Finding yourself addiction treatment can become overwhelming, but understanding how your insurance works is the first step to getting the help you need.
If you or a loved one has Aetna insurance, knowing which Aetna substance abuse treatment are covered and how to use your benefits can make recovery more accessible and affordable for you.
Let’s break it down.
Aetna’s Definition of Substance Abuse
Aetna calls substance abuse “substance use disorder,” which is a medical condition that affects your physical and mental health or daily life. Substance Use Disorder is diagnosed by meeting specific clinical criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Medical necessity is a big factor in coverage. This means the treatment must be deemed medically necessary by a provider to treat your disorder. If you need inpatient care, outpatient therapy, or detox services, Aetna’s definition will dictate what services are covered for you.1
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What Does Aetna Substance Abuse Treatment Cover?
Aetna has you covered for a wide range of substance abuse treatments.
Here are some common ones:
- Inpatient Rehab Programs: In person facilities offering you 24/7 care in a structured environment.
- VIOP Programs: Flexible programs that let you attend therapy sessions while you are at home.
- Detox Programs: Medically supervised withdrawal management treatment.
Coverage may vary by your plan so be sure you check your benefits. Some plans have limits (e.g., only cover a certain number of days or require pre-approval for certain services).2
Note: Cornerstone does not offer detox services, but we can help you find a trusted detox facility. Once you’ve completed the medical detox process, you’re welcome to continue your recovery journey with us through our comprehensive treatment programs.
Quick Tip: Verify Your Aetna Coverage Before You Start
Before you start your treatment, make sure to verify your coverage so you don’t have to deal with surprise bills. Cornerstone Healing Center offers you free insurance verification to help you understand your benefits and plan your recovery. Getting yourself help is the way to live a stable and secure life.
How to Verify Aetna Insurance for Substance Abuse
Understanding your benefits starts with verifying your insurance.
Here’s how you can do that:
- Aetna Online Member Portal: Log in to see your plan details, benefits, and coverage for your treatment.3
- Aetna Customer Service: You can talk to a representative.
- Treatment Centers: Many centers (like Cornerstone Healing Center) offer you free insurance verification to help you through the process.
Doing this will give you clarity on if you are covered for what you need and what you can expect.
Aetna Preauthorization Process
For some treatments, Aetna may require you to do pre-authorization. This means before you start, you have to submit documentation to prove your medical necessity for the treatment. 4
Pre-Authorization Requires:
- A diagnosis from your medical doctor
- A treatment plan from your doctor with recommended services
- Provide your medical records
Your treatment center or your doctor can help you with this process to make sure everything gets submitted correctly.
Frequently Asked Questions
How does Aetna define substance abuse?
Aetna defines substance abuse as a condition where substance use negatively affects a person’s health, relationships, or daily responsibilities. It is recognized as a medical disorder that may require professional treatment, such as therapy, detox, or rehabilitation, depending on the severity and impact on overall well-being.
What types of substance abuse treatments does Aetna cover?
Aetna provides coverage for various substance abuse treatments, including inpatient rehab, outpatient programs, detox services, and medication-assisted treatment (MAT). Coverage depends on your specific plan, medical necessity, and provider network, so it’s important to review your benefits or consult with a treatment center for guidance.
Note: Cornerstone does not offer detox services, but we can help you find a trusted detox facility. Once you’ve completed the medical detox process, you’re welcome to continue your recovery journey with us through our comprehensive treatment programs.
How can I verify my Aetna insurance coverage?
You can check your Aetna coverage by logging into the member portal, calling Aetna’s customer service, or working with a treatment center like Cornerstone Healing Center for a free, confidential benefits verification. This process helps determine what treatments are covered, any out-of-pocket costs, and if preauthorization is required.
Does Aetna require preauthorization for substance abuse treatment?
Yes, Aetna may require preauthorization for certain substance abuse treatments. This means your provider must submit medical documentation proving the treatment is necessary before Aetna approves coverage. Preauthorization helps ensure you receive appropriate care while managing costs within your insurance plan’s guidelines.
Key Takeaways
- Key Takeaways
- Aetna defines substance abuse as a diagnosable substance use disorder requiring medical necessity for treatment.
- Aetna coverage may include inpatient rehab, outpatient therapy, MAT, and detox programs.
- Verifying your Aetna coverage is crucial to understanding what treatments are available. Preauthorization is often required for certain services.
- You are often required to do preauthorization for the care you need.
- Aetna’s substance abuse treatment benefits can make recovery more affordable and accessible.
Get Started with Aetna Coverage at Cornerstone
Understand your Aetna benefits and get started with your recovery. Whether you need residential, outpatient, or virtual services, Cornerstone Healing Center can help you verify your coverage for free and get you the help you need.
Contact us today to verify your Aetna insurance or to learn more about the addiction treatments covered under your plan.
