Aetna Insurance Coverage For Substance Abuse Treatment

Drug and alcohol addiction affects millions of people across this country. A lot of work is being done through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA) to ensure proper services are in place to help people recover from their addiction. Additionally, under the Affordable Care Act, or Obamacare, substance abuse is classed as a mental health issue, and insurance companies should therefore offer at least some coverage for rehabilitation facilities. That said, exactly how they offer coverage, what they cover, and for how long will depend on three factors:

1. The insurance company
2. Your personal plan
3. The state you live in

One popular insurance company is Aetna Insurance, which offer coverage for substance abuse treatment in a very comprehensive way.

Using Aetna Insurance for Drug Rehab

Aetna offers copay only, open access, and high deductible health insurance plans. All of these plans include at least some coverage for drug rehab. However, the exact options that are given to you, and how much these will cost you, vary quite significantly. The company has provided an online tool to all its policy holders to enable them to view their coverage details. Strong online customer support is also provided, through which people can check whether or not a program that they are considering is covered by their insurance package.

About Aetna Insurance
Aetna Insurance is one of the Fortune 100 companies. It is also one of the largest health insurance companies in the country. It was originally founded in 1850 and now offers insurance policies all over the United States. It employs some 34,000 people and its network has some 470,000 thousand providers and doctors. The company is also striving towards a goal of being able to create an improved health care system that is transparent about its motives and easy for patients to understand. This is a promise it has made to its 46 million members, who have a variety of plans. As part of the company’s commitment, its offers regular health insurance and also vision insurance and dental insurance.

Aetna also has a number of subsidiaries, including:

  • Medicity
  • Cofinity
  • Aetna Capital Management
  • Strategic Resource Company
  • Schaller Anderson
  • Aetna Student Health
  • ActiveHealth Management

The plans that Aetna offers are quite clearly laid out, which is part of the commitment to keep things simple. As such:

1. Through an open access plan, people are able to choose their own doctor. No referrals are required, nor do people have to designate a primary care physician.
2. Through a copay only plan, people are guaranteed that any costs they have left after they have paid their personal deductible are copay only. This includes visits to primary care physicians, as well as generic drugs being covered before meeting the deductible.
3. Through high deductible plans, people are able to access preventative care service before they meet their deductible. Sometimes, this includes primary care physician coverage before meeting the deductible, including copay. They also have the options of creating a health savings account.

All Aetna Insurance members have access to a member website, where full details of their plan are highlighted.

Coverage through Aetna Insurance for Substance Abuse Treatment

Aetna offers a Navigator, which is an online program that enables people to view the details of their coverage, search for providers, submit claims, and more. At the website, it is also possible to see the health coverage that is offered through Aetna. As soon as a policy holder logs in, that person has access to various resources specific to the policy. The website also includes a “Find a Doctor” section, where people can find specific providers. Information and details about all types of providers are listed there. These include centers and professionals who specifically treat addiction and substance abuse issues.

Help from the Aetna Website

Through the Aetna Insurance website, patients are also able to speak to Ann, who is a virtual health assistant. She is able to answer questions about general health, and also about specific coverage offered through Aetna. Additionally, the iTriage app is provided to enable policy holders to manage their health on the go. This is a very easy and practical way to use a smartphone to manage any health concerns.

Coverage for Mental Health Problems

For those who have mental health problems, they have access to psychologists, psychiatrists, therapists, counselors, psychiatric nurse practitioners, social workers, and primary care doctors. Substance abuse and mental health problems generally come together, and it is of the utmost importance that both issues are addressed together, on a continuum of care. Significant research has demonstrated that it is vital that people receive simultaneous care if they are to be successful in living a life free from substance abuse and mental ill-health. Aetna tries to make sure that people have the best chance for a sustained, lasting recovery.

Services for Substance Abuse Treatment

If you are covered under Aetna Insurance and have a substance abuse problem, then you will be able to receive coverage for the following services:

1. Detox services
2. Residential and inpatient rehab
3. Intensive outpatient treatment
4. Partial hospitalization
5. “Alumni” programs and continuing care programs

Coverage is determined based on the individual policy holder. As such, there is no limit to the length of time that patients can receive treatment. The company also has solutions in place for those who want to access services from a provider that is not part of the Aetna network, although this would cost more. It is very important, therefore, to check what your personal plan includes, which you can do online, through the app, or by contacting an Aetna Insurance representative. This will enable you to find out how much you are covered for, and whether this includes providers who are outside the network.

Partnership with CRC Health Group for Opioid Addiction Treatment

Of particular interest is the fact that Aetna Insurance has entered into a partnership with CRC Health Group. This was done specifically to provide treatment for people who have an opioid addiction. Prescription painkiller addiction is now a significant problem in our country according to the Centers for Disease Control and Prevention (CDC). In response to this Aetna Insurance has made more treatment options available to people who require care and are covered by its network.

