Using your insurance to help cover the costs of a drug rehab program can save you a significant amount of money. With the average costs of rehab in the United States being just under $4,000 per month, insurance can go a long way to making drug rehab affordable and accessible to many people. The catch is that every insurance provider has slightly different coverage plans and different rehab facilities that are considered to be in-network or covered by your insurance.
Fortunately, all major insurance providers offer some sort of coverage for substance abuse treatment programs. Since the Affordable Care Act was enacted in 2010, insurance companies have been required to provide coverage for behavioral health services. Drug and alcohol addiction treatment programs fall under this category. Whether these services are provided through an employee assistance program (EAP) or as part of a privately purchased individual insurance plan, you can count on your insurance provider to assist you in finding a treatment program covered by your policy.
Cigna is also a large national health insurance company that provides coverage to people living in the U.S. as well as around the world. In fact, 95 million people are covered by Cigna health insurance globally. Cigna focuses on providing individual and family plans, Medicare coverage, dental insurance, supplemental coverage, and international coverage.
If you have Cigna health insurance, there are a number of ways for you to verify your coverage and benefits. The myCigna.com online portal and Cigna’s mobile apps provide easy access to your insurance plans and the services available to you. Through these platforms, you can verify your benefits, find health care providers, pay bills, compare providers, and access additional health and wellness resources, among other services.
For people in need of substance abuse treatment, Cigna has options. If your insurance coverage includes an EAP, Cigna’s EAP offers comprehensive behavioral health services that include treatment for alcohol or substance abuse. Licensed clinicians are available to assess your situation and make referrals to appropriate in-network treatment programs.
In addition to the substance abuse services offered through the EAP, Cigna created the Cigna Designated Substance Use Treatment Provider Program. This program offers treatment at more than 30 health care facilities throughout the country that are considered in-network. Treatment settings include inpatient, residential, partial hospitalization, and intensive outpatient programs.
The majority of your costs for attending any of these programs should be covered, though you will still be subject to copays and deductibles. Additionally, not all services at each facility may be covered. Certain types of nonmedical or non-evidenced-based counseling services, such as educational, vocational, or custodial, may not be covered by your Cigna insurance. Speaking with your Cigna representative can help to clarify exactly what costs you will be expected to cover yourself once you have selected the treatment program you would like to attend.
Blue Cross Blue Shield (BCBS) is another major player in the global health insurance market. About one in three people living in the U.S. is insured through BCBS, which is actually an association made up of 36 health insurance companies. These companies provide localized health insurance coverage, primarily broken down by state.
Treatment for substance abuse includes coverage to attend programs in outpatient settings, residential treatment, and hospitalizations. As long as you select an in-network setting to receive your services, the majority of your costs will be covered. It is possible to use an out-of-network provider if you have a particular program that you would really like to attend, but costs will be higher for you. BCBS is still likely to cover a portion of those costs but not at as great a percentage as at an in-network facility.
Verifying your specific health insurance coverage must be done through your state’s BCBS website. For example, if you live in California, you’ll need to visit Blue Shield California to create your personal account, shop for new plans, verify coverage, find doctors, and pay bills. By logging into your online account, you should be able to review which addiction treatment services are covered through your plan and which treatment facilities are covered.
Aetna also provides global health insurance coverage. It covers health care costs for nearly 39 million people through medical, dental, pharmacy, Medicare, and Medicaid plans. It also offers behavioral health programs as well as medical management.
Components of Aetna’s behavioral health programs include the following:
Aetna’s Behavioral Health Condition Management program focuses specifically on addressing mental health and behavioral conditions that affect individuals’ daily lives. Aetna strives to keep costs low and services accessible, so people are more likely to stay engaged in treatment. Conditions that are frequently addressed through this program include the following:
Fortunately, the Behavioral Health Condition Management program is included with Aetna members’ behavioral health benefits. The goal is to keep these conditions managed on an ongoing basis, so members can live full lives and ultimately keep their health care costs low. For individuals struggling with alcohol or substance use, Aetna provides a screening program, a brief intervention, and referral to appropriate in-network treatment, if necessary.
To verify your coverage, you can take advantage of Aetna’s health and wellness tools. An online member account, mobile app, online personal health record, and community resources are available to help you manage your individual plan and access health care and behavioral health services near you.
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WellPoint merged with Anthem in 2004 and officially changed its name to Anthem, Inc. in 2014. Together, these companies provide health coverage to millions of people across the country and have become the largest for-profit health insurance provider within the BCBS association of companies. Not as big as the above health insurance companies, however, Anthem does not serve members internationally or in all 50 states. It provides coverage for people living in just the following 14 states:
Anthem, Inc. offers all of your standard health insurance plans, such as health, dental, vision, term life, Medicare, prescription drug coverage, and employer group plans. It also offers a comprehensive EAP for people who receive their benefits through their employers.
Alcohol and substance abuse issues are one of the areas addressed through the EAP. EAP counselors can provide quick assessments and make appropriate referrals to additional services.
It is possible, however, that your EAP does not provide sufficient services to address your substance use issues. You may also not qualify for EAP benefits if you have purchased your plan individually. If this is the case, Anthem can take advantage of the behavioral health services provided through BCBS.
The exact services available to you depend on the specific health insurance plan you have. You can expect, however, to get coverage to attend an inpatient, outpatient, hospitalization, and/or detoxification program. Anthem provides comprehensive substance abuse treatment, but it does have criteria that must be met to determine medical necessity for behavioral health services.
If you know you need behavioral health services, you can start by visiting your online account to verify services, pay bills, and find in-network doctors who can help to establish medical necessity for services, if necessary.
