The epidemic of opioid abuse and overdose is quickly growing out of control in the United States. As a disease, it’s spread across all demographics and makes no distinctions as to whom it can affect. Rich and poor, urban or rural, anyone can be impacted by addiction. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 20 million people meet the qualifications for having a substance use disorder but only approximately 12 percent actually receive the treatment they need.
There are a variety of barriers that stand in the way of people seeking addiction treatment. The cost, commitment, fear, and not being ready to change can all contribute to a person remaining in active addiction rather than seeking help. Addiction often threatens your life, health, and relationships. None of the common barriers to treatment should stand in the way of you achieving a productive life.
However, one of those barriers can be overcome by health insurance, which has become a useful tool in addiction treatment since more companies came to recognize the problem as a disease.
Aetna is a popular private health insurance provider that offers coverage for addiction treatment. Aetna, or another private insurance provider, will likely cover at least a portion of treatment for a substance use disorder.
Learn more about what’s involved in addiction treatment and what your insurance provider might cover.
Addiction treatment is designed for treating multiple aspects of a person’s life that may have been affected by addiction or that contributed to addiction in the first place. Quality addiction treatment goes beyond treatment for substance abuse; it addresses multiple needs including medical, psychological, social, vocational, and legal problems. The most sensitive needs are addressed in medical detox, which is highly intensive and represents the highest level of care in addiction treatment.
Medical detox is a key part of recovery for many people, as some drugs can be deadly during the withdrawal phase. However, some insurance companies may be hesitant to cover such a high level of care for everyone who needs treatment. For instance, some insurers don’t cover detox for opioid withdrawal, because, even though it’s uncomfortable and causes powerful cravings, instances of medical complications and fatality are rare.
However, the potential for dangerous withdrawal symptoms isn’t the only reason medical detox might be necessary. Addiction can cause a variety of medical complications that need to be stabilized before treatment can begin. According to the American Society of Addiction Medicine’s criteria of placing clients into a level of care, acute intoxication and withdrawal potential, medical conditions or complications, and psychological conditions or complications can warrant a higher level of care.
After medical detox, the next levels of care include:
After detox, treatment will begin to focus on getting to the root of your addiction. This can mean addressing co-occurring mental health issues, uncovering past traumas that have led to addiction, and learning to cope with cravings and triggers.
Most effective addiction treatment plans involve some form of behavioral therapy. The most commonly recommended therapy option is cognitive-behavioral therapy (CBT), which focuses on developing your thoughts to help control your behaviors. In CBT, you will learn coping techniques that help you deal with stress, cravings, triggers, and other situations that threaten your sobriety.
Other common aspects of addiction treatment include:
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Today, most private insurance companies like Aetna offer coverage for at least a portion of addiction treatment, but there are still plenty of stipulations. Health insurance providers generally look for two things when it comes to covering your treatment: a clear need and quality treatment. If they are going to pay for you to receive treatment, they want to make sure you truly need the service you are getting. If you do need it, they want to make sure that the service will be effective. If you go through effective treatment, you are less likely to require treatment again.
To assure the quality of treatment, insurance companies like Aetna will first check to see whether your treatment center is in-network. In-network providers are ones that Aetna already knows and has a relationship with. They are familiar with their services and they’ve approved coverage for their treatment in the past. If you are planning on attending an in-network facility, the verification process will probably be a lot simpler.
However, just because a treatment center is out-of-network, it doesn’t necessarily mean they will not provide coverage. If you are interested in a facility that’s not in their network, your insurance provider will look for several factors that point to quality.
The first is that the addiction treatment center offers a foundation of evidence-based treatment services (TK). There are a variety of therapy options available, but only a few are evidence-based, which means their effectiveness is supported by scientific studies rather than just clinical experience. There are plenty of alternative therapies that help people every day, but insurance companies want to see treatment services rooted in therapies backed-up by science.
Next, they want to see evidence that the addiction treatment facility has a track record of quality service. If a center is brand new and isn’t associated with any known organization, they are less likely to approve coverage. If a center is associated with a reputable treatment network that has a history of quality care, they will be more likely to approve coverage.
Most insurance providers cover at least a portion of addiction treatment. But to find out what your Aetna insurance coverage specifically covers, you will need to contact your insurance representative or one of your specialists. Exploring your specific policy will cover exactly what will be covered.
“If you seek treatment at a facility with a good reputation, evidence-based services, and one that Aetna’s worked with before, you are more likely to get more out of your insurer.
The coverage you receive will also depend on the state you live in and the state in which you seek treatment. Studies have shown that treatment that lasts long enough is important in effective treatment.”
Generally, the best treatment duration is around 90 days.
However, it’s rare that an insurance covers that much time. Still, we work with insurance companies to get our clients the best treatment possible.
Insurance coverage might be a difficult thing to navigate on your own and determining exactly what your Aetna insurance policy covers can be complicated. It may be especially difficult if you’re are entering treatment for the first time. But don’t let that get in the way of getting the treatment you need to achieve meaningful sobriety. Fortunately, you don’t have to go through it alone.
Admissions specialists at Delphi Behavioral Health Group are standing by to answer all of your questions about addiction treatment and to help you navigate your insurance provider. We will work with you to determine what kind of insurance coverage you have, which aspects of treatment are covered, and how much will be covered. We’ll work to get as much of your ideal treatment covered as possible.
ASAM. (n.d.). American Society of Addiction Medicine from https://www.asam.org/resources/the-asam-criteria/about
SAMHSA. (2017, June). Trends in Substance Use Disorders Among Adults Aged 18 or Older from https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html