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Does Aetna Pay for Detox and Drug Rehab?

You know it’s time to get help for a drug or alcohol problem. But you’ve checked your bank balance, and you also know that you just can’t pay for the treatment you need.

Hooray for insurance!

Your insurance coverage should help you get the treatment you need without draining your bank account.

If your insurance card has the word “Aetna” on it, here’s what you need to know about accessing covered detox and rehab programs.


How Does Aetna Define Addiction?

Psychiatrists and researchers know that addictions stem from shifts in brain chemistry, caused by the chronic abuse of drugs and alcohol. That’s not an opinion. It’s a proven fact. But some insurance companies seem to suggest that substance abuse has an element of choice, and as a result, they place deep restrictions on coverage.

Aetna is different.

The company has a surprisingly progressive view of addiction and recovery. In published documents, Aetna acknowledges that a 28-day stay in addiction treatment was once considered the gold standard. Now, the company says people might need longer or shorter forms of care.

Aetna reports that a variety of different settings might be appropriate for recovery, including:

  • Detoxification. Here, you have the opportunity to wean your body away from drugs. Admission is dependent on the substances you used and the length of your addiction.
  • Residential. You’ll move into a treatment facility (which might be a hospital, Aetna says) for around-the-clock supervision as you recover.
  • Partial hospitalization. You’ll get supervised care during the day, and you’ll head home at night.
  • Intensive outpatient care. You’ll meet three to five times per week to get addiction treatment.
  • Continuing care. You’ll have access to support and resources when you’ve completed the intensive portion of your recovery.

Aetna reports that your need for care will vary, depending on your condition and not based on what others need. The company says it supports individualized treatment plans, and it doesn’t impose “rules” on length of stay or treatment type for recovery.

But these progressive statements don’t apply to all the plans Aetna offers. In a published brochure, Aetna reports that their coverage plans adhere to the 2008 Federal Mental Health Parity and Addiction Equity Act. That means the company provides comparable coverage for physical and mental health disorders.

But, Aetna says, that law doesn’t apply to:

  • Medicare plans.
  • Health plans created and purchased before March 23, 2010.
  • Plans with an exception based on cost.
  • Some state government and private employee plans.

This suggests that while Aetna — as a whole — supports covered and comprehensive addiction care, you might still have a plan that leaves you footing the entire bill for your recovery.


How Can You Use Your Benefits?

If you do have addiction care benefits (and we’ll help you understand how to find that out in just a minute), you’ll probably need to take a few steps before you spend money.

Aetna offers many different types of insurance plans, but most use a doctor as a gatekeeper. You will:

  • Visit your doctor.
  • Talk about your symptoms.
  • Get a diagnosis.
  • Get a referral to specialty care.

These steps help Aetna ensure that people aren’t running to specialists or checking into expensive facilities when they have issues that could be treated with the help of a primary care doctor.

Your doctor can also talk with Aetna about your diagnosis and your need for treatment. Together, your doctor and your insurance representative document what’s happened and what should come next. That’s a preauthorization, and it’s a requirement in many Aetna plans for substance abuse care.


Does This Always Work?

Visiting your doctor, getting a referral, and then checking into care seems straightforward. You won’t run into any problems, right? Unfortunately, some Aetna plans are dense and difficult to understand.

A Florida plan, for example, suggests that you’ll have copayments of $250 per admission, but just one line later, you’re told there is no charge for residential care. This is very confusing language, and you’re expected to understand these terms exactly. If you don’t, Aetna could deny your claim altogether.

This same plan only covers treatment in facilities that have a contract with Aetna. Insurance companies and treatment facilities create these cost-sharing agreements to help them control the quality of care given and ensure a steady flow of patients. It saves both companies money. But if you step outside of those agreements and choose your own doctor, you could be asked to pay for your care on your own dime.

In Pennsylvania, Aetna was sued for making benefits hard to understand, according to news reports. Benefits documents blurred lines between covered care and non-covered care, and they made it hard for people to follow the rules. That meant people either didn’t get the care they needed, or they paid a lot more for treatment that should have been free for them.

If you don’t understand all the ins and outs of health insurance, you’re not alone. A study from Policy Genius suggests that less than 5 percent of American adults understand key health insurance terms like deductibles and copayments.

Don’t let that confusion keep you from getting care. You can — and you should — use your benefits. And there are simple steps you can take to make that happen.

How Can You Get Started?

Aetna is required to help you understand what your coverage means and how it works. And the company wants you to contact representatives with questions. No company wants negative reviews and angry customers, after all.

The easiest way to contact Aetna is to pull out your insurance card and call the customer service number listed on the back. Be prepared to tell the operator:

  • Your name.
  • Your customer ID number.
  • Your plan number.
  • Your date of birth.

With your identity verified, your insurance agent can look at the details of your plan and ascertain what kind of coverage you have and how it works. You can learn more about where to go for treatment and what you need to do before you enroll.

You can also log onto the Aetna website to find out more about your benefits. You’ll need to create an account, and you can’t do that without knowing your customer ID number. But if you’d rather get in touch with the company without picking up your phone, this could be a good option for you.

Your addiction treatment provider might be willing to take these steps for you too. Your chosen group can call your insurance company for you and walk through the preauthorization steps on your behalf. You’ll need to know the results of that conversation and how much you’re expected to pay, but this can be a good choice if you just don’t feel well enough to have this talk yourself.

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