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Premium: Your monthly payment to keep your insurance active.
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Deductible: What you pay out of pocket before insurance starts covering costs.
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Copayment (Copay): A set fee for a service, like a doctor visit or prescription.
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Coinsurance: The percentage of costs you pay after meeting your deductible.
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Out-of-Pocket Maximum: The most you pay in a year; after this, insurance covers 100% of covered services.
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In-Network Provider: A doctor or facility contracted with your insurance for discounted care.
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Out-of-Network Provider: A provider not contracted with your insurance; costs are usually higher.
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Prior Authorization: Approval from your insurer needed before certain services or medications.
What Addiction Treatment Programs Does Aetna Cover in Los Angeles?
Addiction treatment programs Aetna typically covers in Los Angeles:
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Medical Detox for safe withdrawal management
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Inpatient/Residential Rehab with 24-hour care and structured programs
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Partial Hospitalization Programs (PHP) for intensive daytime treatment
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Intensive Outpatient Programs (IOP) for flexible therapy while living at home
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Standard Outpatient Treatment for ongoing therapy and support
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Medication-Assisted Treatment (MAT) with medications such as buprenorphine and methadone, paired with counseling
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Dual Diagnosis Treatment for co-occurring mental health and substance use disorders
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Therapies and Counseling including CBT, DBT, family therapy, and holistic options
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Screening, Brief Intervention, and Referral to Treatment (SBIRT) services provided by clinicians
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Aftercare and Relapse Prevention Programs to support long-term recovery
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Behavioral Health Coaching and Digital Support Tools for ongoing management and wellness
Does Aetna Insurance Cover Dual Diagnosis Treatment?
Yes, Aetna insurance does cover dual diagnosis treatment, but the exact level of coverage depends on your individual plan. Dual diagnosis treatment is designed for people who are living with both a substance use disorder and a co-occurring mental health condition, such as depression, anxiety, PTSD, or bipolar disorder. Because Aetna plans generally include benefits for both behavioral health and substance use treatment, dual diagnosis programs are often covered when they are deemed medically necessary.
Does Aetna Cover Virtual or Telehealth Addiction Treatment?
Yes, Aetna does cover virtual or telehealth addiction treatment, but the details depend on the specific plan. In recent years, Aetna has expanded its behavioral health benefits to include online and telehealth services, making it easier for members to access treatment for substance use disorders and co-occurring conditions.
Covered telehealth addiction treatment may include:
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Virtual Assessments and Screenings to determine treatment needs
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Teletherapy such as individual counseling, group therapy, and family therapy
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Medication-Assisted Treatment (MAT) management through online visits with prescribing providers
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Dual Diagnosis Care with virtual mental health and substance use disorder treatment combined
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Ongoing Support Programs like relapse prevention, behavioral health coaching, and check-ins with recovery specialists
Many Aetna plans cover these services at the same rate as in-person visits, and some waive or reduce copays for telehealth. The type of coverage will depend on whether the provider is in-network, the level of care needed, and whether prior authorization is required.
How to Use Aetna Insurance for Rehab
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Check Your Plan: Log into your Aetna member portal or review your policy documents. Look for details under behavioral health, substance use, or mental health services, and note important information like deductibles, copays, and out-of-pocket maximums.
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Verify With Aetna: Call the number on your insurance card to confirm your benefits. Ask what levels of care are covered, such as detox, inpatient rehab, outpatient programs, or telehealth. Be sure to check if your plan includes dual diagnosis treatment and medication-assisted treatment.
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Find In-Network Providers: Use Aetna’s provider directory or ask a representative for referrals to in-network rehab centers. Staying in-network usually means lower costs and fewer billing complications.
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Get Pre-Authorization (If Needed): Some Aetna plans require approval before you start treatment. Rehab facilities often handle the pre-authorization process by submitting medical documentation directly to Aetna.
