When you or your loved ones needs drug and alcohol rehab, one of your first questions is: how am I going to pay for it? And then: does insurance pay for rehab?
SAMHSA, the US government association that tracks mental health and substance abuse trends, reports that:
- Over 20 million adults suffer from a SUD (substance abuse disorder)
- That’s nearly 1 in 12 adult Americans.
- 7.7 million adults suffer from both SUD and a mental disorder combined.
According the the CDC, The Centers for Disease Control, 10% of people over 12 have used illegal drugs in the past month, demonstrating that the challenge begins early and often continues into adult life.
Given these statistics, chances are that you will be faced with this question in your life. You may be feeling overwhelmed and alone.
Understanding what Cigna pays for is important to ensuring that you get the best care possible.
Here we’ll answer the following questions that you may have about Cigna insurance for rehab:
- What Does Drug & Alcohol Rehab Coverage Include?
- What Does Cigna Drug Rehab Insurance Cover?
- What, if any, Treatments Require Prior Authorizations?
- What, if any, Restrictions are there with Cigna Rehab Insurance Coverage Options?
It’s very important to understand that coverage may vary based upon your policy and a deductible may affect coverage. Additional restrictions may apply.
This is not intended to be your final source of truth. Rather it’s a general guide for Cigna rehab coverage.
If you need help understanding your specific coverage, we have compassionate professionals just a free, confidential call away, there to assist you in understanding your specific policy, working through financial barriers and finding effective treatment options.
Identifying your Cigna Insurance Network
The first step into determining coverage is to determine if you have a network. HMO plans have a select network.
A network is a group of doctors and hospitals who have teamed up to offer people with a certain insurance plan services. If you have a network, then you will have the least out of pocket expense if you stay within your network. Out of network will cost you more or may not be covered at all.
Determining How Much Drug Rehab Insurance Covers
You’ll also want to see if you have a deductible. Your insurance may not “kick in” until you’ve paid a certain amount (your deductible).
Lastly, you will want to know your out of pocket max is. Your insurance may only pay a certain percentage (like 80%) of the bill until you’ve paid a certain amount. After you have reached your out of pocket limit, the insurance pays 100%.
Do You Need a Prior Authorization?
Cigna previously required prior authorization for many drug and alcohol rehab services. To eliminate barriers to care, they no longer require prior auths for most treatments.
However, you will need to review your EOC (coverage documents) to verify coverage.
What Does Cigna Typically Cover in Regards to Addiction Treatment?
Diagnosis – Your doctor will examine you and may order blood or other tests to verify the addiction and to determine the severity of the addiction.
He/she will use this information to determine a best course of treatment. He/she will sign a doctor’s order (prescription) for that treatment.
This will typically be covered by Cigna. This could simply be part of your annual exam which many plans cover even if you have a deductible.
Medical Detox will normally be covered by Cigna to get you started on the road to recovery.
Some Medications will be covered based upon the drug formulary for your plan.
In the case of Drug Replacement Therapy, you will substitute a “less harmful’ prescribed drug for your drug of choice. Doctors will monitor you as they reduce your dosage slowly help you become less dependent.
Methadone, bupreorphine and naloxone, three common drug replacement drugs are typically covered.
Cigna doesn’t cover medications for off-label drug use. This means drugs that are being used for something other than their typical, approved usage. Cigna does have an exception request program that would require documentation from your doctor.
Some outpatient treatment will be covered. Cigna will typically limit the length of treatment based upon your plan.
You may receive intensive outpatient instead on inpatient if your doctor considers it appropriate. Cigna will typically cover this as a substitution for inpatient if your plan covers inpatient rehab.
Inpatient coverage is directly tied to your plan
- PPO plan – A bells and whistles insurance plan that allows you to see any medical providers you want does cover inpatient rehab
- HMO plan – A plan that restricts you to a more narrow network. It doesn’t normally cover inpatient rehab.
If your plan covers inpatient, they may limit the coverage to 30, 60 or 90 days. They may allow you to go to the rehab center of your choice. But if the cost exceeds a certain amount, they may require you to pick up the difference in addition to your co-pay amount which in most cases is 20%.
Aside from visits to your doctor, ongoing relapse prevention treatment may not be covered, so look into community options.
Getting Help With Insurance Questions
Adrugrhab.org is dedicated to helping you find and receive effective care. Contact our free, confidential helpline to speak with a caring and knowledgeable professional today.