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Aetna Insurance Coverage

Aetna covers numerous substance abuse treatments, including detoxification, inpatient and outpatient services, partial hospitalization and continuing care. Learn how Aetna insurance can pay for your addiction treatment.

Founded in 1853, Aetna strives to provide the best health coverage for individuals in need of medical care. Aetna medical insurance covers more than 20 million people including students, Americans who are out of the country and more than 500,000 international members.

Aetna is committed to behavioral and mental health. Its medical teams are trained to identify specific conditions and tailor a treatment plan based on what the individual needs. Aetna members can also call a toll free customer service center — available 24/7 — to inquire about their policies.

Types of Substance Abuse Treatment Covered by Aetna

In the past, the standard approach to substance abuse treatment included a referral to an inpatient or residential program that would span 28 days. Now, an individual can receive different modes of treatment depending on the stage of their substance use disorder.

Aetna covers detoxification, inpatient, residential, partial hospitalization and intensive outpatient programs. It requires precertification of some behavioral and mental health services to ensure that the requested service meets the company’s criteria for coverage.

Services requiring precertification include:

However, these requirements do not apply to behavioral health benefit plans that Aetna administers but does not manage or self-funded plans with sponsors who have bought precertification requirements.

In order to receive Aetna’s Exclusive Provider Organization coverage, the treatment plan must be supervised by an in-network physician or licensed provider and be implemented for a condition that can be positively changed.

Inpatient Treatment Coverage

Aetna covers semi-private room and board and other services at a licensed residential treatment facility, hospital or psychiatric care facility.

Aetna’s inpatient coverage includes:

However, Aetna will only cover hospital treatment if the hospital does not have a separate substance abuse treatment facility.

Outpatient Treatment Coverage

Aetna covers substance abuse treatment received in an outpatient setting in a hospital, psychiatric hospital or residential treatment facility. This plan also covers partial hospitalization services that involve intermediate short-term or medically directed intensive treatment of alcohol and drug abuse.

Aetna’s Continuing Care Support

Substance abuse treatment programs in Aetna’s network include continuing care support. Continuing care consists of weekly support groups, and former patients sometimes organize their own recovery meetings. Continuing care also involves post-treatment therapy.

Recovery from drug and alcohol addiction lasts a lifetime. People in recovery achieve the best results when they remain connected with a professional treatment program and attend support or self-help groups in their community.

Constant support reduces the chances of a relapse. However, if a person relapses they should seek immediate professional help to reestablish their recovery.

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In-Network vs Out-of-Network Providers

In-network providers require a person to pay only their deductible or coinsurance amount.

Aetna’s in-network providers are less costly than out-of-network providers. The table below shows a breakdown of in-network costs versus out-of-network costs for a two-week stay for chemical dependency rehab.

In Network Out of Network
Calculated Treatment Cost $9,729 $17,393
Coverage 80% 60%
Amount Aetna pays $7,783 $10,436
Amount that can be balance billed $0 $1,914
Total Out of Pocket $1,946 $8,871

When a patient goes out of network, Aetna determines the cost of treatment. Individuals are responsible for the difference between the billed amount and Aetna’s calculated treatment costs.

In-network plans cap out-of-pocket costs for covered services. However, when an individual goes out of network, the difference between the out-of-network healthcare provider’s bill and Aetna’s recognized amount does not count toward the deductible cap.

If Aetna members require emergency care while they are away at school or traveling abroad, they can seek treatment at an out-of-network provider and receive in-network coverage. However, Aetna requires proof that the situation was urgent.

Paying the Difference

While Aetna covers the majority of substance abuse treatment programs, individuals may still have to come up with money for copayments and any services not covered by their plan.

People can use their savings to pay for the remaining health care costs. Other ways to help pay for the difference are reverse mortgages, annuities and trusts. You can also speak to your rehab facility to determine whether they have payment plans that will allow you to receive treatment without worrying about payment upfront.

What to Consider When Choosing a Treatment Program

When choosing a treatment program, individuals and their loved ones should consider several factors. While it is important to choose a treatment center that takes your insurance, it is also paramount that the treatment center fits the needs of the individual seeking treatment.

Aetna drafted a list of things to look for when choosing a treatment program, including:

Aetna has carefully selected the health care providers in its network to ensure that members receive high quality care. For further information, contact a rehabilitation facility that will work with you to achieve the best outcome by addressing your financial and health concerns.

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