Aetna Health Insurance for Addiction Treatment in Texas
Aetna is a large nationwide insurance provider that operates in Texas. With an Aetna plan, you will receive coverage for substance use disorder treatment. In this article, we’ll help you understand what your plan may cover and how to check your benefits.
Does Aetna Cover Substance Abuse Treatment?
Yes, Aetna does provide coverage for substance use disorder (SUD) treatment.1
Aetna marketplace insurance plans are required by the Affordable Care Act (ACA) to provide coverage for mental health and substance use disorders, and both the ACA and the Mental Health Parity and Addiction Equity Act require that plans that provide substance use disorder treatment do so at the same rates as they do for medical and surgical care.2
The ACA also protects you from being denied coverage for a preexisting condition. This means that even if you were struggling with an SUD prior to obtaining your current healthcare coverage, you should be covered for treatment.3
The exact amount and type of coverage that you’ll have will depend on your specific plan. Aetna offers many plans, including:4
- PPO plans: These plans typically allow for patients to seek specialty services without a referral from a primary care physician (PCP).
- HMO plans: These plans usually require your PCP to guide your care by providing referrals.
- Elect Choice plans: These plans utilize a PCP to guide care and require patients to stay in a specific network when receiving care.
Each Aetna plan has unique coverage details. For example, while some plans may require you to visit your PCP prior to reaching out to a substance use disorder facility, others may not. Each plan will also provide different amounts of coverage for rehabilitation.
How to Use Aetna Health Insurance to Pay for Rehab
When you use your Aetna plan to pay for rehab, your starting point may depend on your plan. For example, if you have a plan that requires you to get a referral, you may need to schedule a visit with your PCP as your first step. If you don’t need a referral, you may be able to contact a rehabilitation facility directly and begin the process immediately.
Insurance can be very confusing, and you may not know whether your plan covers the type of treatment you want or how much coverage you have. We are here to help you understand your benefits. Greenhouse Treatment Center is in-network with Aetna, and we can help you verify your coverage easily and get basic information about using your Aetna insurance to pay for rehab at Greenhouse.
Simply fill out our to receive an email with information about your insurance benefits in minutes. Or for immediate help, you can call us now at .
Types of Addiction Treatment Covered by Aetna
There are several types of addiction treatment, and your Aetna may plan may cover some or all of the following:1,5
- Medical detox (withdrawal management): Medical interventions to help patients detox safely from any substances on which they are physically dependent. Medical detox may be performed on an inpatient or outpatient basis. At Greenhouse, we offer inpatient detox with 24/7 medical supervision to ensure your safety and comfort.
- Inpatient/residential rehab: Intensive live-in care that provides a great deal of structure and support in a substance-free facility.
- Outpatient services: Treatment programs that allow patients to receive services during the day while continuing to live at home.
- Medication-assisted treatment: The combined use of medications and behavioral therapies for opioid and alcohol use disorders.
Cost of Drug & Alcohol Rehab with Aetna Insurance
Typically, an insurance provider will only pay for treatment that they deem “medically necessary.” Aetna defines medically necessary treatment as that which is provided by a qualified healthcare provider for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease (or its symptoms) and that is:6
- Provided in accordance with accepted medical standards.
- Not primarily for the patient’s or provider’s convenience.
- No more costly than an alternative service that is likely to produce equivalent results.
Be aware that even some services that are medically necessary will require pre-authorization (or prior approval) before the insurance plan will cover it.7,8 If you’re not sure whether the treatment you need requires preauthorization, make sure to call your insurance company (via the number on your card) or ask a prospective rehab provider to reach out to your insurance company to obtain preauthorization before you begin the admissions process.
Provided your treatment is covered, the exact cost will vary based on your plan and factors such as your:9
- Deductible: The amount you must pay for covered services before your insurance begins covering costs.
- Copay: The specific dollar amount you pay for a healthcare expense, such as a doctor visit or a prescription drug.
- Coinsurance: The percentage of costs for a covered service you pay after you’ve met your deductible. For example, a hospital visit may require you to pay 20% of the cost while your insurance pays 80%.
If you elect to participate in an outpatient program, you may be responsible for a modest co-pay for each visit. On the other hand, if you attend an inpatient program, you may receive just one bill based on factors such as your deductible and coinsurance. Again, the exact costs will vary per your specific Aetna plan.
You may be subject to some out-of-pocket expenses after your insurance pays, but many facilities will work with you to find ways to cover rehab costs, including flexible payment plans or loans. Staying in your plan’s network is the most effective way to keep your out-of-pocket expenses low. Going out of network will often lead to significantly higher costs. For example, your plan may offer a 10% coinsurance rate for in-network rehab facilities but raise it to 50% if you go out of network.7
Fortunately, Greenhouse is in-network with Aetna, so using your coverage at our Texas facility may help you receive life-saving treatment without having to worry about breaking the bank.
Why Use Aetna Insurance to Cover Rehab
Aetna insurance provides robust healthcare for Texans. With your Aetna plan, you can get the help you need at in-network Texas-based rehab facilities, such as Greenhouse, Treatment Center.
To start the process and verify your benefits, simply complete the short form below and we’ll contact you right away.