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Will Cigna Cover the Cost of Rehab?

When someone is ready to step up and admit they have a problem with drugs or alcohol, it’s important for them to know they have easy access to treatment. In Massachusetts, there’s a disproportionate number of high-quality addiction treatment centers for a prospective patient to choose from. Of course, quality treatment usually requires a patient be prepared to pay higher costs.

The last thing anyone wants is for finances to be a deterrent, preventing someone from seeking the help they so desperately want and need. For that reason, US lawmakers passed the 2009 Affordable Care Act (ACA) with a provision for the handling addiction treatment costs through healthcare insurance providers.

Prior to 2009, many of the nation’s top insurance providers viewed addiction treatment as an elective procedure. That became the basis for them not covering any portion of a patient’s addiction treatment costs. From 2010 on, the ACA made it clear. Healthcare insurance providers are required to handle claims for addiction treatment the same way they would any other medical condition. Additionally, the preexisting clause in the ACA made it illegal to not cover addiction treatment costs on that basis.

As things stand now, all Americans are suppose to carry some level of healthcare insurance as an individual or through their employers. The healthcare insurance providers like Cigna are required to cover rehab costs with one caveat: the extent of coverage and the types of treatment can be limited based on some criteria.

The following information will address specifics about what addiction treatment costs healthcare insurers are required to cover.

Addiction Treatment Coverage by Healthcare Insurance Providers

As we indicated above, not all addiction treatment processes are required to be covered by healthcare insurance policies. With that said, a major healthcare provider like Cigna might choose to cover a wider range of addiction treatment processes for various reasons. They might do this as a marketing ploy or in order to help the policyholder prevent more serious health issues in the future.

Prior to entering treatment, it’s incumbent on the patient to understand exactly what their policy will cover. Most treatment facilities, especially in MA, will be more than happy to assist in the discovery process by talking directly to the insurance company. Once coverage is understood, the patient will have to determine whether or not they have the financial resources to cover any additional treatment costs. At all times, a lasting recovery should be the primary goal.

Here’s the basic costs the ACA requires insurance companies like Cigna to cover, at least in part:

Detox and Prescription medications

Outpatient care

Inpatient (residential care

Dual Diagnosis Treatment

Aftercare counseling

Let’s look at these costs a little more closely.

Detox and Prescription Drugs

Detox programs help patients get through the substance withdrawal process safely and with a minimum of discomfort. It’s a predicate when substantial addictions are indicated because the patient needs a clear body and mind in order to get maximum benefit from counseling. If prescription meds are necessary during detox, the insurance companies must cover the costs based on the patient’s policy parameters.

Outpatient Care

This type of care requires the patient to attended scheduled appointments for individual and group counseling sessions. Intensive outpatient care programs usually require the patient to be onsite for at least 4 hours a day. Insurance carriers like this option because it costs substantially less than inpatient care. Many policies will cover most or all of outpatient costs for this reason.

Inpatient Care

The patient remains in the treatment facility 24/7 for 30-90 days, though the insurance company may cap costs at 30 days. Treatment includes therapy, counseling, housing and recreation. In many cases, the insurance carrier will restrict treatment to basic care, eliminating holistic treatment options.

Dual Diagnosis Treatment

Some patients enter rehab with an addiction that has been caused by a psychological problem. Dual diagnosis treatment allows the facility to treat both conditions at the same time, making it less likely that relapses will occur in the future.

Aftercare Counseling

As a form of relapse prevention, many insurance companies will continue paying for counseling at the conclusion of a standard treatment program. The low cost of counseling is preferable to paying for another stint in rehab.

If you are unsure to what extent your Cigna healthcare insurance policy will cover your addiction treatment costs, we can help you get answers and treatment.

Ready to Make a Change?

We know that overcoming addiction is not easy and requires courage to ask for help. At Woburn Wellness Addiction Treatment, our team of professionals has decades of combined experience in helping men, women, and families overcome substance abuse.

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