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Aetna Insurance Coverage for Drug and Alcohol Treatment

Aetna has been insuring Americans for over 167 years, though they haven’t always been in the business of medical and behavioral health plans. When the company opened its doors in 1853, they sold life insurance. And even before that, their “parent company” was Aetna Fire Insurance Company of Hartford!

But their quick growth ensured a fast expansion to other areas—including health care, medical, and behavioral health, which make up the majority of its plan offerings. Aetna opened its doors in Hartford, Connecticut; today, its headquarters remain there, but they offer insurance coverage nationally.

Today, Aetna belongs to the CVS Health network, which connects it with services like CVS Caremark and CVS Specialty Pharmacy.

Who Accepts Aetna Insurance?

Aetna has one of the most accessible networks, so it could be easy to find a provider or rehab that accepts it and is in-network. It depends on your location, but Aetna’s huge membership gives providers a reason to accept it.

One of the largest managed health care companies in the nation, Aetna boasts:

To support that many members, there are 1.2 million health care providers, over 690,000 doctors and specialists, and more than 5,700 hospitals and facilities that accept Aetna health care insurance.

Aetna Health Care Plans

Aetna offers a variety of health care plan types to benefit anyone who needs them. They include:

Aetna PPO Plans

Preferred Provider Organization (PPO) plans with Aetna have high premiums, but in exchange you get the most flexible coverage. That means the ability to see specialists and providers who are out-of-network without needing a referral. And even though the premiums are high, your copays and coinsurance fees are typically low if you stay in-network.

Aetna HMO Plans

Health Maintenance Organization (HMO) plans with Aetna have low premiums and deductibles, and the copays are fixed (and typically low too). However, with an HMO, you’re required to see a doctor who’s within your network. If you need an out-of-network doctor, you must get pre-authorization and a referral first.

Aetna POS

Point-of-Service plans (POS) are similar to HMO plans, but have more flexibility for out-of-network provider coverage. In exchange for better flexibility, these plans have a slightly higher premium. A POS is a good choice if you know that one of your preferred addiction providers is out-of-network with Aetna. 

Aetna EPO

Exclusive Provider Organization (EPO) plans are less common than the rest, and they cover in-network care (but with more in-network providers than an HMO would grant you). In some cases, you’ll need a referral to see a specialist, but it depends on the specific EPO.

Aetna HDHP with HSA

High Deductible Health Plans (HDHP) have low premiums, but the copays and coinsurance tend to be higher. However, an HDHP can still be an HMO, POS, EPO or PPO. The biggest difference is that you get a Health Savings Account that you can use to cover part of your deductible, and you can deposit pre-tax income to your HSA to save 30% on taxes.

Can Aetna Pay for Substance Abuse Treatment?

Yes, Aetna can pay for substance use disorder treatment! However, it’s close to impossible to estimate your out-of-pocket cost without knowing factors like:

  • Your exact insurance plan
  • The cost of your rehab of choice
  • The cost of the program you enter and services you receive
  • Whether you’ve met your deductible
  • Whether you have access to an HSA
  • Whether the rehab facility is in-network

Two rehab stays for the same substance use disorder can be wildly different in terms of out-of-pocket cost depending on where you go, what programs you enter, and more. Some people enter rehab paying nothing, while others pay hundreds or thousands in coinsurance. The only way to know what to expect is to estimate treatment cost and coverage for your specific situation. 

Does Aetna Require Preauthorization for Addiction Treatment?

Aetna does require preauthorization for some addiction treatment. Preauthorization (or precertification) means that your provider has to contact the insurance company certifying that the treatment is medically necessary.

If you hear from Aetna about your treatment coverage requiring further action, don’t worry—it’s a part of the process and it doesn’t mean that your treatment coverage will be denied. It’s just one more step on the part of your provider, who has to contact the insurance company.

Aetna requires preauthorization for these services:

All inpatient coverage includes treatment for complications (including detox), a semi-private room, and other services in a licensed treatment facility.

All outpatient coverage covers outpatient treatment that takes place in a treatment facility, mental health hospital, or hospital. It also covers partial hospitalization with short-term intensive treatment.

Find Your Addiction Treatment Coverage and Cost

If you’re ready to get treatment, congrats on making one of the best decisions you’ll ever make! The next step is to determine coverage. You can only guess at the final cost of addiction treatment by reading an article, but when you use our handy addiction treatment insurance coverage tool, we can help you know what to expect!

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Our team of writers are dedicated in providing accurate information. All of our data is sourced from reputable and relevant sources. Our editorial team also reviews the content for inaccuracies in facts and grammar.  

If you come across any information that you might believe is inaccurate, please contact us right away. 

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