Details on Patients Kept Confidential

If you are looking for treatment or rehabilitation for a substance abuse problem or addiction, Aetna Insurance will keep all your details confidential. They will only share your personal information with your permission to providers that are relevant to your personal situation. If you do have an issue with prescription drug abuse, then the Aetna Insurance plans provide medical detox, 12 step program access, and therapy, depending on your specific needs. Your plan will determine how long you will be able to stay in a rehab center, and your personal situation will also be taken into consideration. This is very similar to how other health plans are managed. Aetna Insurance understands that every individual is unique. Hence, treatment should be fully personalized as well, which includes having regular assessments to ensure the care that is being provided is still relevant.

Aetna Insurance’s Own Details About Drug and Alcohol Treatment

Aetna Insurance has reported that the treatment of drug and alcohol abuse has gone through significant changes resulting in substantial improvement. In the past, someone would be referred to an inpatient facility for a 28 day program. Today, however, there are many different types of treatment centers available, enabling patients to integrate help into their lives in a way that is suitable for them and at a time when they are ready.

To make this a reality, Aetna Insurance offers support through the following treatment options to ensure recovery:


It is possible to become physically dependent on drugs and alcohol, and this means that withdrawal symptoms will be experienced when people stop using. At times, detox can happen safely and effectively through a detox program. However, depending on the kind of drug that was abused and/or the amount of alcohol consumed, patients may require a referral to an inpatient facility instead. Other factors that help to determine this are the individual mental and physical conditions of patients, how long they have used a substance, and at what dosage. Other risk factors that are of importance include medical risk factors and the presence of other illnesses or disorders.

Residential and inpatient rehabilitation

These are chemical dependency programs that can be participated in through drug and alcohol treatment facilities, psychiatric hospitals, and medical hospitals. Here, patients are supervised around the clock and receive supervision and intervention for psychiatric conditions, encouraging them to work on their recovery. Once the patients are ready, they can move out of inpatient facilities and into outpatient treatment.

Partial hospital treatment

Here, patients attend four to eight hours of treatment per day, every day, after which they can go home. They usually also have to participate in a self-help group, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), once a week. These services help the patients recover from addiction, while remaining in an environment that is familiar to them and where they experience the triggers and stressors that would lead to drug abuse in the past. In so doing, they are instantly equipped with the right tools to avoid these triggers.

Intensive outpatient treatment

Here, patients attend treatment for a few hours during the week, usually during evenings. They also take part in self-help groups. This program is very similar to partial hospitalization, but therapy is shorter in length. It enables people not just to go home at the end of the day, but to go to work as well.

Continuing care

This is offered through “Alumni” groups. This can be organized by former patients, who are in charge of their own events where they strengthen and celebrate their recovery. Other patients prefer continuing to see a single therapist after treatment.

Aetna Insurance understands that alcohol and drug abuse is a lengthy, complex process. People have different needs relating to their personal condition, and those needs cannot be predetermined. This is why Aetna Insurance does not offer coverage solely for 28 day programs, or other similar solutions. Rather, the company wants to ensure that patients are able to get the best possible results, which usually happens when they are within their own community and participate in self-help groups. Additionally, it means providing ongoing care so that they can avoid relapse.

If relapse does happen, then they must be able to immediately speak to a specialist so that they can get back on the road to recovery. Aetna Insurance understands that relapse is not the same as failure, nor does it mean that the entire process has to be restarted. Rather, it means that a patient requires ongoing support, and this should be made available straightaway.

There are also a number of things people searching for alcohol or drug treatment should take into consideration:

1. Local treatment is generally more effective than distant treatment. This is because it enables people to build a sober support network. Additionally, their family and friends can be more involved.
2. In residential treatment, patients may also be offered intensive outpatient or partial hospitalization options after they complete their inpatient rehab. This enables them to return to the real world gradually.
3. Patients should be protected from exposure to their substance while they are in treatment through drug screening and monitoring.
4. Families should be provided with educational options to learn about addiction and to ensure that they have the skills to help their loved ones.
5. Medication should be offered by the program if needed by the individual. This medication should help patients achieve sobriety and maintain it. Aetna Insurance provides coverage for drugs including Antabuse, Subutex, Vivitrol, and Campral.
6. Patients should be offered psychiatric treatment if necessary if they have a mental health disorder. If they have a family history of mental health issues, they should be offered this treatment as well.
7. Those who use distance programs should still be able to receive details for local programs where they are able to get continued care.
8. Aetna Insurance has screened its network programs very carefully for adherence to modern treatment principles, quality of care, and excellent followup.