In short, yes, Aetna health insurance may cover some or all of the cost of drug and alcohol addiction treatment. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurance companies like Aetna to provide the same level of benefits for addiction and mental health treatment as they do for other types of medical care.
Although Drug and Alcohol Treatment must be covered under MHPAEA, the amount of coverage will depend on your exact plan and if the Treatment Facility is in-network with your insurance.
Lighthouse Recovery is in-network with Aetna health insurance. This means that Lighthouse has a contract with Aetna in which Lighthouse offers Drug and Alcohol Treatment Services (as outlined in Aetna’s insurance health plan) at a lower cost to customers. For the customer, the benefits of choosing treatment at an in-network provider such as Lighthouse (versus an out-on-network facility) can include:
- Discounted rates. In-network providers contract directly with Aetna to provide services at lower costs that are passed on to the patient.
- No “balance-billing.” Clients are not being charged the difference if the bill is higher than the maximum amount that Aetna agrees to pay.
- Lower cost sharing. Out-of-network services (if covered at all) typically result in a higher percentage of costs being owed by the patient as opposed to the insurer.
It is always more cost-effective to seek Drug and Alcohol Treatment at an in-network facility. Furthermore, with some plans, out-of-network services may not be covered at all, meaning the patient would be charged the full amount for services.
The cost for Drug and Alcohol treatment will vary based on the specific care you need and the exact plan you have with Aetna. Some common costs you may encounter include:
- Annual Deductible: The dollar amount you pay before your insurer begins covering costs. After the deductible is met, the plan begins covering some or all of the costs.
- Coinsurance: The portion of medical costs you are responsible for paying after your deductible has been met. For example, if your coinsurance is 20%, you pay 20% of the cost and your insurance pays the other 80% up to the “out-of-pocket limit” (see below).
- Out-of-pocket limit: This is the maximum amount you will pay for medical expenses in a year. This amount includes deductibles, coinsurance, and copays. Once you have reached your out-of-pocket limit, your insurance will pay for any medical costs for the remainder of the year.
- Copayments: A flat fee you pay per session of treatment (per group session for example).
As mentioned previously, your coverage for Drug and Alcohol Treatment will vary depending on your exact Aetna plan. A helpful first step is to verify your benefits, which you can do quickly and confidentially on this page. The information you provide will be sent to our Admissions Department and you will receive a phone call from one of our professionals to further guide you through the process.
At some Substance Abuse Treatment facilities (especially ones out-of-network), you may be required to obtain “prior authorization” (i.e. approval for treatment) by Aetna before starting treatment. At Lighthouse, because we’re an in-network provider, this process is handled for you.