One of the more comprehensive solutions for addicts seeking financial help with rehabilitation efforts is Aetna. Aetna insurance for rehab meets all federal guidelines laid out in the recent Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, which means you will be eligible for coverage that includes rehabilitation. However, your healthcare insurance sponsor can opt-out of such requirements. This could leave you without coverage for substance abuse rehabilitation — unless you’re prepared.
Paying for Rehab with Aetna
Aetna views behavioral health coverage (i.e. coverage of non-physical rehab) as integral to reducing the cost of healthcare insurance overall. Aetna has initiated a program called the Aetna Employee Assistance Program to help identify early stages of mental health decline and intervene with preventative solutions. And because of the MHPAEA, this program will not actually take the place of your rights to get coverage for your own rehab efforts.
The MHPAEA has also made it clear that those seeking coverage for substance abuse or other mental health disorders must be treated similarly to people trying to get coverage for other medical issues, such as a broken arm or eye surgery. As an addict seeking coverage, you will not be restricted as far as cost-sharing or visitation frequency is concerned.
However, your insurance sponsor may not make these benefits available to you.
Determining your Aetna Coverage
Though the MHPAEA makes great strides in helping addicts achieve the insurance coverage they need, it still provides many exceptions wherein a private company can opt-out. If you work for a company that employs between 2 and 50 people, you may not get Aetna insurance for rehab. If you work for a larger company that financially supports its own healthcare plan under Aetna, you also may not get coverage. Other exemptions include: retiree-only health plans, Medicare Supplemental Insurers, and those groups that would incur a 2% first-year increase in cost (though they must eventually become compliant).
Once you’ve determined that your plan sponsor provides substance abuse coverage through Aetna, you can determine what specific instances are covered. As of January, 2011, Aetna has become compliant in all the federally mandated areas of the updated MHPAEA. That means you will get coverage within the six main classifications: inpatient preferred, inpatient non-preferred, outpatient preferred, outpatient non-preferred, emergency, and pharmacy. Depending on your specific plan, your financial obligation will change for each of these classifications.
Aetna considers rehab services that include a professional component but don’t require an overnight stay to be of the outpatient classification. That means there will be a co-pay or co-insurance option available for more than two-thirds of instances you will find yourself in a rehab center.
Generally, rehab coverage falls into HMOs (health maintenance organizations) and PPOs (preferred provider organizations). Both provide you with a network of physicians, specialists, pharmacies and facilities, but an HMO has a few more restrictions and comes at a cheaper rate than a PPO.
Getting Aetna insurance for rehab can be a complicated process, but there is help. Fill out the form to the right of this page to find out what your coverage includes and how to get started with treatment right now.