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Will Coventry Cover Drug Rehab and Treatment

Coventry health insurance plans cover substance abuse treatment to some degree. The exact level of coverage will depend on the particulars of the specific plan.

The company’s coverage is comparable to other health insurance companies.

Coventry Insurance

Coventry Health Care is an insurance company, one of many owned by Aetna, Inc. It was brought into their fold in 2012 when Aetna bought Coventry for $5.7 billion.

Although owned by Aetna, Coventry still operates as its own brand, with at least some plans available in the following states:

  • Florida
  • Georgia
  • Illinois
  • Iowa
  • Kansas
  • Louisiana
  • Missouri
  • Nebraska
  • North Carolina
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • Utah

Many insurance companies have various edge cases, where some specialized plans may be available outside the designated states. It is unlikely you will have a Coventry plan if you do not live in the above states, but it is not impossible.

Rehab Coverage From Coventry 

Substance abuse treatment is generally categorized as a mental health treatment. In the past, insurance companies would often cover these types of treatments differently, and it could be fairly difficult to get coverage for some rehab options.

rehab coverage

Slowly, laws and public opinion changed. In 2008, Congress passed the federal Mental Health Parity and Addiction Equity Act (MHPAEA). Barring a few exceptions, this law brought mental health treatments more in line with other therapies in terms of how insurance companies covered them. 

Substance abuse treatment and drug rehab will be covered about as reliably as other medical treatments. Your deductibles, copays, and the percentage of costs you pay out of pocket should generally be the same as what you would pay for other medical treatments.

Coventry covers behavioral health treatment services, including rehab services, through their MHNet behavioral health division.

It’s important to get clarity on exactly what will and will not be covered at a particular substance abuse treatment center. Most of these facilities have people experienced in navigating insurance, and they can help you to maximize your coverage. 

You, of course, need to choose a drug rehab center that accepts Coventry health insurance plans.

How Much Gets Covered?

The United States government has established a classification system for insurance plans based on precious metals. Plans are essentially graded as bronze, silver, gold, and platinum. These plans cover at least 60, 70, 80, or 90 percent of approved health care costs respectively. The percentage left over is then paid out of pocket by the patient. 

Each plan will also generally have a deductible that must be paid first. Once you meet the deductible, the insurance company will cover the cost of care at the set percentage rate. For example, Coventry may cover 80 percent of the care costs, and you are still responsible for paying 20 percent out of pocket. 

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Most plans will have a limit on the number of days you can spend as an inpatient at a rehab center during a given time period, often during a calendar year. Many times, you will need preapproval for inpatient rehab. The qualification may be that you have first attempted outpatient rehab without success.

Similarly, most plans will place a limit on the number of treatment sessions allowed during a quarter or year. For example, you may be entitled to 12 outpatient therapy sessions each quarter.

It’s important to nail down the specifics of your coverage, as they can vary greatly between plans. You don’t want to enroll in rehab, complete the program, and then be surprised by a large bill at the end when you thought Coventry would fully cover the costs.

How Much Does Coventry Cost Each Month?

calculating costs

Like basically every insurance plan, it is difficult to predict how much Coventry insurance plans will cost a given customer each month. It has a great deal to do with your location, your age, and any risk factors you may have. The general nature of health insurance is the more likely they believe you are to get sick, the more expensive your plan will be. 

The company Purch did a review of Coventry insurance. They were impressed by its wide variety of plans to help a customer suit their specific needs, but they found that some of these plans were not at the best price points. 

They found a cheap plan that cost about $56 a month and a plan that would be suitable for most people’s general needs at around $100 a month. The percentages of procedures covered were notably lackluster; some fairly expensive procedures could require the customer to pay as much as 50 percent of the cost. Meanwhile, Coventry’s family plans were a bit overpriced, according to the review.

Conclusions

Most Coventry plans should suit the needs of someone seeking substance abuse treatment. Just make sure the treatment center in question takes your insurance. Most insurance plans have in-network providers, and it is much cheaper for you to get treatment from an in-network provider than an out-of-network option.

Sources

(2017) Understanding Mental Health Parity: Aetna Behavioral Health. Aetna. from http://www.aetna.com/individuals-families-health-insurance/document-library/understanding-mental-health-parity.pdf

Glossary of Health Coverage and Medical Terms. Centers for Medicare and Medicaid Services (CMS). from from https://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf

(May 2013) Aetna Becomes Third Insurer To Submit Rates For State Health Exchange. Hartford Courant. from https://www.courant.com/business/hc-xpm-2013-05-31-hc-aetna-rates-exchange-20130531-story.html

When Silver Costs More Than Gold: How Trump’s Actions Have Scrambled Insurance Prices. The New York Times. from https://www.nytimes.com/2017/10/27/upshot/when-silver-costs-more-than-gold-how-trumps-actions-have-scrambled-insurance-prices.html

Quick Links. Coventry Health Care. from http://coventryhealthcare.com/quick-links/index.htm

Coventry Review. Purch. from https://www.toptenreviews.com/services/insurance/best-health-insurance-providers/coventry-review/

Aetna Completes Acquisition of Coventry Health Care, Inc. Aetna. from https://news.aetna.com/news-releases/2013/05/aetna-completes-acquisition-of-coventry-health-care-inc/

Aetna Agrees to Buy Coventry in $5.7 Billion Deal. The New York Times. from https://dealbook.nytimes.com/2012/08/20/aetna-is-said-to-strike-deal-for-coventry-health-for-5-7-billion/?mtrref=www.google.com&gwh=BAF9571B316AD9A6090E413ABC5DD62A&gwt=pay

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