Aetna Rehab Coverage for Drugs & Alcohol

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Aetna Rehab Coverage

As a health insurance provider, Aetna offers coverage for millions of individuals, including those suffering from substance abuse, substance use disorder (SUD), and other behavioral and mental health conditions. Since the inception of the Affordable Care Act (ACA) in 2010, most health insurance companies must cover at least a portion of drug abuse addiction treatment and recovery services. 

If you or a loved one is suffering from addiction and ready to make the first step toward a life of sobriety, we can help. If you’re unsure about the specifics of your insurance coverage for drug and alcohol rehab, contact Zinnia Health at (855) 430-9439 to speak to a compassionate treatment specialist. With your permission, we can contact Aetna on your behalf to learn what’s covered so you can make an informed decision regarding treatment and your out-of-pocket costs, if any.

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Does Aetna Insurance Cover Alcohol Rehab?

Aetna insurance provides coverage for all or a portion of your costs for alcohol rehab, but your specific level of coverage depends on your unique policy and other factors, such as:

  • Your state of residence
  • Whether you have an employer, state, or federal policy 
  • If you purchased a Marketplace policy under the umbrella of the ACA
  • Your plan’s healthcare deductibles for mental and behavioral health services
  • Whether the drug and alcohol treatment, such as inpatient rehab, is deemed medically necessary and recommended by a board-certified, licensed healthcare provider

In addition, how much Aetna covers for alcohol treatments or other inpatient rehab services depends on the type of plan you’re enrolled in.

Aetna plans include: 

  • Health maintenance organizations (HMOs)
  • Exclusive provider organizations (EPOs)
  • Preferred provider organizations (PPOs)
  • No-cost preventive healthcare appointments, annual checkups, flu vaccines, and most routine screenings

Policies vary by location, age, current health, the care you require, and whether you’ve received your Aetna policy through your employer, the Aetna Medicaid program, or the Marketplace.

Whenever you receive care using your Aetna insurance, you’re provided with an EOB, or Explanation of Benefits, detailing your coverage, any copays, and other important policy information. The Aetna website offers a variety of resources.

Does Aetna Insurance Cover Substance Abuse Treatment?

Yes, Aetna Insurance offers coverage for substance abuse treatment and mental health services, but coverage varies according to plans. The ACA paved the way for more people from varying backgrounds and income levels to obtain healthcare coverage that fits their lifestyle, healthcare requirements, and budget. In addition, the law requires insurance companies to provide certain types of service coverage and care levels.

Addiction treatments your Aetna Insurance may cover include (but aren’t limited to) include:

  • Detox
  • Counseling programs
  • inpatient care and outpatient treatments
  • Medication-assisted treatment and therapy

Your policy’s provisions depend on many variables, such as where you live. Your out-of-pocket costs depend on what your specific policy covers, the intensity of the treatment plan you require, how long your treatment takes, and where you’ll receive treatment.

Aetna’s preventive care appointments are included at no cost, but for visits considered non-preventive, you may need to:

  • See only in-network doctors
  • Obtain a referral from your primary physician
  • Receive treatment from hospitals or other facilities considered in-network
  • Set up appointments with in-network specialists when required or recommended
  • Obtain a statement of payments/coverage if you have coinsurance
  • Pay any remaining deductible amount for the policy period (typically 12 months) before Aetna pays its portion for your treatment.

Aetna Insurance benefits offer coverage to begin the treatment process, and your plan might also include benefits such as:

  • Confidential counseling or therapy sessions.
  • Multiple substance abuse treatment options.
  • Ongoing access to recovery treatment specialists, outpatient rehab, and aftercare programs.
  • Personalized life skills coaching or support that can work around your personal schedule and unique challenges.

Zinnia Health offers facilities that are in-network with Aetna. Call us at (855) 430-9439 to learn more about our substance abuse treatment programs for drugs and alcohol.

Does Aetna Cover Mental Health Treatment?

Aetna offers coverage for mental health services and treatment for policyholders. Benefits vary, but your policy may provide access to:

  • Referral services, including:
  • Online resources
  • Life skills coaching
  • Community support and outreach programs
  • Outpatient programs
  • Initial consultations
  • Case management and follow-up
  • Provision of mental health treatment
  • A network of licensed behavioral and mental health services providers

Aetna Inpatient Coverage

Aetna policies may provide inpatient hospital care coverage for substance abuse treatment according to each policy. The reason for hospitalization must be listed on Aetna’s list of covered injuries and illnesses. You can learn more about Aetna plans on the Aetna Individual & Family Plans benefits page.

