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Aetna Rehab Coverage: Does It Cover Substance Abuse?

Last Updated: March 27, 2024

Authored by Isaak Stotts, LP

Reviewed by Michael Espelin APRN

Addiction is a behavioral disorder that includes many factors, forming a repetitive and maladaptive use pattern, repercussions, and fallout. According to the NSDUH, nearly 8.1% of the American population either needs or gets recovery treatment for SUDs. Founded in 1850, Aetna has become the third-largest health insurance provider in the United States, with coverage including mental health, behavioral health, and therapy services.

Aetna rehab coverage offers different health insurance options to help decrease the cost of addiction treatment in a variety of centers. Continue reading this article for more information on insurance plans and their coverage.

Aetna Rehab Coverage

An estimated 39 million people are enrolled in Aetna insurance plans. About 22.2 million medical members, 12.7 million dental members, and 13.1 million pharmacy benefit services members are covered by their health insurance programs. Among the treatments covered by the insurance are substance use disorders.

So, the insurance coverage does extend to drug and alcohol rehabilitation. However, what it covers can vary depending on the type of policy, where the insured is located, and whether or not it is through an employer. Aetna rehab coverage is contingent upon the insured getting a referral from a doctor before entering into active rehabilitation treatment. As such, users cannot randomly check into a center of their choosing and still expect to use company insurance for rehab.

To get information on what an individual plan covers, which includes coinsurance, copays, and deductibles, contact the insurance provider.

In-Network vs. Non-Network Rehab Providers

Not all company plans need service providers to be in-network. Some plans cover non-network care as well but only in an emergency. Going out of the Aetna rehab provider network usually costs more than what the program recognizes or allows.

Nurse giving recommendations to a patient.

On choosing specialists, centers, or other healthcare providers out of the Aetna rehab provider network, the company pays for the care with the reasonable charges obtained from the industry database or a local market fee set by it. The insurance provider can give detailed information about the payable amount.

Aetna Drug Rehab Treatment

The insurance offers robust coverage for alcohol and drug abuse rehabilitation. The company covers detoxification, inpatient, residential, partial hospitalization, intensive outpatient programs, and numerous smaller services related to them. Residential treatment centers approved by the company usually cover between 1-6 weeks of treatment, while approved outpatient centers are typically covered for 1-3 months. However, it does require precertification to access a recovery treatment program. Precertification means that the requested service has been determined to meet the company’s standards for coverage.

Services That Require This Additional Assessment Include:

  • Inpatient treatment
  • Residential treatment center admissions
  • Partial hospitalization programs
  • Intensive outpatient programs
  • Psychological testing
  • Neuropsychological testing
  • Outpatient electroconvulsive therapy
  • Biofeedback
  • Amytal interview
  • Psychiatric home care services
  • Outpatient detoxification

In addition to these services, company insurance plans cover continuing care support, including weekly support groups and post-treatment therapy. Aetna rehab coverage helps users remain clean after ending active rehabilitation. It is often critical for success. The company offers coverage for a wide variety of addictions, and in 2012, it launched an opioid addiction treatment program to combat the crisis in the United States. Its policy of opioid coverage is extensive, making it one of the better options on the market.

Aetna Therapy Coverage

A variety of evidence-based approaches to treating alcohol addiction are available. Many people experiencing addiction usually get a combination of methods as not every treatment program works for everyone. Common interventions might include a combination of rehabilitation programs, self-help groups, counseling, and medication. Besides, several therapies are also used for treating substance use disorders. Because all insurance providers nowadays must cover addiction rehab, and the rehabilitation often includes therapies and counseling, it’s logical to conclude that Aetna covers therapy as well, as a part of drug rehab.

Other than Cognitive Behavioral Therapy (CBT) and counseling, many other addiction therapies also exist that help people engage in alcohol and drug abuse treatment. For example, different therapies like eye movement desensitization and reprocessing (EMDR), transcranial magnetic stimulation (TMS), neurofeedback, and biofeedback help individuals change their attitudes around using alcohol and other substances and support other addiction treatments.

Some plans offer Aetna therapy coverage. The Aetna TMS policy is quite extensive, adding it one of the great options in the industry.

