Aetna Rehab Coverage

Sometimes, it is not the unwillingness or lack of ambitions that stop addicted people to steer clear of rehab. There are times that they are worried not about popping holes in their reputation but popping holes in their pocket.

Sadly, rehab can be an expensive pursuit. Even if a person believes that the rewards will be worth the expense, we can’t pay for rehab treatment with force of will as a currency. Thus, people seek help in paying for rehab. Thankfully, there are various ways of paying, such as with Aetna insurance. Aetna with its rehab coverage is one of the insurance providers that help pay for rehab.

This article aims to explain Aetna insurance coverage for substance abuse

Does Aetna cover rehab costs?

Short answer: Yes! But there are exceptions and details that should be considered.

Legal Background

Aetna, just like other insurance providers, is required to cover substance abuse rehab thanks to two laws.


Prior to ACA, getting the most out of mental health insurance coverage is rather difficult. Most of the times, access to the mental health aspect of insurance is locked behind restrictions higher than that of physical health. Various obstacles existed including higher copayments, out-of-pocket maximums and coinsurance.  ACA addressed this problem by requiring the limitations of mental health to be not as restrictive as its counterpart. However, there is a catch: ACA does not require plans to cover mental health. This is where MHPAEA` comes in.

Whether a plan is individual or small group plan, MHPAEA requires providers to include mental health coverage in their plans. In addition, MHPAEA requires this mental health coverage to comply with ACA. Therefore, MHPAEA and ACA work in tandem to make sure that insurance plans provide mental health coverage.


Getting the Most out of Your Aetna Insurance Plan

Insurance plans can sometimes become too much of a headache to comprehend. However, understanding them will help you assess the cost and get the most out of your insurance plan thus helping you to avoid increasing costs instead of decreasing them.

In-Network vs Out-of-Network Rehab

If a facility is within Aetna’s addiction treatment network, you will likely get discounts throughout your treatment. Insurance providers have negotiated contracts and deals. Thus, you can get discounts even if your insurance is not yet kicking in. This way, you will usually find treatment cheaper despite the premiums.

Out-of-network rehab facility is not always covered. If it is, you will have to pay higher coinsurance and copayments because of the absence of discount contracts with insurance providers.

Rehabilitation Copayments and Coinsurance

When choosing the right plan, copayments and coinsurance should be considered, especially if you are going into a long-term rehab treatment.

Copayments are fixed values you pay each time a service is rendered. For instance, you will have to pay $20 for a therapy, and the insurance pays the rest. On the other hand, coinsurance is a percentage of the total cost you will pay. For instance, you may have to pay 20% and your insurance provider will pay the rest. If you are looking into changing insurance plans for long-term rehab, look for a plan with low copayments and coinsurance. This may come at the expense of higher premiums and out-of-pocket maximums, but recurring copayments and coinsurance can easily accumulate into more expensive chunks.

Determining Aetna Insurance Coverage for Substance Abuse

Your safest bet is to call Aetna customer service, though there are guidelines to help you determine the chances of being covered.


           Is the Treatment Medically Proven?

           Aetna, just like most insurance providers out there, does not cover experimental methods. If an addiction treatment method is backed by concrete scientific evidence, the method will be covered as long as it is approved by the appropriate authorities. This restriction also applies to experimental medications. For this same reason, it can be a challenge to find an insurance that covers alternative medicine.


Is the Treatment Medically Necessary?

Aetna and other insurance providers will cover a substance abuse treatment or medication if and only if it is medically necessary. Necessities and preferences are two different cases. A treatment method can merely be preferred either by the doctor or the patient and not necessary. Because of this, a patient is sometimes required to provide documents that will deem the treatment necessary. In most cases, a written letter from the doctor that explains the necessity (and urgency, in some cases) will help coverage be approved.

Insurance companies have unique guidelines when it comes to substance abuse coverage. For more details, you can contact your insurance provider.

Types of Rehab Covered by Aetna

When we say “Aetna addiction coverage,” we are talking about a very general topic. What does Aetna cover when it comes to addiction rehab? Does it cover alcohol treatment? Substance abuse treatment? Does it cover the medications? Below is a list of frequently asked questions about the types of rehab covered by Aetna and its extent of coverage:

  •         Does Aetna Cover Drug Rehab?

Yes, as mentioned earlier insurance providers are required to include addiction rehab as part of their mental health coverage. Aetna is no exception to this.

  •         Does Aetna Cover Alcohol rehab?

In the eyes of mental health, alcoholism and substance abuse are of equal footing. In fact, alcoholism is a type of substance abuse. Thus, any insurance plan that covers drug rehab covers alcohol rehab as well. Hence, Aetna covers alcohol rehab. Take note, however, that Aetna provides different insurance plans. Thus, the degree of coverage may vary. Some plans may completely cover rehab, while others will only cover it partially.

  •         Does Aetna Cover Mental Health Services?

Yes, in compliance to ACA and MHPAEA Aetna covers most forms of mental health services as long as they are not experimental. This will include various therapies and treatments for disorders such as PTSD, schizophrenia and mania.


  •         Does Aetna Cover Out-of-State Rehab Centers?

Aetna does cover both local and out-of-state rehabilitation The network of Aetna will not span on your state alone thus you can rest assured that Aetna got your back. The safest way to be sure is to contact your insurance agent to find out if the rehab center you chose is covered by Aetna.

  •         Does Aetna Cover Out-of-Network Rehab?

