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Does Cigna Cover Rehab for Drugs and Alcohol?
Cigna is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. It covers some or all of the cost of rehabilitation for drug and alcohol addiction.
Cigna service more than 86 million customers around the world, including those who struggle with alcohol and substance use disorders, as well as co-occurring mental health issues.
Addiction treatment coverage is available at a variety of facilities that provide varying levels of care. Many of these organizations also provide support for people with dual diagnoses or co-occurring mental health issues that may be linked to addiction.
Coverage varies depending on your plan but usually includes:
- Drug rehabilitation
- Alcohol rehabilitation
- Counseling for addiction treatment
Cigna Insurance Plans for Rehab
Benefits and coverage for addiction treatment vary from one plan to another.
Cigna’s bronze plan has less expensive premiums than more comprehensive plans. With the bronze plan, though, you’ll pay a higher deductible and have more out-of-pocket expenses.
Silver, gold, and platinum plans offer more comprehensive coverage, but monthly premiums increase based on the extent of coverage. Cigna coverage for addiction treatment also varies by state.
Cigna provides coverage for addiction treatment from in-network and out-of-network providers. In some cases, the cost of out-of-network care is completely out-of-pocket. This means you’ll pay the entire cost of treatment if the provider you choose is not within Cigna’s network of approved providers.
Keep in mind: Treatment coverage from out-of-network providers requires precertification. Cigna reviews requests for out-of-network treatment based on nationally recognized guidelines. Precertification is based on your plan.
Types of Addictions Cigna Covers
Cigna provides treatment coverage for a variety of addictions, including:
- Prescription opioids
- Prescription stimulants
- Sedatives and sleep aids
- Various other drugs
What Rehab Services Does Cigna Cover?
Cigna also offers coverage for a variety of rehabilitation services, including:
Depending on the Cigna plan, coverage varies for inpatient treatment:
Bronze plans pay 60 percent and you pay 40 percent.
Silver plans pay 70 percent and you pay 30 percent.
Gold plans pay 80 percent and you pay 20 percent.
Platinum plans pay 90 percent and you pay 10 percent.1
Inpatient programs offer comprehensive support for dealing with substance abuse and addiction. Their around-the-clock care and supervision is especially helpful for people dealing with addiction linked to mental health disorders.
Cigna plans cover most outpatient substance abuse treatment programs, including:
- Substance and drug detox
- Addiction medication management
- Individual, family, and group therapy programs
- Intensive outpatient treatment
- Anti-craving medication management
- Mental health support
Depending on the Cigna plan, coverage varies for outpatient treatment:
Bronze plans have a coinsurance amount of 0-50% for in-network treatment providers, meaning that the covered individual will be responsible for 50-100% of the allowed costs.
Silver plans require coinsurance for some plans, while others require only a copay per visit to in-network treatment providers.
Gold plans sometimes require a small coinsurance percentage of co-pay for in-network treatment.
Platinum plans require minimal coinsurance or co-pays for in-network providers.
Some plans offer out-of-network coverage but typically charge higher coinsurance rates.
Medical detox is the first step in treating substance abuse. It’s also when risk of relapse is the highest. Sometimes it requires prescription medication.
Cigna offers coverage for prescription medications used to treat drug and alcohol addiction. This coverage is available for those in inpatient and outpatient treatment.
Coverage of addiction medications prescribed by a doctor is usually available even if someone is not participating in a formal treatment program.
Intensive Outpatient Programs (IOPs)
Cigna offers coverage for intensive outpatient programs (IOP). The amount of coverage varies based on the level of someone’s plan (bronze, silver, gold, or platinum).
IOPs usually meet 3 days a week for 10 to 20 hours. Intensive outpatient treatment programs range from 1 to 3 months and usually include both individual and group counseling.
Partial Hospitalization Programs (PHPs)
Partial hospitalization programs (PHPs) combine inpatient and outpatient care. They typically meet 5 days a week for most of the day. Participants live at home but spend a significant amount of time in the program.
Coverage for care at these treatment centers varies based on their plan.
How to Check Your Cigna Coverage
There are 2 ways to check your Cigna coverage:
1. Contact Your Treatment Facility
If you’ve chosen a rehab facility, the staff can help you determine what coverage is available and how much, if any, you’ll owe for treatment.
2. Contact Cigna
If you haven’t chosen a facility, or you’d rather speak directly to your insurance provider, contact Cigna directly. They can give you information about your policy and provide you with treatment resources in your community.
Many Cigna plans have deductibles, copays, coinsurance, or a combination of these.
What is a deductible?
A deductible is the amount the customer must pay for covered services before the insurance provider begins to pay any expenses.
For example, if your drug and alcohol addiction treatment costs $10,000 and you have a $1,000 deductible, you’ll pay the first $1,000, and Cigna will cover their portion of the remaining $9,000 owed to the treatment facility, depending on your coinsurance rate and the allowed cost.
What is a co-pay?
A co-pay is a set amount a customer pays for a covered service before and after they’ve met the deductible obligation.
For example, you might pay $10 out-of-pocket when you go to the doctor, and Cigna covers their portion of the remaining allowed charges once you meet your deductible.
What is coinsurance?
Coinsurance is the percentage of a covered service you pay before and after you’ve met your deductible.
For example, if your coinsurance is 20 percent, you’ll pay 20 percent of the cost of all medical care, in addition to your deductible and co-pay.
In addition to understanding your out-of-pocket payment obligations, it’s also important to determine if you need pre-authorization for care. In some cases, you’ll need Cigna to approve a service and/or service provider to guarantee coverage.
Paying for Uncovered Rehab Costs
In many cases, insurance doesn’t cover the entire cost of substance abuse treatment. People struggling to pay out-of-pocket costs shouldn’t give up. There are resources and support available to help you.
Remember: The cost of continuing an addiction may be many times that of a successful substance abuse treatment program.
In some cases, your treatment provider can help you find ways to cover the gap between insurance coverage and what you owe. Some facilities offer grants or scholarship programs. Others provide payment plan options that stretch payments over time.
Additionally, most substance abuse rehab facilities for addiction treatment accept credit card payments. This way, you don’t need to pay cash upfront for your treatment.
Keep in mind that inpatient treatment programs cost more than outpatient programs. If you’re unable to afford a residential problem for substance abuse, consider an outpatient program.
Nobody should have to back out of addiction treatment or choose an unsuitable program due to financial concerns. Support staff at your chosen substance abuse rehab facility can help determine the best way to proceed.