According to the Aetna Tms Policy, the Therapy Is Covered Under Its Plans if the Member:

  • is 18 years or older
  • has a confirmed diagnosis of severe major depressive order (single or recurrent episode)
  • has no contraindications to TMS
  • is a candidate for electroconvulsive therapy (ECT)

Depression is a mental condition frequently co-occurring with substance use. The Aetna TMS policy considers TMS re-treatment important for people with depression relapse who have relapsed following TMS despite other recovery treatment approaches and had earlier at least a 50% decrease in depressive symptoms with TMS. In addition, research shows that up to 59% of people with post-traumatic stress disorder (PTSD) subsequently develop SUDs. For the treatment of PTSD, Aetna considers EMDR therapy vital as it helps heal the brain’s information processing system and promotes symptom reduction.

Aetna Drug Rehab Plans: Available Options

Like most insurance companies, this health insurance comes in many forms, allowing the insured to opt for the policy that works best for them. While there are many variables at play, there are three primary types of plans: open access, copay only, and a high deductible.

Open Access Plans

Open Access plans allow the insured to see any doctor or receive recovery treatment at healthcare centers within the Aetna rehab provider network without a referral. It means that if the insured wants to enroll in a rehabilitation center, they need to get some information, select one within the Aetna rehab provider network, and enroll. There is no need to get permission from a primary care physician or another doctor in advance.

Copay Only Plans

With copay-only plans, the insured pays their premiums and must pay a given copay for all treatment. This copay could be a set amount or a percentage of the overall cost of any given Aetna therapy treatment program. However, it eliminates deductibles, making the company insurance more affordable.

Patients paying Aetna copay to the receptionist.

High Deductible Plans

With a high-deductible plan, the insured pays low premium amounts but must cover more of their healthcare expenses out of pocket before Aetna rehab coverage kicks in. While some opt for these plans to save money, it can often cost them more in the long run.

Verify Rehab Coverage To Start Treatment

It is essential to have health insurance as a safety net for those who can’t afford treatment. For individuals struggling with SUDs, health insurance enhances access to the best healthcare services and offers financial protection against high expenses that are relatively unaffordable to some people. Those within Aetna insurance can get their treatment covered in part or in full at a nearby center. Contacting the provider can help one get information on what their program covers. With the right help on the recovery path, living a better and healthy life is possible.

Frequently Asked Questions

Does Aetna Cover Mental Health?

Yes. The significant progress in the medical field has helped the community recognize that addiction and mental illness are closely associated, both of which need treatment to encourage long-term sobriety. Depending on the insurance plan, the insurance covers many popular mental health treatments, such as EMDR, CBT, and biofeedback.

How Much Does Aetna Cover for Therapy?

The amount of coverage it provides varies based on a person’s insurance plan and chosen therapist. For example, if the therapist is from the network, the therapy may cost between $15-$50 per session after meeting the deductible. But if the therapist is not in-network, the person has to pay the therapist’s full fee at the time of the session.

Does Aetna Cover Counseling?

Yes, there are policies covering treatment and counseling for those who struggle with substance use disorder and co-occurring mental health problems. However, coverage may differ from patient to patient and depends on a specific plan and location.

Does Aetna Cover Suboxone?

Yes, the coverage for Suboxone treatment is provided. The amount it contributes to paying for Suboxone will differ based on an individual insurance plan. There are generally co-payments for every prescription. Some plans may cover different types of Suboxone like the generic instead of the brand name.

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Page Sources

  1. Lipari, R. N., Park-Lee, E., & Van Horn, S. (2016). America's need for and receipt of substance use treatment in 2015. The CBHSQ report. https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html
  2. Gorelick, D. A., Zangen, A., & George, M. S. (2014). Transcranial magnetic stimulation in the treatment of substance addiction. Annals of the New York Academy of Sciences, 1327(1), 79–93. https://pubmed.ncbi.nlm.nih.gov/25069523/
  3. Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and anxiety, 27(12), 1077–1086. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/
  4. Every-Palmer, S., Flewett, T., Dean, S., Hansby, O., Colman, A., Weatherall, M., & Bell, E. (2019). Eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder in adults with serious mental illness within forensic and rehabilitation services: a study protocol for a randomized controlled trial. Trials, 20(1), 642. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868700/

Published on: October 2nd, 2019

Updated on: March 27th, 2024

About Author

Isaak Stotts, LP

Isaak Stotts is an in-house medical writer in AddictionResource. Isaak learned addiction psychology at Aspen University and got a Master's Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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