What is Aetna Drug Rehab Insurance?

After deciding to receive treatment for a substance use disorder, you must gather the funds to pay for rehab. Luckily, due to the Affordable Care Act (ACA), health insurance companies must provide just as much coverage for addiction and mental health treatment as they do physical health issues. One health insurance company that is great to use when paying for addiction treatment is Aetna drug rehab insurance. 

What is Aetna Drug Rehab Insurance?

Aetna drug rehab insurance is one of America’s top diversified health care benefits companies. Aetna health insurance offers medical, pharmacy, behavioral health, life, disability, and medical management insurance plans and services. These plans and services are offered to more than 45 million people every day. 

Types of Aetna Drug Rehab Insurance Plans

There are three main types of Aetna drug rehab insurance plans available. These three plans include open-access plans, co-pay only plans, and high-deductible plans. 

Open-Access Plans

Open-access Aetna drug rehab plans allow customers freedom when it comes to choosing their physicians. In fact, Aetna drug rehab open-access plans don’t require a referral or primary care physician. 

Copay Only Plans

Copay Aetna drug rehab insurance plans bring the cost that Aetna customers have to pay out-of-pocket when attending rehab down. It does this by making it so that Aetna drug rehab insurance customers only have to pay their co-pays after paying their deductibles.

Aetna drug rehab copay only plans cover the cost of generic drugs and visits to primary care physicians. Aetna offers these forms of coverage prior to individuals even having to pay their deductibles, let alone their copays.

High-Deductible Plans

Aetna drug rehab high-deductible insurance plans offer preventative care services and different health savings account options. These offers occur before you’re even required to meet your deductible. Once individuals make their co-payments, Aetna drug rehab high-deductible insurance plans will sometimes even provide coverage for one’s primary care physician.  

In-Network Aetna Drug Rehab Insurance Plans

In-network Aetna drug rehab insurance plans provide high-level coverage for treatment at rehab facilities that work directly with Aetna. Having a network of rehab facilities is beneficial for Aetna. This is because it forces those rehab facilities to contractually accept discounted fees and payments from Aetna. In return, Aetna drug rehab insurance will refer their customers to those specific in-network rehab facilities. Aetna-drug-rehab-300x200

All in-network Aetna drug rehab programs must follow current standards of practice. Thus, if you’re attending addiction treatment at an in-network Aetna drug rehab facility, you can rest assured that the care that you’re receiving is of high-quality. 

Rehab facilities that are out of Aetna’s drug rehab network aren’t required to follow the same practices. Thus, if you contain Aetna drug rehab insurance, it’s best to receive addiction treatment at an in-network rehab facility. 

Pre-certification or authorization are required for certain addiction treatment programs in Aetna’s network. That way, Aetna’s in-network addiction treatment programs meet their clinical criteria for coverage. The Aetna drug rehab in-network addiction treatment programs that must meet clinical criteria for coverage include inpatient admissions, outpatient detox, residential treatment admissions, intensive outpatient programs, and partial hospitalization programs.  

You’re allowed to receive care at an out-of-network Aetna drug rehab facility. Your Aetna health insurance would just cost you more than it would for care at an in-network rehab facility. 

Out-of-Network Aetna Drug Rehab Insurance Plans

Out-of-network Aetna drug rehab insurance plans help pay for addiction treatment at rehab facilities that aren’t within Aetna’s network. These Aetna drug rehab insurance plans don’t provide the discounted service rates that in-network Aetna drug rehab insurance plans do. As a result, attending addiction treatment at a rehab facility that’s out of Aetna’s network is more expensive.

One way to ensure that you’ll at least receive basic insurance coverage when receiving treatment outside of Aetna’s network is to make sure that the rehab facility that you’re receiving care at accepts Aetna as an out-of-network provider. That way, you can still receive some Aetna drug rehab insurance benefits. 

Aetna-Drug-Rehab-Insurance-300x201There are various Aetna drug rehab out-of-network insurance plans. The type of Aetna drug rehab out-of-network insurance plan that you get will determine how much you’ll pay out-of-pocket. In fact, there are two primary factors that affect how much an Aetna customer must pay out-of-pocket when receiving treatment at a rehab facility that’s outside of Aetna’s drug rehab network. 

One is the method that one’s Aetna out-of-network plan uses to set the allowed amount. The other is the percent of the allowed amount that one’s Aetna’s out-of-network insurance plan is set to pay. 

An out-of-network Aetna drug rehab plan partly bases the allowed amount on Medicare-based rates. It also bases the allowed amount on any of your reasonable, usual and customary, and prevailing charges. Other types of rate schedules also factor into how much the allowed amount of an out-of-network Aetna drug rehab insurance plan is. 

There are Aetna out-of-network insurance plans that offer zero out-of-network benefits. Customers of those Aetna insurance plans will still receive out-of-network insurance coverage for emergency situations. This is just one of the many ways that Aetna goes out of its way to take care of its customers. 

