Saturday, January 22, 2022

Aetna Health Insurance Drug Rehab Coverage

One of the prevailing myths that still exists today is that insurance companies won’t cover drug rehab costs. For instance, there are drug rehabs covered by Aetna, one of the biggest insurers in the world and listed in Fortune’s World’s Most Admired Companies.

The Aetna drug rehab coverage includes inpatient and outpatient treatment for heroin, prescription opioids, barbiturates, and benzodiazepines. It also includes alcohol rehab treatment. Rehab facilities offer a good chance for individuals to kick their addiction by putting them in a controlled environment where they will be monitored 24/7, and their withdrawal symptoms minimized.

There’s a need to change the mindset considering that a lot of people still have no healthcare insurance for drug and alcohol abuse treatment. According to the study, 1 in 12 people has alcohol dependency while about eight million or so have a drug problem.

This is a health issue considering that there were 43,982 drug overdose deaths in the United States in 2013.

For instance, addressing the problem of illicit drugs, alcohol, and tobacco is costing the US economy about $600 billion annually.

According to the Substance Abuse and Mental Health Services Administration, 19.3 million individuals have not received treatment for their drug addiction.

Despite those staggering numbers, only 11% are getting treatment. They fail to get treatment because they can’t afford the costs associated with rehab. Almost 5 in 10 of rehab patients said that they paid for the treatment. This means that the taxpayers are unduly burdened of shouldering the expenses.

However, navigating through the world of insurance can be daunting. There’s a lot of wrong information out there and these often spread so quickly because of biases and preconceived notions.

What do Copay, Deductible and Out-Of-Pocket Max Mean?

If you plan on going to Aetna drug rehab facilities, you need to understand some of the terms used by the industry.


A copay or copayment refers to the fixed fee that you have to give to your doctor for consultation or prescription. Look at your insurance policy and the amount is reflected right there, and this represents the portion of the expenses you have to shoulder in each doctor or emergency visit. You can avoid paying this if your insurance will include 100% coverage for preventative care, or if you don’t exceed your annual out-of-pocket maximum.

Your out-of-pocket maximum is an important feature of your health plan because it limits the total amount you pay each calendar year for healthcare including co-pays, deductibles, and co-insurance.


The deductible refers to the amount that you have to pay every year to cover the costs of medical services or prescriptions. Once you reach the benchmark, your insurance will then steps in however you still cover a small percentage of the cost.

To simplify, if you chose a $2,000 deductible, you need to max that out first then your insurer will then cover the rest of the expenses until the end of the calendar year.

Among the medical procedures that you can count into your deductible are the CAT scan, MRI, x-rays, laboratory tests, hospitalization, mental health treatment, and others. They should be listed in your insurance policy.


Coinsurance sets in after you have used up all your deductibles. The percentage of the cost that you shoulder will depend on the plan.  Going back to the $2,000 example, if your plan only covers 70% then the $600 will be your out-of-pocket expenses.

Out-of-Pocket Max

The out-of-pocket max works essentially like deductibles only it’s much higher because it takes into account the copay and the coinsurance. Also, you don’t have to pay anything in the out-of-pocket max after you have used up the max amount. If the max is $2,000 and you already paid your portion by September, the insurer will cover all the costs of eligible medical procedures until the end of the year.

Regardless, the insurance company’s representative will explain each of these concepts, particularly in relation to your intention to enter Aetna drug rehab facilities.

Does Insurance Cover the Cost of Detox?

Addiction to prescription opioids, heroin, and barbiturates needs intensive detox to manage the withdrawal symptoms, which can range to uncomfortable and even painful for some patients.

Drug detox is essentially the first step toward recovery. Well, technically the second step if you count entering into rehab as the first. Nevertheless, it’s a process by while the facility will try to cleanse your body of all the toxins that accumulated through the years of abuse.

As already mentioned, the process can be uncomfortable and sometimes painful. But under the care of the medical professionals, the chance of the procedure being fatal is negligible.

The length of the detox may vary, depending on the drug that you are abusing. It can last for just a few days or up to two weeks. The physical symptoms are much easier to manage the intense cravings are much more difficult to fight for some dependents. And what are these physical withdrawal symptoms?

  • Sweating
  • Palpitations
  • Muscle cramps
  • Tightness in the chest
  • Erratic heart beat
  • Difficulty breathing
  • Tremors and shakes
  • Diarrhea
  • Vomiting
  • Nausea
  • Insomnia

But you also have to deal with the emotional withdrawal symptoms, as well, such as:

  • Cravings
  • Restlessness
  • Anxiety
  • Depression
  • Irritability
  • Violent mood swings
  • Poor concentration
  • Headaches

The severity of the symptoms will depend on the following:

  • How long have you been abusing the drugs
  • What type of substance you are addicted to
  • How do you take in the drugs, whether through injection, smoking, or swallowing
  • How much are you ingesting each time
  • The addiction history of your family
  • Your own predisposition to addiction
  • Dual diagnosis

All these symptoms need to be managed not just during the detox and rehab treatment, but also post-rehab care. The fact is you will probably deal with all the emotional symptoms throughout your life. It’s no wonder that the relapse rate is so high. According to studies, 85% of patients suffer a relapse at some point within the year. The one-year period is crucial considering that the rate quickly declines after that.

