Aetna, Inc. is an American-based handled healthcare business that was founded in 1853. The business came down from the Aetna Fire Insurance Company of Hartford, Connecticut, which got its name from Mount Etna, an active volcano in Europe.
The company markets standard and consumer-directed health care insurance coverage strategies and other services, such as pharmaceutical, dental, and special needs strategies. The business provides coverage to over 20 million Americans and has nearly 50,000 staff members. Although Aetna abides by legislation under the Affordable Care Act, it has withdrawn the majority of its participation in the Marketplace.
Treatment Programs for Drug Abuse: What Does Aetna Cover?
Aetna uses medical insurance choices in a number of states, however the level to which your strategy covers drug abuse treatment programs will vary. Whether your Aetna strategy covers treatment programs will depend upon your state’s regulations and whether you have employer supplied insurance or a private strategy. For employer provided insurance strategies, federal regulations may affect the level of coverage your strategy attends to mental health and addiction treatment.
Whether or not your strategy covers substance abuse treatment programs, you will most likely requirement to get your treatment and treatment services approved prior to registering in a program. Knowing what services are covered and how to get pre-approval can be tough, so your best option is to deal with an experienced substance abuse treatment professional or center. A professional can ensure that documentation is submitted appropriately and develop a treatment program that will fit your requirements and finances.
- Admission to an inpatient or residential Aetna approved drug rehab
- Partial hospitalization treatment (treatment happens in a healthcare facility setting however the patient is not housed in the hospital).
- Extensive outpatient treatment.
- Outpatient withdrawal management programs.
- Any mental tests for evaluation purposes.
- Biofeedback (e.g., neurofeedback).
- In-home psychiatric services.
Aetna drug rehab coverage covers expenditures associated with treatment services administered by in-network companies (those in the Aetna network of treatment suppliers) and suppliers that are outside the network. However, people need to think about using in-network companies as the coverage is much more substantial. For example, Aetna will frequently cover up to 80-90 percent of the charges incurred with suppliers within their network, whereas they are most likely to cover just 60 percent or less of charges sustained from out-of-network service providers. In addition, in-network suppliers are usually less expensive than out-of-network service providers, making the savings a lot more remarkable as an outcome of copays.
How Protection for Substance Use Disorder Treatment Is Determined
The services covered by Aetna and the amount of coverage used are determined by many aspects, such as:
- The medical necessity of the treatment: Medical necessity refers to the treatment being needed for the specific condition as opposed to it being chosen by a physician or client. Insurer have guidelines to determine the medical requirement of particular treatments. For example, inpatient withdrawal management services would most likely not be approved for someone who abuses marijuana products other than under very severe conditions or scenarios, whereas an individual who abuses opiate drugs would be far more likely to have the services approved. While insurer have particular guidelines to determine the medical requirement of specific treatments for specific kinds of conditions, a well-written recommendation from a physician can also add to specific services being labeled as medically required for an individual.
- Empirical evidence: Treatments that have empirical evidence to support their success in dealing with a particular condition are more likely to be covered. Empirical evidence describes research findings.
- Suitability for dealing with the condition in concern: This especially uses to medications. Medications utilized throughout medical management for people with compound use conditions will often just be covered if the medications are created to deal with concerns with drug abuse. Typically, insurance provider depends on reputable research study findings to identify this. Medications utilized on an off-label basis are less likely to be covered.
Aetna provides substantial coverage for drug use condition treatment, including attending a Aetna drug rehab facilities including inpatient and outpatient rehab. According to information from its site, the company suggests that policyholders get in touch with a customer agent to talk about substance usage disorder treatment. Members have assistance 7 days a week, 24 hours a day, and support personnel can help customers discover a specific rehab center or physician.