Aetna Insurance Coverage for Drug and Alcohol Rehab Treatment (2024)

Does Aetna Insurance Cover Drug or Alcohol Rehab?

Aetna drug rehab coverage depends on a member’s particular Aetna health plan and the addiction treatment provider they choose. There are many rehab centers that take Aetna insurance, including American Addiction Centers’ Recovery First Treatment Center in Hollywood, Florida; River Oaks Treatment Center outside of Tampa; Oxford Treatment Center in Etta, Mississippi; Greenhouse Treatment Center in the Dallas-Fort Worth area of Texas; and Desert Hope Treatment Center in Las Vegas. At AAC, we are in-network with Aetna health insurance and offer different levels of care for those with substance misuse issues and addiction. We are in-network with many insurance companies, including Aetna, which means that your addiction treatment could be covered fully or partially depending on your policy.

Does Aetna Cover Mental Health and Substance Abuse Treatment?

To learn more about your Aetna substance use and mental health coverage,you can access the online program that allows you to view your coverage details, make claims, search for providers, and much more.6

Simply logging in gives you access to a wide variety of resources for Aetna users. You can also visit the Find a Doctorportion of their website to search for providers.7 You can find information on all types of providers there, including professionals and centers that treat substance misuse and substance addiction.

For mental and behavioral health problems,you are given access to psychiatrists, psychologists, counselors, therapists, social workers, psychiatric nurse practitioners, and primary care doctors.8 In many cases, mental health problems can co-occur with substance use, so it is important to address mental health concerns if you are seeking care for substance misuse and addiction.

Use the search form below to find out if substance addiction treatment is covered by your insurance with us.

Does Aetna Cover Outpatient Rehab?

Outpatient treatment includes a range of services and care levels based on the American Society of Addiction Medicine’s (ASAM) continuum of care. Basic outpatient services are level 1 within ASAM’s levels of care, which range from .5 to 4. However, level 2 (including 2.1 and 2.5) is also considered outpatient services, and these levels include intensive outpatient programs (IOPs) as well as partial hospitalization programs (PHPs).10

With traditional outpatient rehab, patients stay in their own residences but attend individual and group treatment sessions at a healthcare, mental health, or treatment facility. Level 1 treatment typically involves fewer than 9 hours of services per week.11

With IOPs, services are similar to Level 1 outpatient services, but they’re on a more intense scale.12 Again, patients live at home and attend treatment during the day, in the evenings, or on the weekends at a treatment facility. PHPs, on the other hand, are often considered the midway point between inpatient and outpatient care.13 They provide slightly less-intenstive care than an inpatient rehab, but higher levels of care than a traditional outpatient program.14

Thanks to the Affordable Care Act (ACA), all health insurance coverage (exceptgrandfathered plans) must offer substance use disorder and mental health services. Plus, any plan purchased through the HealthCare.gov Marketplace can’t have a cap on the amount of substance use or mental health treatment covered.15

As such Aetna plans provide coverage for substance use disorders. However, the scope of that coverage is dependent on the specific plan you have as well as whether your chosen provider is in-network or out-of-network with Aetna.

American Addiction Centers’ various facilities offer a host of outpatient services, ranging from detox and inpatient treatment to the aforementioned outpatient care, PHP, and IOP services. Specific facilities provide aftercare options as well.

When it comes to Aetna IOP coverage and Aetna’s outpatient drug rehab coverage, the best way to determine how much you’ll pay is to contact Aetna directly or reach out to us at and allow us to verify your insurance benefits for you.

Does Aetna Cover Therapy?

Aetna and other insurance companies typically cover individual therapy, such as cognitive-behavioral therapy (CBT) for substance use disorders. The amount of coverage depends on a person’s specific health insurance plan and their chosen therapist.

