared regularly on the Dr. Phil Show as an expert since 2003. She has also been featured on many other TV shows, podcasts and has contributed to written publications as well as podcasts.