Anthem has a large network of psychiatrists, psychologists, social workers, and other mental health providers that work in a variety of settings, including hospitals, residential treatment centers, and intensive outpatient treatment programs. You don’t need a referral to access your behavioral health services, though preauthorization is necessary to participate in a treatment program.
Humana is a health insurance company dedicated to providing high-quality Medicare Advantage plans as well as employer-sponsored health insurance plans. As of 2018, it planned to stop providing the option to purchase health coverage plans individually, as it was having trouble competing in the individual health care market. Nonetheless, it continues to offer a wide range of services to all its members.
Drug rehab is covered through Humana’s Medicare and employer-sponsored plans. Mental and behavioral health services that are provided by Humana’s network of treatment providers are covered. Many substance abuse treatment facilities are also within Humana’s network of treatment providers.
Behavioral health services, including substance abuse treatment, that Humana covers include the following:
To receive the above services, Humana, like most health insurance companies, requires preauthorization. Your primary care doctor can help you establish a medical need for treatment and provide referrals to appropriate treatment facilities. If your insurance plan does not cover sufficient drug rehab, you can buy supplemental insurance that covers substance abuse and behavioral health treatment.
Speaking with a customer service representative at Humana is a great place to start to verify your services, find in-network providers, and get an understanding of exactly what steps need to be made for you to receive rehab services that are covered by your Humana health insurance plan.
Centene is a unique health insurance company that grew out of providing coverage through a single Medicaid Plan. It began as a small nonprofit organization and is now the largest Medicaid Managed Care Organization in the country. Through Centene and the health care organizations it contracts with, more than 12 million people living in 29 states receive health care coverage.
Like the other health insurance companies discussed, Centene provides coverage for substance abuse treatment. As always, exact coverage depends on your individual health plan. Plans vary by state and depend on the specific company within Centene that provides your insurance. Copays and deductibles will apply to your costs of services and vary depending on how much of a monthly premium you pay.
While 100 percent of rehab costs are unlikely to be covered, a significant portion of costs will be. Centene provides coverage to receive treatment through many types of programs.
Similar to the BCBS network of plans and providers, you must consult the specific insurance company that provides coverage in your state to verify your coverage for drug rehab. Through your personal online account or by speaking to a customer service representative directly, you can confirm what services are covered by your plan and receive resources for in-network treatment providers and facilities. Centene’s goal is to provide local, affordable, and accessible services to all its members.
The cost of rehab is one of the barriers people encounter that prevents them from getting treatment. Additional barriers include lack of accessibility and difficulty being admitted. Researchers estimate that half of people who want to receive treatment for their addictions don’t receive it. Nearly 20 million people in the U.S. need treatment and don’t get it.
If you are fortunate enough to have health insurance, there are many resources available to help you access the treatment you need. All major health insurance providers these days provide coverage for behavioral health services, which include addiction treatment. While out-of-pocket expenses vary depending on your provider, specific insurance plan, and treatment needs, your insurance plan gives you access to treatment that millions of people struggle to find.
If you are ready to attend a drug rehab program, don’t hesitate to access your EAP, learn more about available behavioral health services, or contact the customer service department of your insurance provider. The sooner you start asking questions about your treatment coverage, the sooner you can benefit from the services you deserve.
Affordable Care Act. U.S. Centers for Medicare & Medicaid Services. from https://www.healthcare.gov/glossary/affordable-care-act/
(January 2012). Behavioral Health Medical Necessity Criteria. Anthem Blue Cross and Blue Shield. from https://www11.anthem.com/provider/ct/f3/s9/t1/pw_e175456.pdf?refe
(March 2012). Can’t Get In: Barriers to Addiction Treatment. Psychology Today. from https://www.psychologytoday.com/us/blog/all-about-addiction/201203/cant-get-in-barriers-addiction-treatment-entry
BCBS Companies and Licensees. BlueCross BlueShield. from https://www.bcbs.com/bcbs-companies-and-licensees
Behavioral Health Programs. Aetna. from https://www.aetna.com/insurance-producer/behavioral-health/behavioral-health-programs.html
Behavioral Health Services. Humana. from http://www.humana.com/provider/medical-providers/education/referral/behavioral-health-services
Company History. Anthem, Inc. from https://www.antheminc.com/AboutAnthemInc/CompanyHistory/index.htm
Facts About Cigna. Cigna. from https://www.cigna.com/about-us/company-profile/cigna-fact-sheet
Health & Wellness Tools. Aetna. from https://www.aetna.com/insurance-producer/health-wellness/health-wellness-tools.html
(February 2017). Humana to Fully Exit Obamacare in 2018. Forbes. from https://www.forbes.com/sites/brucejapsen/2017/02/14/humana-will-leave-obamacare-in-2018-citing-unstable-risk-pools/#8cbfdcc70c19
Licensed Clinicians Available Through EAP. Cigna. from https://www.cigna.com/individuals-families/member-resources/employee-assistance-program
Live and Work Well. Optum. from https://www.liveandworkwell.com/content/en/public.html
Manage Your Health with Cigna Mobile Apps. Cigna. from https://www.cigna.com/individuals-families/member-resources/mobile-apps/
MyCigna. Cigna. from https://my.cigna.com/web/public/guest
Our History. Centene Corporation. from https://www.centene.com/who-we-are/history.html
(July 2018). The Costs of Alcohol and Drug Treatment. Verywell Mind. from https://www.verywellmind.com/the-costs-of-alcohol-and-drug-treatment-67863
United Healthcare. United Healthcare. from https://www.uhc.com/