How to Check Aetna Rehab Coverage

Aetna health insurance has many different insurance plans with different levels of coverage. Depending on your plan, your addiction treatment could be covered. AAC has facilities across the country, offering different levels of care. To learn more about AAC’s rehabilitation options and Aetna addiction treatment coverage, give us a call at Or you can verify your insurance by filling out the form below.

Aetna Insurance Coverage for Drug and Alcohol Rehab Treatment (2024)

FAQs

Are insurance companies required to offer the same level of service for addiction as they do other diseases? ›

California's Mental Health Parity Act, as amended in 2020, requires all state-regulated commercial health plans and insurers to provide full coverage for the treatment of all mental health conditions and substance use disorders.

Is addiction covered under the ADA? ›

The ADA ensures that people with disabilities, including people with addiction to alcohol have the same rights and opportunities as everyone else. These protections also apply to people who experience prescription drug use disorder and opioid use disorder.

Does rehab affect life insurance? ›

The longer you've been sober, the more affordable your rates will be. Recovering alcoholics usually have to wait three years after their last drink to be approved for most term and whole life insurance options. Proving that you've received treatment or counseling may help you get cheaper premiums.

Why do insurance companies deny rehab? ›

Common reasons for denials include the insurance company deeming the treatment as lacking medical necessity, utilizing out-of-network providers, or encountering incomplete documentation.

Is alcoholism considered a pre-existing condition? ›

Under the ACA, alcohol and other drug addiction is not considered a pre-existing condition and treatment for it cannot be denied.

Is alcoholism a protected disability? ›

Alcohol use disorder (AUD) is considered a disability under the ADA when someone can no longer do major life activities because of long-term, heavy alcohol use. This means the ADA protects people with AUD against any discrimination that may happen ― from organizations or employers, for example ― because of their AUD.

Is alcoholism classed as a disability? ›

Whilst addiction itself isn't a disability, impairment caused through alcoholism or substance abuse can be classed as a disability. For example, if drug or alcohol abuse causes a co-occurring mental health impairment, or results in organ failure, a disability may be diagnosed.

What is the difference between rehab act and ADA? ›

The ADA is broader than the Rehab Act, however, in that is applies to disabilities in public services, places of public accommodation—such as restaurants, hotels, and theaters—and also requires employers to make reasonable accommodations to allow employees with disabilities to do their jobs.

Does alcoholism void life insurance? ›

Yes, alcohol consumption can affect whether a life insurance policy is paid, or whether an applicant for insurance can get coverage. If an insured discloses on their initial application for life insurance that they use alcohol, the insurance adjuster will take that into consideration when writing the policy.

Can insurance refuse to pay if you were drunk? ›

In most cases, the driver's insurance company is responsible for paying the claim of an accident victim, even if the driver was intoxicated or drugged at the time of the crash. However, you must prove the drunk driver caused the DUI accident before you can recover any compensation for your damages.

How long do you have to be sober to get life insurance? ›

Insurance companies that accept policyholders with a drug or alcohol abuse background typically require two to three years of sobriety without a relapse.

How do insurance companies decide which drugs to cover? ›

In practice, insurers use an internal committee or group, often called a pharmacy and therapeutics committee, to review formulary changes. According to the Insurance Department, these committees typically meet quarterly to review new drugs and, if the drugs are to be covered, determine the drugs' formulary tiers.

Why does insurance not cover some drugs? ›

In some cases, certain medications may be excluded from coverage due to their potential misuse or abuse. Formularies often don't cover brand-name or expensive drugs when generic or less expensive medications are available. Each plan's formulary is different, so it's important to check with your insurance provider.

What is a substance abuse policy? ›

A Substance Abuse Policy is a document that outlines the expectations and consequences for employees who abuse drugs or alcohol. The policy should include a definition of substance abuse, expectations for employee behavior, and consequences for violating the policy.

Why do insurance companies deny treatment? ›

Denials usually fall into two categories: Technicalities: missing codes or authorizations, claim filing mistakes. Medical: treatment not considered a medical necessity or is considered experimental/investigational.

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