Can I Expect Aetna to Cover My Opioid Rehab?

Edited by: Editorial Staff
Last updated on June 13, 2022

Opioids are substances that are used to reduce or relieve strong and chronic pain. According to the Institute of Medicine, almost 100 million Americans suffer from chronic pain in their everyday lives.1 Opioids are considered safe if used according to doctor’s instructions for a certain amount of time, but they can also produce euphoric effects which makes them a potential target for misuse.2

Treatment of mental health issues like opioid addiction is considered as one of essential health benefits that must be covered by all healthcare plans that are sold on the Marketplace. If your doctor assesses that you need opioid rehab you will be covered by your Aetna healthcare plan.3

With Aetna nationwide coverage you won’t have a yearly or lifetime dollar limit or be charged more for rehab if you suffer from a pre-existing condition. You can also count on Aetna mental health coverage to provide parity between your addiction treatment services and medical or surgical benefits.4

Parity protections will extend to:4

  • Financial limits including, copays, coinsurance, and out-of-pocket maximums.
  • Treatment service limits, meaning the number of inpatient days or outpatient visits covered.

aetna substance abuse providers and drug treatment programs

What Does Aetna Mental Health Coverage Include for Opioid Treatment?

Opioid epidemic has become a serious national crisis with number opioid deaths spiking significantly in 2020 to almost 69,000 lives from the previous number of 46,800 thousand in 2018.5 Even though deaths from illicit street drug heroin are falling since 2016, this alarming rise is mostly the result of an ever increasing popularity of very deadly opioid fentanyl.5

Opioid addiction can be treated with an appropriate rehab plan but it’s important to remember that each case of substance abuse is different and needs an individually tailored approach. For this reason, various treatment approaches have been developed over time to treat different types and stages of substance addiction.6

With Aetna rehab coverage you will have the option to choose which treatment approach best suits your medical needs, including:7

Aetna mental health coverage will also include screenings and early interventions which are used by the doctors as a tool for spotting possible problems before the addiction fully develops or even before the first symptoms start appearing.8

Which Aspects of Opioid Rehab Aetna Insurance Doesn’t Include?

Elements that are usually not part of Aetna rehab coverage are those benefits and services that aren’t considered a necessary part of addiction recovery procedure. These are usually treatment techniques that have not been proven to constitute safe or mandatory part of rehabilitation recovery.9

In practice, this means that Aetna usually won’t provide coverage for:9

  • Non-medical amenities.
  • Holistic care services.
  • Alternative medicine and therapeutic approaches.
  • Recreational programs.
  • Personal comfort items.

Keep in mind that states reserve the right to decide which benefits will be deemed mandatory so they might differ from state to state. Certain individual plans might provide coverage for some of these things, so if you want to find out more call the number on the back of your Aetna insurance card or call a helpline dedicated to opioid related issues and get all the relevant answers.3

How Much Does Aetna Opioid Rehab Cost?

The costs of Aetna addiction treatment, including opioids, is not easy to determine upfront because there are many factors which influence the overall price of rehabilitation. First thing to remember is that costs of rehab tend to depend on the type of Aetna healthcare plan that you have since not all plans offer the same level of coverage.10

As was mentioned before, the state in which rehab is taking place might influence the costs since states have their laws that regulate health insurance benefits.3 The type of opioid that individual is hooked on can also be a factor because treatment for heroin is not the same as treatment for some synthetic opioids like codeine or oxycodone.10

Other important factors that will have an impact on the overall costs of opioid addiction rehab are:10

  • The type of inpatient drug rehab center in which treatment is taking place since there are different types of inpatient facilities. From those that offer high class luxury and executive rehabs to those whose offer is more basic.
  • Amenities that are offered and used in treatment, including private rooms or television and Wi-Fi access.
  • Intensity of services that are offered during treatment because milder cases might not need the same level of care as severe addicts.
  • Duration of treatment is a major factor since rehab which lasts a month will obviously be less expensive than the ones which last for a couple of months or even years.
  • Type of treatment that is administered, since rehab approaches differ and have their unique characteristics.

How Much Does Inpatient Opioid Rehab Cost?

Inpatient opioid rehab is a type of treatment which takes place inside a specialized addiction recovery facility making it more expensive than other forms of treatment. For this reason, inpatient rehab is a very intensive program which aims to get the most out of treatment during patient’s stay in the facility.7

Duration of treatment will play a great part in determining the cost of inpatient rehab since standard 28-30-day rehab programs cost less than longer ones which last 60 days or more.10 Nationwide inpatient rehab centers will greatly vary in cost since certain addiction centers might be located in a resort like surroundings or have many luxurious amenities, including a lobby “like that of a five-star hotel”.11

Type of treatment received will also influence the cost of rehab because certain patients might go through a quick 1 or 2 week opioid detox before continuing with a follow-up outpatient program, while others might need different types of treatment in case of persistent co-occurring disorders which take longer to treat.6

How Much Does Aetna Outpatient Opioid Rehab Cost?

Outpatient rehab is a very adaptable and popular form of addiction treatment because many people can’t afford the time off work or the costs associated with inpatient rehab. Costs of outpatient rehab will vary since it can take place in many different settings including offices, clinics, school-based and primary care clinics, and facilities offering additional treatment for various mental health programs.12

Outpatient rehabs can be adjusted in terms of its intensity. They can offer counseling and less than 9 hours of sessions per week, or in case of intensive outpatient programs (IOP) for more severe cases up to 30 hours per week.12 Outpatient rehab can also serve as a continuum of care service for those individuals that completed inpatient drug rehabs and are now being slowly integrated through mutual-help and support groups.13

How Much Do Opioid Partial Hospitalization Programs (PHP) Cost?

