Aetna Rehab and Cocaine Detox Coverage

By Admin User, January 20, 2016.


Aetna Rehab and Cocaine Detox Coverage

Aetna does offer its members rehab and cocaine detox coverage. The level of coverage a member receives toward cocaine rehabilitation and detoxification expenses depends on his or her specific plan.

In order for a member to be eligible to receive benefits related to substance abuse, his or her physician must determine that treatment is medically necessary. Aetna uses the Screening, Brief Intervention and Referral to Treatment (SBIRT) approach when considering a member’s eligibility for rehab and cocaine detox coverage: SBIRT is a program designed to assist physicians in determining medical necessity.  

The SBIRT Program

1. Screening

Screening involves a quick assessment of the severity of the patient's cocaine use. The physician uses this information to decide which level of care will serve the patient best.

2. Brief Intervention

This step focuses on increasing the patient’s understanding of cocaine use and motivating behavioral changes.

3. Referral to Treatment

Once a physician deems inpatient or outpatient rehab and cocaine detox treatment a medical necessity, Aetna will cover some of the costs related to treating cocaine addiction.    

Aetna’s Coverage Amounts Vary

The amount that Aetna pays toward rehabilitation and cocaine detoxification services depends on the member's plan. A member with a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan receives a higher level of benefits by seeking substance abuse care through an ‘in network’ provider; nevertheless, members who choose to receive rehabilitation and detoxification services from an ‘out of network’ provider are still eligible to receive benefits, just at a lower level (provided their out of network annual deductible is met).

Some of the cocaine addiction services that Aetna covers include:

  • Intensive Outpatient Programs
  • Residential Treatment Centers
  • Inpatient Admissions
  • Outpatient Detoxification
  • Partial Hospitalization Programs

Dual Diagnosis

If a member meets the diagnostic criteria for cocaine addiction, as well as a mental health condition, this is considered a dual diagnosis, also referred to as co-occurring disorders. Some of the health plans that Aetna offers have reasonably good inpatient coverage for its members who have co-occurring disorders.

The Road to Recovery

Since Aetna offers a variety of health plans, there are numerous deductible amounts, copay levels and out of pocket expenses: A member’s specific health plan determines the amount of coverage he or she receives; furthermore, members who are interested in receiving care at a particular facility need to find out if that facility is covered under their plan. If the member's plan is an HMO or PPO, he or she receives the most benefit by choosing an in network provider.

The first thing that Aetna plan members who are in need of substance abuse treatment need to do is obtain a referral from their physician.