Cigna Health Insurance is a global company that serves more than 15 million customers. In 2015, it processed more than 158 million medical claims, including claims for substance use disorder treatment.
The company displayed its commitment to treating drug addiction when its chief medical officer, Dr. Douglas Nemecek, rappelled down a 17-floor building in Atlanta to raise funds for Shatterproof, a nonprofit organization dedicated to preventing addiction. The Cigna Foundation donated $100,000 to Shatterproof in 2015.
All Cigna plans cover substance abuse treatment as required by President Barack Obama’s health care law. The Affordable Care Act lists alcohol and drug rehab as an essential health benefit that must be covered by all health insurance plans.
Rehab is the most effective way to recover from a substance use disorder. At outpatient and inpatient facilities, certified addiction professionals use evidence-based treatments to make clients as comfortable as possible during detox. Then they teach clients to abstain from alcohol and drug use through counseling and therapy.
Unfortunately, rehab is expensive. Rehab can cost between $5,000 and $50,000 depending on the type of treatment, length of treatment and other factors. But insurance covers a significant portion of how much rehab costs.
The cost of treatment and the portion covered by Cigna depend on whether treatment is inpatient or outpatient. Outpatient treatment usually involves multiple counseling, therapy and medical appointments at an outpatient rehab center each week. Many people with mild substance use disorders receive outpatient or partial hospitalization treatment.
Inpatient treatment is more appropriate for people with moderate or severe substance use disorders. During inpatient or residential treatment, clients live inside a rehab facility for multiple weeks or months. The amount of time that Cigna covers treatment varies by insurance plan.
All Cigna plans cover outpatient substance use disorder services that are in network, but you will probably be charged a copay or a percent of the claim for coinsurance. Few Cigna insurance plans cover out-of-network services. If out-of-network services are covered, your copay or coinsurance payment will usually be higher than for those of in-network provider. Your policy will detail the rates for copay or coinsurance payments associated with outpatient substance use disorder services.
Cigna insurance also covers inpatient substance use disorder treatment from providers that are in network, but you usually have to receive preauthorization. That means Cigna will determine that inpatient treatment is medically necessary before approving your coverage. Some plans also cover a portion of the cost for out-of-network providers, but the amount of coverage is usually lower.
Your copay or coinsurance payment will likely be higher than the cost of an outpatient visit, but Cigna will cover a large portion of the cost of treatment. In general, inpatient rehab takes at least 30 days. Your plan may limit the number of days that you spend in residential treatment. Check your policy for limits on length of stay.
Cigna’s coverage for treatment of other mental health disorders is similar to its coverage of substance use disorder treatment. Mental health care is an essential health benefit under the Affordable Care Act, so all insurance providers must cover mental health treatment.
Inpatient and outpatient centers treat co-occurring mental health disorders or common conditions such as eating disorders. Inpatient treatment is usually more expensive than outpatient treatment, and some Cigna policies may cover only in-network providers.
The limitations and exclusions of Cigna coverage vary by plan, but in general, Cigna plans do not cover complementary or alternative services, such as massage therapy, animal therapy, music or dance therapy, art therapy, acupuncture or yoga.
Other common exclusions:
Cigna health insurance plans do not cover high-end treatment, such as luxury facilities, and it’s unlikely that they’ll cover additional amenities, such as a private room.
Cigna health insurance will cover the bulk of the cost of treatment, but individuals or families still have to find ways to cover copays, coinsurance payments and any complementary or alternative therapies that aren’t covered by their plan.
If you have money in savings, you can pay for the additional costs out of pocket. You may also decide to finance the additional costs by placing the balance on a credit card or by taking out a loan. Rehab facilities want their clients to be successful, so they’ll often work with you to develop cost-effective treatment plans and establish payment plans when necessary.
Some forms of aftercare treatment may be fully or partially covered by Cigna. Long-term counseling is usually covered, and some forms of drug testing may be covered. However, there are usually limits to the number of drug tests that Cigna will cover each year.
If your aftercare plan includes medication-assisted treatments or prescription drugs prescribed by an in-network provider, most Cigna plans cover a portion of the cost.
Some insurance plans also cover stays at sober living homes, but there are usually limits to the amount of time that someone is covered. After insurance runs out, you’ll have to find another way to pay for sober living.
Finding addiction treatment usually begins with finding a facility that is covered by your insurance provider. However, you should also ensure that the facility you choose uses evidence-based treatments. If you have any co-occurring mental health conditions, make sure that the facility treats addiction and those conditions simultaneously.
Ask about the lengths of treatment the facility provides and how the treatment plans are developed. The best treatment centers also help clients establish aftercare plans to keep them on track after they leave the facility. By working with your insurance provider and your rehab facility, you can recover from addiction.
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