Partial Hospitalization programs could be described as having an intensity of inpatient rehab with patients sleeping in their homes just like in outpatient drug treatment programs. They are more intense than IOP since they involve daily sessions of at least 30 hours per week and in some cases even 50 hours with patients spending practically their entire day in a rehab facility.13

This makes PHP an ideal fit for those who need inpatient intensity and level of care but just can’t commit to spending their nights in a hospital due to their work situation. For this reason PHP is sometimes called day treatment or full-day outpatient rehab. PHP is a good option for people who have a stable and supportive home environment that is void of triggers and negative influences from peers as well as those who can be counted on to keep regular attendance.13

How Much Does Medication-Assisted Treatment (MAT) Cost?

Opioid addiction can be a hard problem to shake off resulting in multiple attempts at treatment and painful withdrawal symptoms and relapse episodes.14 Medication-assisted treatment combines several FDA approved medications in combination with proven behavioral treatments to provide a full recovery from opioid addiction. For treatment of opioid addiction FDA tested and approved 3 substances:15

  • Buprenorphine.
  • Methadone.
  • Naltrexone.

Medication used in MAT can reduce both opioid related criminal activity and recidivism, and the rate of opioid overdose mortality.15 MAT can simultaneously improve individual’s occupational and social functioning making them able to function in their everyday home and work environment as a contributing members of the community.16

Will Opioid Rehab Cost Less Than Opioid Addiction?

Opioid addiction is becoming a significant drain on US finances with the economic costs of opioid addiction totaling more than a trillion dollars just for the year 2017.Costs varied significantly between different states, ranging from less than a billion for the state of Wyoming to a staggering 72.5 billion for the state of Ohio.17

Personal expenditure also varies between the states amounting to just over 12 hundred dollars per capita in Hawaii to more than 72 hundred dollars for every resident of West Virginia.17 According to some research, substance abuse treatment costs 1500 dollars on average resulting in a monetary benefit to society of nearly 12,000 dollars, producing a benefit to cost ratio greater than 7:1.18

In addition to the loss of income and potential future earnings which persons who suffer from opioid misuse have to pay, there are the costs of resulting health problems and the costs of maintaining opioid addiction itself which demands constant expenditure on addictive substances that are misused.18

What Length of Opioid Rehab Does Aetna Cover?

Opioid addiction is a complex and persistent mental health issue that causes modification in the way the brain functions, altering people’s behavior and habits. These changes in the brain remain even after a person achieves sobriety. For this reason individuals carry the risk of relapsing long after they stop using opioids.6

Ample research shows that entering into treatment as soon as possible is only matched by the need to remain in treatment as long as necessary as the most important principle of successful recovery from opioid addiction.6 Most individuals need at least 3 months of treatment to substantially reduce or entirely eliminate opioid use.6

But every case of opioid addiction is a different story and the treatment that works for one person might not yield the same results in case of another.6 For this reason Aetna offers a variety of insurance policies giving people the option to match their specific medical needs with an appropriate healthcare plan.

If you want to enquire about the details of your Aetna nationwide coverage, call the number on the back of your Aetna insurance card.

Should I Choose Aetna Inpatient or Outpatient Opioid Rehab?

If opioid addiction that you, or someone you know closely is suffering from is not so severe to make everyday life unlivable, then outpatient rehab might be the best choice. This also holds for people who are able to maintain regular appointments, motivate themselves to remain in treatment as long as needed, and avoid company of people who might encourage wrong kind of habits and behavior.7

But, if opioid misuse is starting to impact your day-to-day functioning in a negative way, you should consider inpatient rehab before things get worse. Since patients spend their days and nights in a medical facility their progress is constantly monitored by medical professionals.10 Doctors and hospital staff can assess your situation on a daily basis adjusting the treatment according to your developing needs and recovery progress.6

Inpatient rehabs offer a treatment ecosystem that is based on a structured program with a daily schedule that fosters accountability and develops responsibility.7 They also provide a focused environment that combines support groups and individual therapies.6 For all these reasons dedicated inpatient rehab facilities offer the greatest quality of care and represent the best option for severe and chronic opioid addicts.10

How to Use Aetna Insurance for Opioid Rehab?

First step on the way to opioid rehab is through a consultation with a doctor. Doctor is authorized to assess your mental health situation and recommend a suitable treatment to adequately address your personal needs.6

After you’ve finished with a doctor’s appointment, you can start looking into American Addiction Centers (AAC) nationwide selection of rehabilitation facilities which offer different types of Aetna mental health and addiction treatment programs and find the one that best matches your preferences.

What’s the Easiest Way to Find Opioid Rehabs That Accept Aetna Insurance?

Aetna runs a 24/7 helpline that is reserved for opioid addiction issues. Because this is a touchy subject that deals with illicit substances and potential criminal activity, you won’t have to worry about being open and honest since all calls are 100% confidential and private.6

AAC’s professional admissions team will help you determine your ability to use insurance for the treatment of your choice. You can also count on them to help you in determining the extent of Aetna nationwide coverage, the details concerning your benefits, potential alternative payment options, or various state funded grants if you have trouble with payments.

The admissions team is composed of people who truly understand and sympathize with your predicament since many of them suffered from addiction issues before completing recovery and taking back control over their lives.AAC partnership with Aetna insurance means you’ll have the option to select an in-network opioid treatment in one of their top-notch substance abuse treatment facilities. AAC’s nationwide network of inpatient drug rehab centers is the largest in the US and located in virtually every corner of the country in a variety of soothing and easily accessible locations.

 

 

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