Muse Treatment: Aetna Insurance Coverage for Drug Rehab Treatment

Deciding to enter rehab is a crucial first step on the path to recovery. However, individuals often encounter numerous challenges in accessing the treatment they require, such as identifying where to seek help, determining the appropriate type of rehab, and figuring out how to pay for treatment. Fortunately, most health insurance plans, like Aetna, cover mental health treatment, which includes substance use disorders, which can help lower the costs of rehab. The Aetna rehab coverage depends on a member’s plan and addiction treatment provider. How much a plan covers and out-of-pocket costs are also determined by whether the provider is in-network or out-of-network. Rehab health insurance plans using Aetna may pay for various aspects of addiction treatment, including behavioral therapy, medication, detox, and inpatient treatment.

Addiction is a persistent and relapsing condition marked by an uncontrollable urge to seek and use drugs, even when faced with adverse consequences, making it challenging to overcome without adequate professional support. According to the 2022 National Survey on Drug Use and Health, 48.7 million people aged 12 or older in the U.S. had a substance use disorder, as reported by the Substance Abuse and Mental Health Services Administration (SAMHSA). Sadly, less than a quarter of them get the treatment they need. While the stigma surrounding mental health and substance use continues to be a common obstacle to seeking out treatment, many don’t get treatment because they simply cannot afford it. Thankfully, with the Affordable Care Act, insurance providers are required to cover addiction treatment, which has enabled many to access the care they desperately need.

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Does Aetna Cover Addiction Rehab in California?

Aetna is a well-known insurance provider, and numerous drug rehabilitation centers in California accept their coverage. Thanks to the Affordable Care Act (ACA), Aetna’s rehab plans might cover all or a portion of the expenses related to using insurance for addiction treatment in California. Furthermore, they may also include coverage for dual diagnosis programs that address both mental health issues and substance use disorders at the same time. However, it’s essential to keep in mind that there are various out-of-pocket expenses tied to addiction treatment, including deductibles, copays, and coinsurance. Aetna provides a range of insurance options tailored to the unique needs of its members, offering plans with either high deductibles and lower monthly premiums or those with lower deductibles and higher monthly costs. Additionally, some recommended treatments may not be included in your insurance coverage, so you must cover those expenses yourself.

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What Addiction Programs Does Aetna California Cover?

Aetna offers a variety of health insurance plans, including behavioral health programs like rehab in California. Depending on your plan, insurance may cover at least part of the costs of addiction treatment and services, such as:

Detoxification – Medical detox provides around-the-clock care by a staff of doctors, nurses, psychiatrists, and therapists who oversee patients as they go through the withdrawal process. They can administer medications and provide medical support to ease withdrawal symptoms and ensure the person completely rids their body of addictive substances.
Residential or Inpatient Treatment – These programs are designed to help those with severe substance use disorders and may be covered by insurance if deemed necessary. Patients will live at the rehab facility full-time and receive care from addiction professionals. Programs are designed to be highly structured and provide a safe space to heal, away from outside stressors and influences.
Outpatient Treatment Programs – There are various types of outpatient programs ranging in intensity, including partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs). These are highly structured programs as well but allow patients to reside at home or a sober living facility throughout treatment. Patients must travel to the facility and adhere to a certain amount of treatment per week. Outpatient rehab costs with insurance may be much lower than inpatient treatment.

Some insurance plans may also cover aftercare treatment, such as weekly therapy sessions and psychiatric medications. People can also struggle with long-term health effects from their substance use disorders, such as cardiovascular issues, dental issues, and liver disease. Health insurance plans can cover many of these complications, including dental work.

How to Check Aetna Rehab Coverage

When considering rehab or addiction treatment and want to check whether your Aetna plan covers costs, there are a few ways to check coverage. One way is to call them directly and ask what your plan covers. They can explain your coverage, including how much of your deductible you need to fulfill before benefits begin and any additional out-of-pocket expenses like copays and coinsurance. An Aetna representative can also assist you in finding in-network providers and offer referrals to addiction treatment facilities that accept your insurance. Alternatively, you can independently log into their website to review your plan details.

The Aetna 360 Behavioral Health Program connects members with a dedicated “360 Care Advocate” who can oversee care, coordinate with healthcare providers, and link members to pertinent community resources. Their licensed clinical staff ensures members receive optimal care advice and collaborate with healthcare providers to facilitate necessary treatment. To access this program, you can call the toll-free number on your member ID Card, which is available 24/7.

Another option is to reach out to a treatment facility in California that accepts Aetna insurance. The staff at these rehab centers are experienced in working with insurance companies and can help coordinate treatment based on your coverage. They can verify your insurance and inform you about what is included and any out-of-pocket expenses. Clinicians can develop a tailored treatment plan that aligns with your coverage, and while they may suggest therapies not covered by your insurance, many facilities offer financial assistance to help cover essential treatments.

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Navigating the Insurance Verification and Approval Process

Getting your insurance verified is the first step; you must also gain approval for treatment coverage. Aetna utilizes the SBIF (Screening, Brief Intervention, and Referral to Treatment) program, which assists healthcare providers in identifying substance abuse problems and determining appropriate levels of treatment. This program is designed to spot patients at risk for substance use disorders. It provides early intervention through screening, a brief conversation to address concerns, and then referral to further treatment if needed. The primary goal is to catch potential issues early before they become more severe while clarifying the extent of care insurance will support.

Aetna Rehab Coverage Available at Muse Treatment

Muse Treatment is here to help you confirm your Aetna rehab coverage if you’ve chosen to pursue addiction treatment. Our committed team will reach out to Aetna on your behalf, providing you with details about what is included in your plan and any potential out-of-pocket expenses. We offer a comprehensive range of care options, from medical detox and inpatient treatment to outpatient services and aftercare, all of which may be covered by your Aetna insurance. Our programs utilize evidence-based approaches, including behavioral therapies such as cognitive behavioral therapy and medication management. Furthermore, we have various financial assistance options for treatment not covered by insurance, including payment plans and connections to loan programs, grants, and scholarships, ensuring you receive the care you need.

To verify your Aetna insurance for rehab or any other provider, contact Muse Treatment today at 800-426-1818.