Aetna Drug & Alcohol Rehab Coverage in Ohio

Will Aetna Pay For Rehab?

Generally, yes, Aetna will pay at least a portion of drug and alcohol rehab. Any out-of-pocket costs will depend on the specifics of your policy. Most members can expect co-pays, deductibles, or co-insurance.

If your annual deductible is already satisfied, then addiction treatment could be completely covered by Aetna – even 30 to 45-day inpatient rehab.

The type of services covered by Aetna will also depend on the severity of your substance use disorder. For example, Aetna may not approve a claim for medical detox if it is not medically indicated. However, they may approve residential treatment or outpatient services instead.

The best way to understand if you qualify for addiction treatment and what your policy will cover is to contact us for an assessment. Alternatively, you could contact Aetna directly.

Types of Aetna Plans

Like other providers, Aetna has various plan types that will affect your upfront costs for addiction treatment and which providers you may choose. Aetna plans include:

Aetna HMO

A popular Aetna plan, a health maintenance organization, or HMO, carries coinsurance in exchange for lower premiums and deductibles. Co-insurance means Aetna will cover a percentage of addiction treatment after your deductible is met, and you will be responsible for the other percentage, until your out-of-pocket maximum is met for the year. 

With an HMO plan, you must choose a facility that is in-network with Aetna.

Example: Julie has an HMO plan with a $1,000 deductible and $4,000 out-of-pocket maximum. After she pays her $1,000 deductible, Aetna agrees to pay for 80% of her addiction treatment. Julie is responsible for the other 20%, however, not to exceed her annual out-of-pocket maximum of $4,000. Any amount over her annual out-of-pocket maximum of $4,000, Aetna will cover.

We encourage you to reach out to us if you are concerned about out-of-pocket costs. We understand ability to pay is often a barrier to addiction treatment and we may be able to offer payment plans and other programs to assist with out-of-pocket costs. You can reach one of our specialists at 800-481-8457

Aetna POS

A point of service plan, or POS, is similar to an HMO plan, but it offers out-of-network benefits with a referral. That means Aetna will help cover treatment with out-of-network facilities, but it will still carry higher out-of-pocket costs compared to in-network providers.

Aetna PPO

Aetna’s preferred provider organization, or PPO, is another popular plan that offers increased coverage for out-of-network providers and specialists without a referral. However, like other Aetna plans, in-network facilities will carry much lower out-of-pocket costs.

Aetna EPO

An exclusive provider organization, or EPO, is a less common Aetna plan. Like HMO, EPO plans only offer coverage for in-network providers. However, EPO plans have a larger network than HMO.

Aetna Coverage For Medical Detox

Our central Ohio detox center is in-network with all Aetna plan types. Medical detox is an intensive level of inpatient care to manage drug or alcohol withdrawal. Aetna does offer coverage for medical detox, but it will depend on the severity of your substance use. Typically, Aetna offers coverage when chemical dependency is possible or present. Aetna will typically cover:

• Alcohol detox
• Heroin or Prescription Opiate Detox
• Fentanyl Detox
• Benzodiazepine detox, such as Ativan or Xanax

If medical detox is not medically appropriate, Aetna may instead cover another level of care. 

Residential Rehab That Accepts Aetna

OARC offers in-network 30-45 day residential rehab for various substance use disorders. Residential rehab is an intensive level of care that includes individual therapy, group therapy, education, relapse prevention, aftercare planning, and more. Residential treatment aims to address the underlying causes of substance use disorders and prevent recurrence. 

For some substances, such as cocaine or other stimulants, Aetna may not approve detox, but still approve residential treatment.

Aetna Outpatient Coverage at OARC

We also have various outpatient programs that are in-network with Aetna. These include:

Partial Hospitalization (PHP): PHP is similar to residential treatment. The only difference is clients do not sleep at the facility. Instead, they reside at home or in a sober living home and return to treatment during the day to engage in the same therapies as residential treatment. PHP can offer a more budget friendly approach to a similar quality of care as residential treatment. However, residential treatment is preferred due to increased accountability and separation of temptations or triggers.

Intensive Outpatient (IOP): At Ohio Addiction Recovery Center, IOP is a level of aftercare, meaning most clients first complete residential treatment or PHP before starting IOP. IOP meets in the evenings, allowing clients to transition into work or school during the day, while still engaging in addiction treatment programming and support.

Aetna Mental Health Coverage

OARC is a dual diagnosis facility, which means we also treat co-occurring mental health disorders. Aetna also offers coverage for psychiatry which is also in-network in our program.

Understanding Your Aetna Coverage at OARC

We understand insurance can be confusing and overwhelming. We strive to offer clarity and transparency as it relates to addiction treatment healthcare costs. Whether you choose to go to treatment or not, we would be happy to verify your policy and let you know what types of costs may be associated with addiction treatment. You can reach us at 800-481-8457 or use our instant chat to verify your policy.

Aetna Care Advocates

Aetna also offers Aetna Care Advocates for addiction treatment. Aetna Care Advocates can help arrange a full continuum of care and provide other recovery resources.