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Confirm With the Rehab Center: Once you select a facility, ask them to verify your benefits with Aetna. Request an estimate of your out-of-pocket costs and confirm whether they bill Aetna directly.
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Begin Treatment: After admission, you will go through intake and assessments to start your treatment program. Aetna may request updates during your stay to ensure continued coverage.
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Use Aftercare Benefits: Many Aetna plans cover outpatient counseling, relapse prevention, and telehealth services after rehab. Ask about ongoing mental health and recovery support included in your plan.
Can I Use Aetna Insurance in a Different State?
Yes, you can often use Aetna insurance in a different state, but coverage depends on your plan type. For PPO plans, you can usually see providers across state lines, and while you may receive some out-of-network benefits, staying in-network generally lowers your costs. HMO plans are more restrictive and typically only cover care within your network and service area, with out-of-state treatment generally limited to emergencies unless the facility is part of the HMO network. EPO and POS plans vary, with some offering out-of-state care only if the provider is in-network, while others provide limited out-of-network coverage. Emergency care is covered nationwide, even if you are out of state or out of network. For rehab or behavioral health treatment in another state, Aetna may cover the program if the facility is in-network and treatment is medically necessary. Prior authorization is often required, and the rehab center can assist in verifying your benefits.
Aetna Insurance Eligibility for Rehab Coverage
Most Aetna plans include coverage for substance use disorder treatment, such as inpatient and outpatient rehab, detoxification, and behavioral therapies, as required under the Affordable Care Act. The extent of coverage, copayments, deductibles, and requirements for prior authorization vary by plan. Coverage is influenced by factors such as plan type, with PPO plans typically offering broader access including some out-of-network providers, while HMO plans usually require care within a specific network. Treatment must meet Aetna’s criteria for medical necessity, and many plans require pre-authorization for inpatient rehab or detox programs. Using an in-network facility generally reduces out-of-pocket costs. To determine your eligibility, review your plan documents or log into your Aetna member portal, contact Aetna customer service to confirm coverage specifics, reach out to rehab centers to verify that they accept your insurance, and obtain pre-authorization if required.
Medical necessity for rehab is the standard insurance companies like Aetna use to determine whether treatment is required for a health condition. For substance use disorder, this typically means your condition meets clinical criteria showing that rehab is essential to stabilize your health, prevent deterioration, and support long-term recovery. Factors that establish medical necessity often include the severity of your substance use disorder, evidence that outpatient treatment or previous detox attempts have failed, risk of withdrawal complications, co-occurring mental health conditions, and functional impairment that affects daily responsibilities, employment, or personal care. Coverage may be denied if the treatment is not considered medically necessary, if you use a non-network provider, if documentation is incomplete, if the program is experimental or non-evidence-based, or if required prior authorization is not obtained. Ensuring proper documentation, using in-network providers, and securing pre-authorization when needed can significantly increase the likelihood that Aetna will approve your rehab coverage.
About Aetna Insurance
Aetna Inc. is a prominent American managed health care company headquartered in Hartford, Connecticut. It was established in 1853 as the Aetna Life Insurance Company, named after Mount Etna, symbolizing strength and resilience. Originally a fire insurance provider, Aetna has evolved into a leading health insurer offering a wide range of services, including medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans. In 2018, Aetna became a subsidiary of CVS Health, expanding its reach and capabilities in the health care sector.
Aetna provides health care coverage to over 36 million people across the United States. This includes a diverse range of services such as medical, pharmacy, dental, Medicare, Medicaid, and behavioral health plans.
Aetna offers a variety of plans from individual and family plans to Medicare Advantage plans. Aetna plans are often categorized into metal tiers:
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Bronze: Lower premiums with higher out-of-pocket costs.
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Silver: Balanced premiums and out-of-pocket costs.
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Gold: Higher premiums with lower out-of-pocket costs.
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Platinum: Highest premiums with the lowest out-of-pocket costs.
