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How Much Will Cigna Help Cover Drug Rehab?
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Cigna insurance plans cover drug rehab to some degree. Depending on the plan you have, your level of coverage will vary. Some plans offer much more extensive coverage than others.
Overview of CIGNA
Cigna is a global provider of healthcare services, headquartered in Enfield, Connecticut. The company employs individuals in over 30 countries, has annual revenue exceeding $32 billion, and is a publicly traded company on the New York Stock Exchange.
Basic Cigna Plans
Cigna offers numerous insurance plans for employers and private individuals. The basic major plans provided include two preferred provider organization plans (PPO) and a health maintenance organization plan (HMO).
A PPO is a managed care network of health care providers that have agreed to provide health care at reduced rates for individuals who go to the specific providers. Cigna offers two major PPO plans.
- Their low-option PPO plan has a $1,000 individual deductible for network providers ($3,000 family) and a $2,000 deductible for non-network providers ($6,000 family). After the deductible is met, 80 percent of expenses are covered within the network, and 50 percent of expenses are covered out of network).
- Their high-option PPO plan has a $300 deductible for individual services ($600 family) within the network and a $500 deductible ($1,200 family) out of network. For in-network providers, after a $20 co-pay is made, 100 percent of routine services are covered. After the deductible is met, 90 percent of the costs are covered for most other services. The coverage rate is 70 percent for out-of-network providers for most services after the deductible is met.
Their HMO plan covers health care provider services only within the recognized network. There is a $20 copay for most services and a $30 copay for specialists.
Rehab Coverage
Under the specifications of the Affordable Care Act, insurance providers must offer the same services for the treatment of substance use disorders as they do for other medical conditions. Thus, the above specifications would apply to the treatment of substance abuse given the policy the individual has.
The rehab services covered include:
- Withdrawal management services on an inpatient or outpatient basis. The need for inpatient treatment would have to be specified. It must be medically necessary.
- Outpatient treatment services, including physician services, medications, therapy, and other treatments.
- Other services and equipment as deemed necessary.
Medicaid
Medicaid is a government-funded insurance program that is available to individuals with very low-income levels. The guidelines for Medicaid eligibility are set by each state.
Medicaid coverage is typically comprehensive, but not all facilities and providers accept it.
Cigna appears to offer comprehensive Medicaid services in some states, such as Texas. To find out if Cigna has a Medicaid program in a particular state, contact them through their website.
Medicare Plans
Medicare is a government-funded form of insurance that is available for individuals 65 years and older and some people with disabilities. Premiums are based on a person’s income and are designed to be affordable.
Cigna provides the following Medicare services:
- Medicare supplemental insurance: Medicare typically pays 80 percent of hospitalization through Part A and outpatient services through Part B. Cigna provides a supplemental health care plan to cover part of the remaining 20 percent balance for individuals who wish to use it.
- Medicare Advantage plans: These provide comprehensive benefits for members, including a specific network of hospitals and doctors to provide medical care at reduced rates.
- Medicare Part D plan: This can help with the cost of prescription medications.
Contact Cigna directly to learn about the availability of these programs in your area.
How Medical Necessity Fits in
The notion of medical necessity —that the service is relevant to the problem being addressed by research studies and is not being used merely for convenience purposes — is generally specified by statutes from Medicare. Most rehab services must be deemed medically necessary to be covered by insurance.
Physician referrals may be required for inpatient rehab. Sometimes, it’s specified that a client must first be unsuccessful with outpatient treatment before inpatient rehab is covered.
Numerous services may not be covered, such as:
- Housekeeping services at residential treatment centers
- The cost of recreational activities unless they are deemed as medically necessary or appropriate to treat a situation.
- Procedures that do not have research evidence to support their use for the treatment of substance abuse, like acupuncture, yoga, and others.
- Some medications that are not directly involved in addressing the condition they are prescribed for.
Additional Services CIGNA Will Most Likely Not Cover
Cigna is very thorough in describing the types of services it does not fully cover. These services are not included, but they may be part of substance use disorder treatment in some rehab facilities in some instances.
- Cosmetic surgical procedures are not covered except when related to a few very specific conditions, such as constructive surgery following a mastectomy. If a person has physical damage related to addiction, cosmetic procedures to improve physical appearance may not be covered.
- Procedures on the gums or teeth may not be covered. This means dental treatment related to methamphetamine abuse may not be covered, depending on the specifications in the policy.
- Educational training may not be covered, and this may include psychoeducation for substance abuse.
- Experimental medications that are not approved by the U.S. Food and Drug Administration (FDA) are usually not covered.
- Biofeedback, hypnosis, sleep therapy, employment counseling, nutritional supplements, and dietary supplements are usually not covered.
When it comes to using Cigna insurance for drug rehab, call a Cigna representative to pinpoint your exact coverage levels. Confirm this coverage with a representative from your chosen drug rehab to ensure there are no hidden costs.
Sources
(2019) Cigna. Cigna. Retrieved from https://www.cignahealthbenefits.com/en
(2019) Insurance is complicated. We’re here to help. Cigna. Retrieved from https://www.cigna.com/individuals-families/
(2019) Medicaid Plans. Cigna Health Spring. Retrieved from https://www.cigna.com/medicare/resources/plan-documents
(2019) Choose Your Doctor. Cigna. Retrieved from https://www.cigna.com/individuals-families/campaigns/csbsearchlp/?afid=192034&cid=s004&utm_source=PPC&utm_medium=PPC&utm_campaign=979700&campaign_ID=979700&WT.mc_ID=Cigna_IFP_979700&WT.srch=1&sid=979700&call=888-228-2242&gclid=CjwKCAjw-OHkBRBkEiwAoOZqlw1qZ
(December 2018) Medical Necessity Definition in Health Insurance. Verywell Health. Retrieved from https://www.verywellhealth.com/medical-necessity-1738748