Addiction Treatment in Western Pennsylvania 
Aetna Meaningful Treatment with Dignity

Aetna Insurance for Addiction Treatment in Pennsylvania

Helpful Information for Aetna Customers

If you are suffering from a substance use disorder and need treatment, look into your Aetna insurance plan to find out if you are covered for addiction rehabilitation.

Aetna is a health insurance company that provides medical, pharmaceutical, and other types of managed health care plans. CVS Health moved to purchase Aetna in 2017, a buyout that the press reported would change American health care in the future. The company is presently based in Hartford, Connecticut, with plans to move its headquarters to New York City.

A Little History about Aetna Inc.

Aetna had its beginnings as the Aetna Fire Insurance Company in Hartford, Connecticut. The name of the company was chosen in the 1800s to sound like Mt. Etna, Europe’s active volcano at the time. By the 1850s, Aetna became primarily a life insurance company.

It wasn’t until the 1990s that Aetna became the largest provider of healthcare benefits in America, with 21 million members. Today, they are the country’s third largest health insurance company with 37.9 million subscribers.

Aetna Health Insurance Plans

Many employers offer their workers a health insurance plan with Aetna. There are often some options when opting for an Aetna health insurance plan at work.

Network-Only Plans

With this type of plan, your healthcare is coordinated by your primary care physician and referrals. You can alternatively opt for access to any network healthcare professional or hospital without the need for referrals, as long as you stay within a network of approved healthcare professionals on the Aetna list. The network-only plans can be linked to a health savings account (HSA) and often come with health and wellness offers for discounts on eyewear and gym memberships. These plans are usually less expensive than the network option plans.

Aetna network only plans include:

  • HMO
  • Aetna Select
  • Open Access Aetna Select
  • Elect Choice Open Access
  • Aetna Access Elect Choice
  • Health Network Only

Indemnity Plans

This is Aetna’s most flexible type of health insurance plan, with the freedom to go to any licensed health professional or facility of your choice. There is a deductible and coinsurance payment applied, with wellness and preventive programs available.

Network Option Plans

This type of insurance plan lets members use providers whether they are in or out of network, with or without referrals necessary. These plans are more flexible than the network-only plans, and they can be linked to a health reimbursement account (HRA) or HAS.

Some examples of network option plans at Aetna include:

  • QPOS (Quality Point of Service)
  • Aetna Choice POS II
  • Managed Choice
  • Aetna Open Access Managed Choice
  • Open Choice PPO
  • Health Network Option

Medicare

If you’re retired or on Medicare, Aetna has the Medicare Advantage group plan, with HMO and PPO plans available.

Other options are:

  • Standalone Aetna Medicare Prescription Drug (PDP) Plan
  • Aetna Supplemental Retiree Medical Plan
  • Aetna Traditional Choice Plan
  • Pre-65 Early Retirees (not yet eligible for Medicare)

Addiction Treatment Options

If you or a loved one needs to enter an addiction recovery facility and Aetna is your insurance provider, it’s important to find out what is covered during your residential stay. If Aetna is your insurance carrier, you may be pleasantly surprised to learn that this company generally does cover some of the costs of addiction treatment.

The types of treatment for addiction recovery noted by Aetna include:

  1. Detoxification: Weaning someone off substance use when a physical dependency is in place sometimes causes severe withdrawal symptoms. During the detox phase of recovery, clients are often given medications to ease the pain of withdrawal. Aetna bases the need for a client’s admission as an inpatient upon the length and severity of their substance use. The client’s physical and mental conditions and medical risk factors are also considered.
  2. Residential Rehabilitation: A chemical dependency program in a medical or psychiatric hospital, or in an alcohol and drug treatment facility, may be offered. 24 hours of supervision with medical management while working on recovery may be covered. Upon being stabilized, you may be required to move to outpatient care for the duration of your treatment.
  3. Partial Hospital Treatment: These are day programs in a treatment facility or hospital consisting of 4 to 8 hours of programming during the day. In the evening, you are allowed to go home. A self-help group, like Alcoholic Anonymous, can be added in the evening to help with stress and triggers for relapse.
  4. Intensive Outpatient Treatment: These group programs meet in the evenings for a few hours, usually 3-5 times a week.
  5. Continuing Care: This is support in groups that meet weekly to help prevent relapse.

Aetna Benefits for Addiction Treatment

You may be covered for many of the above treatment options, but Aetna makes determinations for rehab coverage on an individual basis. There is no set limit on the number of days an insured may be in treatment. If your addiction treatment provider is out of network and you have a network-only plan, you will have to pay additional costs. You can contact your Aetna representative to confirm the type of coverage you have for out-of-network providers in this field.

Aetna’s coverage for addiction treatment often covers dependency upon:

  • Alcohol
  • Cocaine
  • Heroin
  • Opiates/opioids

Silvermist & Aetna

When you contact Silvermist for information about addiction treatment, we will work with your Aetna insurance provider to determine which costs will be covered, depending upon how long your stay will likely be, how severe your level of addiction is, and whether you have any co-occurring mental health conditions. Silvermist accepts Aetna private insurance and self-payment on an out-of-network basis.

Addiction can be successfully managed with appropriate treatment. Treatment, whether residential or outpatient, needs to last at least 90 days to be effective, with a much lengthier time resulting in more positive and longer-lasting outcomes.

Public or Private Treatment

Substance addiction is a major public health problem in the United States. A large portion of drug treatment funding is provided by local, state, and federal governments. There are state-funded clinics and treatment centers that support those in recovery from addiction to drugs or alcohol. There is often a waiting period, however, for treatment to begin, as there are often large groups of people hoping for a space in one of these programs. Limited funding also often means that the most current technologies and treatments aren’t available.

Private insurance, however, can also help with the cost of treatment, especially when residential inpatient treatment is preferred, with more advanced treatment modalities and comfortable surroundings available. Long-term care in a non-hospital setting like Silvermist usually takes between 6 and 12 months for recovery. Depending upon your circumstances, your Aetna coverage may help with much of the costs incurred at a private facility.

Is Insurance Accepted?

When you’ve decided upon the best rehab facility for your needs, askwhether they will work with your Aetna insurance. Your plan may only cover a portion of your rehab stay, making it important to not only ask the facility whether they accept Aetna but to also check with your insurance representative on your own about your coverage when enrolling in a substance recovery program.

Silvermist Will Help

You can make a confidential phone call to Silvermist at any time, 24 hours a day, to request a free assessment of whether we are the right program for your recovery. There is no commitment linked to this important phone conversation. During this call, we’ll take your insurance information and look into your out-of-network coverage to verify your benefits at no extra cost to you.

Resources:

1. Aetna Facts – About Us

2. How long does drug addiction treatment usually last?

3. Types of Treatment Programs

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