Cigna is one of the five largest health insurance companies in the United States, covering millions of subscribers of all ages and backgrounds. While many people think of health insurance as something that covers broken bones and cancer treatment, Cigna and other insurance companies also pay for a wide variety of mental health services, including addiction treatment.
If you have a drug or alcohol addiction, it’s important to understand the extent of your Cigna drug rehab coverage and know how to use your insurance benefits to get the treatment you need.
Substance Abuse Treatment with Cigna Insurance
It wasn’t always so easy to use your insurance benefits to pay for substance abuse treatment. Before the Mental Health Parity and Addiction Equity Act went into effect, insurance companies often controlled costs by limiting mental health benefits or treating mental health conditions less favorably than medical conditions. The Mental Health Parity and Addiction Equity Act prohibits large group health plans from setting limits on mental health benefits that aren’t imposed on medical and surgical benefits. As a result, it’s much easier to access treatment for drug and alcohol addiction.
Many Americans have also benefited from the provisions of the Patient Protection and Affordable Care Act, which requires each health insurance provider to offer treatment for drug addiction and alcoholism. Cigna covers a wide range of services, but the amount of coverage available may depend on how severe your addiction is, your medical/psychiatric history and the presence of any other mental health disorders. Even if your Cigna plan covers addiction treatment, it may not pay the full cost, meaning you may have some out-of-pocket costs to cover.
The amount of coverage available depends on your Cigna plan, but you may be able to get help paying for the following:
- Intensive outpatient treatment
- Supervised medical detox
- Inpatient or residential treatment
- Medication-assisted treatment
- Behavioral therapies
Cigna rehab coverage also extends to treatment for injuries and illnesses related to your addiction. For example, if you develop cirrhosis due to excessive alcohol consumption, your plan may cover some or all of the costs of the treatment.
Outpatient Treatment With Cigna Rehab Coverage
Residential treatment is the most comprehensive, but it’s not an option for everyone. You may need to enroll in outpatient treatment if you can’t get time off from work to go to a residential treatment center, for example. Outpatient treatment may also be appropriate if you have a lot of support from your family and friends. Your Cigna health insurance plan may pay for outpatient therapy, medications to help you with opioid addiction and other services provided on an outpatient basis.
Inpatient Treatment With Cigna Rehab Coverage
Cigna pays for both inpatient and outpatient treatment, but your out-of-pocket costs will vary based on the details of your plan. According to the National Institute on Drug Abuse, treatment outcomes vary based on the length of the treatment. Residential treatment is appropriate if you need several weeks of intensive treatment before transitioning to outpatient therapy and other services. You may also need residential treatment if you currently live with people who make it difficult to abstain from alcohol, illicit substances or prescription medications.
Determining Medical Necessity
Regardless of whether you want to seek outpatient treatment or stay at a residential treatment facility, your Cigna coverage will only pay for services that are considered medically necessary. Cigna, like other health insurers, relies on the ASAM criteria, a set of objective guidelines for determining if a service is medically necessary based on the patient’s medical and psychological needs. Rather than covering the same set of services for every patient, Cigna uses the ASAM criteria to determine if a specific service is appropriate based on an individual patient’s circumstances.
When determining if a treatment is medically necessary, Cigna representatives check to make sure the treatment is offered based on accepted standards of practice and is clinically appropriate based on the patient’s diagnosis. Cigna doesn’t cover services that are performed primarily for the doctor or patient’s convenience.
Types of Addictions Covered by Insurance
Depending on the terms of your plan, your Cigna coverage may pay for treatment for alcoholism, addictions to illicit substances and addictions to prescription drugs. An illicit substance is a substance that’s illegal to use, such as cocaine, methamphetamine or heroin. Prescription medications have a wide range of legitimate uses, but some of them can be addictive, especially drugs taken for pain management and anxiety. If you’re addicted to an illicit substance or a prescription medication, you’ll be able to use your Cigna plan to cover some of your treatment-related costs.
Many Cigna insurance plans include prescription coverage, which means you may be able to get help paying for the medications you need to recover from your addiction. Cigna also covers medications used to treat the symptoms of illnesses associated with drug and alcohol abuse. For example, if you have a heart condition related to the use of cocaine, your Cigna plan may cover some or all of the cost of the medications you need to treat the condition and prevent complications.
Coverage for Mental Health Services
It’s common for people with addictions to drugs and alcohol to have co-occurring mental health disorders. Some people with mental health issues develop addictions when they start using drugs or alcohol to cope with their symptoms. It’s also possible for someone with an addiction to develop a mental health disorder as their addiction worsens. Cigna covers a wide range of mental health services, including therapy, to ensure you have the support you need to recover from an addiction and address any underlying mental health issues.
Contact Us to Verify Your Benefits
Not all Cigna plans offer the same level of coverage for addiction treatment and mental health services. If you’re not sure what your specific plan covers, call (877) 244-3250 to ask one of our admissions coordinators to verify your benefits. One of our staff members can tell you what your plan covers and what your out-of-pocket costs are likely to be. If your plan doesn’t cover the full cost of residential rehab, we can also explain your payment options in detail.