What you may not believe is that relapse is still part of the addiction treatment. It’s part of the process so don’t think that you are a failure just because you gave in to the temptation after having just graduated from the treatment facility.

The good news is that your detox treatment will be covered in Aetna-approved drug rehab facilities. You can just call your insurer to determine how much out-of-pocket expenses you may incur, especially with a lengthy detox.

The insurer also has drug recovery resources which you can access 24/7 bys calling their customer representatives.

Apart from detox, the insurance coverage will also include:

You can still use your Aetna plan for out of network treatment, however, it’s important that you try to seek help from Aetna-approved drug rehab centers because the costs are much cheaper.

Which is Best: Inpatient or Outpatient Rehab?

There are basically two types of substance abuse treatment options: inpatient and outpatient.

Inpatient is when the individual has to stay during the duration of the treatment. Most facilities adopt programs that can last from 30 days, 60 days, and 90 days. Those are the typical durations of rehab. However, some patients are still being treated after a year so there’s really no fixed interval for treatment.

Just like the name suggests, you will enter the facility and won’t be allowed to go out without the express approval of the supervisor. Family visits will also be heavily regulated. Because you will enter the rehab, you will likely take a lengthy leave of absence from work. Your movements inside will be controlled. The idea is to totally isolate you from your current environment, which may have contributed to your substance abuse problem.

Outpatient treatment program, meanwhile, is designed for minimal disruption. You are asked to decide on your scheduled treatment. This a good option for those who don’t want to suffer the stigma of drug addiction. This is a good way to protect your privacy because you can always go see the counselor after work or class. As long as you commit 10-12 hours every week for your rehab treatment then you can pretty much continue on with your life and go see your family anytime you like.

Just like with inpatient, the outpatient typically lasts about three months at the most although it’s not uncommon to see some patients extending their treatment up to one year. You can expect individual and group counseling in outpatient rehab, behavioral therapy, peer counseling, family counseling, marital therapy, psychotherapy, and the like.

However, it should be noted that the number of patients who dropped out of the outpatient program is higher compared to inpatient. This suggests that a controlled environment may be the preferred option when dealing with serious drug problems.

Also, while outpatient programs also offer detox, it’s best to undergo detoxification under the care of medical personnel for the sake of your health.

For the most part, the primary evaluator will determine if you need inpatient or outpatient program.  The Aetna drug rehab facilities offer both inpatient and outpatient programs.

In both outpatient and inpatient programs, aftercare support is crucial to prevent the occurrence of relapse. Aetna drug rehab coverage also includes post-rehab support like counseling, group support, 12-step programs, as well as referrals and access to addiction recovery resources.

Inpatient Vs Outpatient

What is the Average Copay for Each Rehab Stay?

The numbers vary from state to state, of course, so most of the figures stated below are just the ballpark figure. The aim is to give you an idea of the cost of drug rehab.

Regardless of the treatment cost, however, there’s bound to be a center that is perfect for you with the help of drug rehabs covered by Aetna.

First, let’s talk about the overall cost of rehab. The detox alone will cost between $1,000 and $2,000 per day. The cost could be more if there’s apparent risk to life due to the substance being abused, as well as the length of time the person is dependent on drugs.

For inpatient treatment, a 30-day treatment program will set you back at least $6,000. However, the luxury rehab facility will cost $20,000 for the same duration. Some patients may stay in the center for two or three months, and those will cost between $12,000 and $60,000. The Betty Ford Center in California, for instance, charges $50,000 for a 90-day stay.

Outpatient programs, meanwhile, are much cheaper compared to being committed into the center. A 90-day program will cost at least $5,000. However, well-known facilities will double that cost. The cost is quite flexible depending on the needs of the patient. Some individuals may be required to come in 4-5 times a week while others only require 2-3 days.

We should probably point out that those costs exclude medication. Some addiction, like heroin dependency, may take one year before you are going to be pulled out of the medication. Expenses can run up to $5,000.

For your copay or coinsurance, you may share as low as 10% of the cost or as high as 50% depending on your plan. But the insurer may cover 100% of the cost after deductible, again depending on your plan.

There used to be a time when inpatient drug rehab will be refused to be covered by the insurance company; or the restrictions are so strict. Those days are gone after the approval of the Mental Health Parity and Addiction Equity Act. Call the facility to determine your Aetna drug rehab coverage.

Also, the Affordable Care Act (ACA), which was signed by President Obama in 2010, classified drug addiction treatment as an essential health benefit. It was a landmark law because it didn’t distinguish drug rehab treatment with other medical treatment.

