Aetna Opiates Rehab and Opiod Detox Coverage

By Admin User, January 18, 2016.

Aetna Opiates Rehab and Opioid Detox Coverage

On Jan. 1, 2014, the Affordable Care Act (ACA) added substance abuse and mental health care to the list of essential health benefits; therefore, all small business and individual plans are required to offer coverage for these conditions.

All health insurance policies sold on the open exchange, including Aetna, are required to provide some degree of coverage for drug and alcohol dependence. This coverage must include benefits for drug detoxification services.

Opiates Rehabilitation and Opioid Detoxification Coverage is Included in Aetna’s Health Plans

Aetna does not offer a specific plan for addiction treatment; however, each of the health insurance plans Aetna offers includes this benefit. Aetna classifies drug and alcohol addiction as a medical illness; hence, if treatment is deemed medically necessary, many of a client’s rehabilitation and detoxification costs should be offset through his or her health insurance plan.

Opiates Rehab and Opioid Detox Coverage  –  Determining Medical Necessity

Although the ACA requires insurance providers to cover substance abuse treatment services, each insurance provider has the right to make sure that they are paying for services that are considered a medical necessity. Therefore, patients seeking coverage for opiate rehabilitation and opioid detoxification must request that their physician provides Aetna with documentation stating that addiction treatment is medically necessary.

Aetna Follows the American Society of Addiction Medicine (ASAM) Guidelines

According to Susan Millerick, who is Aetna’s spokeswoman, the company follows the guidelines set forth by the ASAM: Aetna uses these guidelines as a means to determine what kind of detoxification is suitable, as well as the length of time a client needs to receive care for substance abuse.

There are inpatient and outpatient drug detox programs available. Inpatient care is more expensive, which is why insurance companies lean towards outpatient drug detoxification programs. However, if inpatient care is proven to be medically necessary, Aetna covers a portion of these charges: Each determination is made on a case-by-case basis.

Coverage Amounts Vary

The only way a client can determine the amount of coverage he or she has is to review his or her Aetna health insurance policy or contact an Aetna representative.

How to Find a Substance Abuse Treatment Center

To simplify the process of finding a rehab and detox treatment center that accepts Aetna, the company provides its clients with a directory of substance abuse facilities.