Aetna Outpatient Coverage

Aetna Insurance offers healthcare coverage for outpatient visits and intensive outpatient treatments (such as partial hospitalization programs, or PHPs) at clinics, urgent care locations, and other medical facilities that don’t require overnight stays in a hospital, such as:

  • Physical therapy
  • Counseling sessions and individual therapy
  • Prescription medications (Aetna partners with CVS Pharmacy for prescription drugs and other health benefits)
  • Weight-loss support programs
  • Drug rehab and alcohol rehab services
  • Preventive and wellness checkups
  • Lab tests, MRIs, and other diagnostics
  • Surgery, chemotherapy, and other outpatient treatments

To know what your policy covers, review your Summary of Benefits.

Rehabs That Accept Aetna Insurance Near You

Zinnia Health has locations across the United States to reach as many individuals as possible. We provide substance abuse, drug addiction, and alcohol addiction recovery services to help ease the pain of addiction and offer a helping hand on the road to recovery.

We are in-network with Aetna and accept Aetna insurance and many other health insurance plans, such as Cigna and Horizon BCBS plans, at our locations.

Start your journey to healing at one of these Zinnia Health locations:

If you or a loved one has been diagnosed with a co-occurring disorder, such as a drug addiction paired with depression or anxiety, Zinnia Health can help. From residential inpatient treatments in a comfortable, homelike environment to convenient outpatient programs and group therapy sessions, our compassionate substance abuse treatment specialists can jumpstart your recovery. Contact Zinnia Health at (855) 430-9439 to learn how to live a life of sobriety.

How to Check Your Aetna Coverage

To check your Aetna coverage:

  • Gather necessary information. Write down your policy ID number, the type of plan (HMO, PPO, or EPO), and other information you might need, such as your primary care doctor’s name and location, health problems you might have, and any prescriptions you’re taking. Having it handy will make the process smoother.
  • Sign into your account or download the app. You can find all your Aetna insurance plan policy information, including past doctor visits, copays, and deductible amounts paid for the period. The online account and smartphone app are relatively user-friendly, with easily navigable pages and tabs to find the information you’re looking for.

You can also:

  1. Call Zinnia Health at (855) 430-9439.
  2. Speak to one of our caring admissions specialists.
  3. Provide the insurance information (policy number, plan type, etc.) that you wrote down earlier.
  4. Zinnia Health will contact Aetna for you and find out exactly what your policy covers and let you know your out-of-pocket costs for substance abuse treatment if your policy doesn’t cover the entire amount.

Navigating the many nuances of insurance coverage is challenging, but knowing what your policy covers is essential. While most facilities offer payment options and can put you in touch with assistance programs, it’s still important to understand your coverage and total out-of-pocket costs.

Types of Aetna Plans That Cover Addiction Treatment

The Aetna Mental Health Program plan covers addiction treatment with a few caveats:

  • You likely need to obtain a referral from your primary healthcare provider to access benefits for substance abuse treatment, such as partial hospitalization or an intensive outpatient program, especially if it’s out-of-network.
  • Aetna may not cover mental or behavioral health services or substance abuse treatment provided by a physician or facility that’s out-of-network.
  • Aetna may cover most costs of mental health issues, behavioral health services, and/or substance abuse treatment if the treatment provider or rehab center is in-network.
  • If you haven’t yet met your deductible, you must pay the remainder of your deductible plus your share of the total cost of treatment, and then Aetna pays its portion.

Frequently Asked Questions

What Length of Stay Will Aetna Cover?

Hospital stays for substance abuse and mental health treatments vary and require prior authorization. Treatment for addiction is important, but be sure you’ve received proper authorization before beginning treatment.

How to Pay for Costs Aetna Doesn’t Cover?

If your Aetna insurance plan doesn’t cover all the costs of inpatient rehab or other types of addiction rehab, there are state and federally-funded intervention and assistance programs that can help you cover treatment costs, in addition to sliding fee scales and payment plans.

What to Do if Aetna Doesn’t Cover Rehab?

Most Aetna plans cover all or a portion of rehab treatment services as long as certain criteria are met, such as prior authorization. 

Do Rehab Facilities Need to Be In-Network?

Aetna Health Insurance doesn’t require treatment facilities to be in-network. However, for inpatient substance abuse treatment for certain services, such as opioid treatment and inpatient mental health services, there’s a gap in the per-stay deductible between in-network and out-of-network. If you have Aetna insurance and a treatment program is not in the Aetna network, you can consider other payment options.

Or you can choose a different treatment center that’s in-network, like Zinnia Health. Our caring treatment professionals are available 24/7 to answer questions, verify insurance coverage, or just lend an ear if you need someone to talk to. Contact Zinnia Health at (855) 430-9439.

Call us
Ready to get help?
(855) 430-9439
Why call us? Why call us