Out of Pocket Cost for Drug Rehab

Since 2012, Aetna has stepped up its efforts regarding prescription opioid addiction. The insurer also offers support 24 hours a day, seven days a week so you will be referred to Aetna drug rehab facilities or a hospital if your case warrants it. All calls to the company will be strictly confidential so you don’t have to worry about your privacy. The support extends to the post-rehab through the 12-step support programs.

There are several insurance plans for patients, including open access, high-deductible, and copay only. With the open access, you have the choice of which rehab center you want. You also don’t need referral or a primary care physician.

With copay, the expenses will only be copay after you’ve met your deductible. Visits to the primary care physician or the medication covered will also be copay. High-deductible plans cover preventative care before you hit the deductible.

The out-of-pocket cost will vary from state to state or the type of plan that you have. The restrictions and limitations will play a part, including the out-of-pocket maximum, the deductibles, and the facility that you selected.

How Many Days are Covered by Your Insurance?

Again, it’s best to call the drug rehabs covered by Aetna and tell them your policy to determine the kind of plan you took out. If the insurance plan covers 30 days and the recommendation in your case is for 60 days, you can ask the facility for an in-house financial plan. Most treatment facilities offer this kind of service. You can pay in easy increments that will not unduly burden your household budget.

There’s no fixed number of days that you will stay at the Aetna drug rehab facilities. The coverage will be from case to case basis. Again, when you choose a facility out of the Aetna’s network, you will pay more.

Another option is to ask the rehab facility for any recommendation that should fit your budget but still ensure minimal disruption on your treatment. Or you may opt for a no-cost treatment, which is being sponsored by the government. Ask your local health office for any community-based programs or health clinics that offer drug rehab.

Will the Insurance Company Inform My Employer About the Drug Rehab?

Unfortunately, if you use a company health insurance, chances are your boss will find out. That’s the perils of using the group insurance to pay for your rehab. Besides, you can never keep your confidentiality and privacy when you enter into rehab. The center is only prohibited from sharing your information outside of those who have need-to-know basis.

However, you will be subjected to an insurance review. This means a case officer will be assigned to you and try to find out if you really need to undergo a rehab, whether residential or outpatient. You will answer some questions that you feel may be invasive but these are necessary to make the correct assessment report. This report will be sent to management for approval.

The Health Insurance Portability and Accountability Act (HIPAA), however, requires the insurance company from getting a letter of consent from you before it can inform the employer. However, it couldn’t approve your treatment plan without disclosing the nature of treatment to your HR. So it’s really a Catch-22 situation. The more likely thing that will happen is that your employer will still know in the end.

Besides, the HIPAA doesn’t prohibit the employer from inquiring about your situation, especially if you are taking a long leave of absence from work because you need to enter rehab. The most prudent approach would be to inform the employer and be done with it.

The good news is that your boss can’t fire you just because you entered into rehab. This is guaranteed by the Family and Medical Leave Act of 1993. The same law also gives the employee the right to take up to 12 weeks of medical leave within the year. The leave of absence can be paid or unpaid.

Being secretive about the whole thing may even backfire. Instead, you need to be working with your employer to enroll in Aetna drug rehab facilities. It’s also a good move on the employer’s part because addiction may hamper the quality of your work.

How do I get time off of work to attend addiction rehab?

What Part of Treatment Will Insurance Cover?

The Aetna drug rehab coverage varies according to your plan. The coverage may only cover detox, for instance, or inpatient rehab. It may also just cover outpatient rehab, which is substantially more affordable compared to residential treatment.

Insurance are no longer allowed to reject an application for coverage due to prior mental health problem. Obamacare also made it more affordable to get coverage for substance abuse treatment.

What is going to be covered?

  • Inpatient or outpatient treatment
  • Behavioral treatment such as counseling and psychotherapy
  • Detox
  • Drug abuse treatment

Again, insurance may only cover one or two of those treatment options or it may cover all aspects from detox to post-rehab medication.

Questions to Ask Your Insurance Company

Before entering rehab, make sure that your insurance coverage is settled first. Be sure to ask the following questions from your insurance provider:

  • How does your insurance review and evaluation process work?
  • Are there specialized insurance coverage in case I’ve maxed out my out-of-pocket cost?
  • Will my information be protected?
  • How much is my copay, deductible, and coinsurance?
  • Will insurance also cover medications after rehab?
  • Will insurance cover detox?
  • What’s your policy regarding inpatient and outpatient rehab treatment?
  • What are the accredited Aetna drug rehab facilities? 
  • Can I choose rehab centers not accredited by the insurance company? If so, how much should be added into my out-of-pocket expenses?
  • Do you have aftercare support?
  • How many days of stay inside the treatment facility will be covered by insurance?
  • Do you carry a provider network?

Call the insurance provider to determine the Aetna drug rehab coverage and the accredited rehab centers. It’s better to be safe than sorry.