While Aetna covers out-of-network rehab, there can be additional costs. For instance, there may be higher copayments and out-of-pocket maximums. Insurance providers have contracts and deals with rehab centers within their network thus lowering the cost both for you and your insurance provider.

  •         Does Aetna Cover Luxury Rehab?

Luxury rehab is a little complicated when it comes to rehab coverage. Before, they rarely accept insurance and only accept cash payment. Thankfully, many luxury rehabs are now open when it comes to insurance. Usually, the costs of luxury rehab can be steep (but is usually offset by the quality of service they provide). Thus, insurance providers impose higher restrictions (copayments, out-of-pocket, etc) to compensate for the cost. However, once you reach the point where insurance will pay for luxury rehab, you will save a lot more than what you invested.

  •         Does Aetna Cover Ultra-Rapid  Opioid Detox and Rapid Detox?

“Aetna considers ultra-rapid opioid detoxification (UROD) experimental and investigational as a clinical detoxification treatment and for all other indications because its effectiveness has not been established.” – Aetna’s policy for UROD

Aetna does not cover UROD and Rapid Detox, mainly because they are considered unsafe and experimental. Aetna based these conclusions on a good number of studies that points out the lack of safety of UROD. For instance, Aetna cited a review by Weaver and Hopper which pointed out the adverse effects related to anesthesia-assisted rapid detoxification.

  •         Which Does Aetna Cover? Inpatient or Outpatient Rehab?

Thankfully, it Aetna covers both. It is no longer a question of “Does Aetna cover inpatient rehab?” but a question of which rehab is the best for you.


  Outpatient vs Inpatient Residential Treatment Centers


    Inpatient rehab is when a person will have to reside in a controlled sober environment. On the other hand, outpatient does not require the presence of a patient 24/7 but only requires them to do scheduled visits and therapies.


    If a person has been addicted for a long time, inpatient rehab is recommended while outpatient is better for those who are only mildly addicted.

  •         How Long Will Aetna Cover my Rehab?

Usually, Aetna will cover your rehab as long as you need it. Of course, this depends entirely on your plan. There are plans that cover very long stays but will require higher copays and coinsurance (in some cases, deductibles too). To be safe, contact your provider for complete details.

  •         Will Rehab Cause my Aetna Premium to go higher?

Insurance premiums will rarely (if ever) increase because of rehab stays. However, costs can still increase because of recurring copayments and coinsurance. If you will choose your plan wisely, you can mitigate this cost so that your insurance plan will cover your expenses in a way that the costs are decreased, not increased.

  •         Will Aetna Cover Multiple Rehab Stays?

Just like how Aetna will cover long rehab stays, multiple rehab stays will be covered. Depending on the plan, Aetna may pay for your entire expense. Such cases usually happen in a setting of high insurance premium in an in-network facility. Sometimes, you will have to pay for a part of your rehab but these instances are usually associated with low out-of-pocket maximums and premiums. Either way, in-network rehab is a surefire way to make your costs drastically decrease.

  •         What Type of Substance Abuse is Covered

Aetna will cover most types of substance abuse, as long as these substances are medically proven to be addictive or damaging to the mental health. Such substances include the following:


o   Adderall

o   Alcohol

o   Ambien

o   Ativan

o   Benzodiazepines in general

o   Cocaine

o   Crack

o   Heroin

o   Methadone

o   Valium

o   Ketamine

o   Klonopin

o   Marijuana

o   Methamphetamine

o   Opiates in general

o   A plethora of other addictive drugs such as some prescription drugs


  •         Will Aetna Cover Recovery Aftercare Expenses?

Yes, Aetna covers such expenses as long as it is medically necessary. Aftercare is a vital part of recovery and plays an important role in helping a person to cope again with his environment. After a long stay in rehab, an individual needs emotional and psychosocial support in order to avoid relapse. Such support is provided by professionals and is usually considered as a part of the treatment method itself, hence being covered by insurance.

Does Aetna Cover Rehab baseed on Complementary and Alternative Medicine?

NO, it does not. “Aetna considers alternative medicine interventions medically necessary if they are supported by adequate evidence of safety and effectiveness in the peer-reviewed published medical literature. ” – Aetna’s Policy for Complementary and Alternative Medicine

It is not guaranteed that Aetna will cover alternative medicine. Generally speaking, there is only a limited list of alternative methods that Aetna supports, including Acupuncture, Biofeedback, Chiropractic Services and Electrical Stimulation. Of these four, only Acupuncture and Chiropractic services are used for addiction. Unfortunately, Aetna does not cover the application of these methods to addiction treatment.


How To Cover What Insurance Won’t

State/Federal Programs and Insurance

If you are not enrolled in an insurance plan, you can utilize the aid of the government. Several state and federal programs offer help in paying for rehab. These programs usually require a person to fall into a category. For instance, Tricare is for veterans, Medicaid is for the poor and Medicare is for the elderly. Rest assured that all these programs will cover mental health and addiction services.


Philanthropic Sponsorships

Some rehabs are run by philanthropic groups and therefore offer cheap to free services. There are also organizations that may provide grants to help you pay for rehab, though this usually requires a lot of paperwork and will have prerequisites such as being a single parent or under an income threshold.


Payment Negotiations

Rehab service providers have hearts too. There are cases that they will organize payment options for clients, such as paying monthly or sliding scale fees. Sliding scale fees are charged directly proportional to your net worth and income, thus the nearer you are to the poverty line the less you will pay.

Keep in mind that rehab is a medical necessity, not a luxury. If you let a loved one’s addiction go on for a very long time, you risk not only his sobriety but his life as well.