Aetna, Inc. is a large U.S.-based insurance provider that was founded in 1853 and began to insure for healthcare in 1930. Aetna provides a wide range of policies, from pricey open-access healthcare plans with few restrictions to lower cost, high-deductible plans. For individuals with the lower cost plans, finding rehabs that take Aetna insurance can be a daunting task. Many rehabs narrow their scope of accepted insurance providers in order to ensure a higher rate of return for providing detox and rehabilitation services.
Most health insurance providers now offer some degree of coverage for services related to addiction and mental health disorders, thanks to key pieces of legislation enacted within the last ten years. However, no insurer is mandated to include this coverage, but if they do benefits must be weighted equally with those for physical health conditions. When seeking treatment for a substance use disorder, mental health disorder, or dual diagnosis (co-occurring disorders), it is important to review the individual policy carefully to gain a clear understanding of exactly what is covered.
Mental Health Parity and Addiction Equity Act of 2008
The Mental Health Parity and Addiction Equity Act (MHPAEA) legislation was signed into law by the 110th U.S. Congress in the year 2008. This federal law aimed to prohibit group health insurers from offering inequitable coverage for individuals in need of mental health or addiction services. Formerly an insurer could institute limitations on the level of care offered for people needing such services, providing lower dollar amounts and imposing limits on care for mental health or addiction treatment. As the word parity implies, the MHPAEA ensures equal benefits regardless of whether the condition is a medical condition or a mental health disorder. While the Act requires equal treatment of the health conditions, be they physical or psychological, it does not mandate that group insurers provide mental health or addiction services. In addition, the Act does not apply to small employers or private, self-insured healthcare plans.
Affordable Care Act of 2010
With the passage of the Affordable Care Act in 2010 (ACA), any healthcare plans available on the government exchange were mandated to include mental and behavioral health services. These services include:
- Behavioral health treatment, as in psychotherapy or counseling services
- Substance use disorder treatment
- Mental and behavioral health inpatient services
Pre-existing conditions were to be covered as well, allowing individuals with existing addiction or mental health conditions to have access to treatment under the ACA, and was available the day the policy went into effect.
Aetna Insurance for Substance Use Disorders
Aetna insurance policies include coverage for drug or alcohol addiction treatment services. This can include detoxification, outpatient rehabilitation programs, partial hospitalization treatment, inpatient rehabilitation programs, medication-assisted treatment, and continuing care treatment. Aetna determines coverage for addiction-related services based on each individual’s specific needs, versus a boiler plate approach with a set number of days for treatment.
During the precertification process, authorization of treatment is required to determine if the requested services meet Aetna’s criteria for coverage. Each individual Aetna policy may have different copays, deductibles, and coverage benefits, so it is important to contact an Aetna representative or access the Aetna Navigator online to review your specific plan’s benefits.
Aetna Insurance for Mental Health Disorders
Large health insurers have come to realize the importance of offering coverage for mental health conditions, understanding the future long-term costs of medical care for an individual whose mental health disorder was never treated. Untreated mental health conditions can result in deteriorating psychological health and physical health, unemployment or disability, and even suicide. Aetna is among these insurers who provides mental health care coverage. Their online mental health tool can help members learn about mental health disorders and how to seek help within their network of mental health providers.
Aetna Insurance for Dual Diagnosis
Further compounding an individual’s struggle with addiction is the coexistence of a mental health disorder. This dual diagnosis can exacerbate the individual’s suffering and escalate the use of alcohol or drugs in an attempt to self-medicate the mental health difficulties.
Aetna insurance can cover, to varying degrees depending on the individual healthcare plan, treatment related to both the substance use disorder and the mental health disorder. It is widely understood that when a dual diagnosis is present, both disorders should be treated concurrently for the best recovery outcome, instead of treating one disorder first before addressing the other. Included in the coverage will be any medications needed to stabilize the mood disorder, allowing for a better overall treatment result.
Discretion in All Aetna Covered Services
Stigma is still a problem that dogs those who suffer from a behavioral health or mental health condition. Many may forgo treatment just to avoid possible stigma if it became public information that they accessed treatment for an addiction or mental health disorder. While the efforts to eliminate the stigma that surrounds substance use disorders and mental health disorders continues, it is important for individuals to understand the ways their privacy is protected.
Aetna provides complete privacy protection for members accessing treatment for these conditions. Under the auspices of the 2003 Health Insurance Portability and Accountability Act (HIPAA), regulations are in place that protect patient privacy and insure complete discretion when a member uses their Aetna policy to obtain treatment for any medical condition, including for addiction and/or mental health services.
Solutions 4 Recovery Rehab that Takes Aetna Insurance
Solutions 4 Recovery, one of the rehabs that take Aetna insurance, is located in Orange County, California. Solutions 4 Recovery specializes in providing expert addiction and dual diagnosis treatment and recovery services, utilizing proven evidence-based therapeutic approaches. At Solutions 4 Recover, our top tier clinical team will devise a completely customized treatment plan that is specifically tailored to the individual’s unique treatment needs. For more information about the program, please contact Solutions 4 Recovery today at (888) 417-1874