Addiction Treatment Programs That Aetna Drug Rehab Insurance Covers

Some types of addiction treatment programs have a greater chance of being covered by health insurance than others. The addiction treatment programs that Aetna drug rehab insurance tends to cover are detox, inpatient treatment, residential treatment, partial hospitalization program treatment, intensive outpatient program treatment, and continuing care treatment programs. 

Aetna Drug Rehab Insurance Coverage for Detox

Aetna drug rehab insurance will likely cover the cost of a traditional inpatient detox. To receive Aetna drug rehab insurance coverage for outpatient detox, pre-authorization and a medical referral are necessary. Aetna drug rehab insurance doesn’t cover the cost of rapid detox.

Aetna Drug Rehab Insurance Coverage for Inpatient Treatment

 This form of drug rehab insurance almost always provides coverage for inpatient addiction treatment. Still, the amount of inpatient addiction treatment Aetna coverage and services that individuals receive depend on their insurance plan. 

One thing that could factor into how much coverage a person will receive in his or her Aetna inpatient treatment plan is the state that you live in. Another factor is your Aetna drug rehab insurance policies and programs. 

Aetna drug rehab insurance policies and programs include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS), and Exclusive Provider Organization (EPO). Because the rules of each of these policies and programs change in each state, so will the deductible levels of each of these policies and programs. That means that the services of your Aetna drug rehab inpatient insurance plan can vary depending on the insurance policies that you have and the state that you have them in.

Levels of Aetna Inpatient Treatment Plans

There are four levels of Aetna inpatient treatment plans. These levels are Platinum, Gold, Silver, and Bronze. These four inpatient Aetna drug rehab plans differ in their deductible and monthly premium levels.

When individuals have a high deductible and a low monthly premium, it means that they pay more out-of-pocket before their insurance kicks in to pay the rest but pay a lower amount each month to maintain their insurance coverage. On the other hand, if a person has a low deductible and a high monthly premium, that person pays less out-of-pocket before their health insurance kicks in, but more each month to maintain insurance coverage. 

To be more financially secure, most people prefer to have a lower deductible and a higher monthly premium. That way they won’t have to pay much for their medical bills and will know around exactly how much they’ll need to pay for insurance coverage each month. Due to this preference, the higher, preferred levels of inpatient Aetna drug rehab insurance provide lower deductibles and higher monthly premiums than the lower levels. 

Platinum Inpatient Aetna Drug Rehab Plan 

The highest Aetna inpatient treatment plan level is Platinum. The Platinum inpatient Aetna drug rehab plan has a lower deductible and a higher monthly premium. 

Gold Inpatient Aetna Drug Rehab Plan

The second highest Aetna inpatient treatment plan level is Gold. The Gold inpatient Aetna drug rehab plan has a slightly higher deductible than the Platinum level plan. The Gold inpatient Aetna drug rehab plan also has a slightly lower monthly premium than the Platinum one does. 

Silver Inpatient Aetna Drug Rehab Plan

The Silver inpatient Aetna drug rehab plan has a higher deductible than both the Platinum and Gold inpatient Aetna drug rehab plans. It also has a lower monthly premium than both the Gold and Platinum plans.

Bronze Inpatient Aetna Drug Rehab Plans

The Bronze inpatient Aetna drug rehab plan has the highest deductible of all the inpatient Aetna drug rehab plans. It also has the lowest monthly premium of all the inpatient Aetna drug rehab plans. 

Aetna Drug Rehab Insurance Coverage for Outpatient Treatment

There are many factors to how much outpatient treatment Aetna drug rehab insurance coverage a person receives. One factor of outpatient Aetna drug rehab insurance coverage is the state that you live in. This is because the rules and deductible levels of outpatient Aetna drug rehab insurance policies and programs vary from state to state.

Another outpatient treatment Aetna drug rehab insurance coverage factor is your insurance policy. For example, some Aetna drug rehab insurance policies don’t even offer coverage for regular outpatient treatment. Others have a fixed coinsurance or copay for outpatient treatment. 

North Jersey Recovery Center Accepts Insurance Coverage for Addiction Treatment

At North Jersey Recovery Center, we understand the importance of having funds to pay for rehab. That’s why we accept coverage from a variety of different health insurance companies. Thus, whether you have Aetna drug rehab insurance or some other form of health insurance coverage for rehab, there’s a chance that you can use that coverage to pay for your treatment at our facility. 

To verify and review your health insurance coverage at our recovery center, click on “verify your insurance” at the bottom of the North Jersey Recovery Center website and fill out the digital insurance verification form. 

To learn even more about your health insurance coverage at our facility, feel free to contact us over the phone. There we will provide you with immediate assistance.

Reviewed for Medical & Clinical Accuracy by Laura Riley

Laura-Riley-Cropped-Profile-150x150Laura Riley, MA, LCADC, CCS is an Administrator with North Jersey Recovery Center.