Does Evernorth Insurance Cover Drug & Alcohol Rehab in Los Angeles?

What Addictions Does Evernorth Cover?

Evernorth generally provides coverage for a wide range of substance use disorders, though the exact benefits depend on your specific plan and whether care is in-network. In most cases, Evernorth follows evidence-based treatment guidelines and parity laws, which means addictions are treated as medical conditions similar to other chronic illnesses.

Addictions commonly covered include alcohol use disorder, opioid use disorder (including heroin and prescription painkillers), stimulant addictions such as cocaine and methamphetamine, prescription drug misuse including benzodiazepines, sedatives, and stimulants, cannabis use disorder, and nicotine dependence. Coverage often extends to medically necessary services such as detox, inpatient or residential rehab, partial hospitalization, intensive outpatient programs, individual or group counseling, and medication-assisted treatment when appropriate.

Some plans may also cover treatment for co-occurring behavioral or mental health conditions that accompany substance use disorders, such as depression, PTSD, or anxiety. Alternative or holistic therapies, like yoga or equine therapy, may be included only when offered as part of an approved program, usually during inpatient stays.

Since benefits vary, the best way to confirm which addictions and treatments are covered under your Evernorth plan is to review your Summary of Benefits or call the customer service number on your insurance card for specific details.

What Addiction Treatment Programs are Covered by Evernorth?

Evernorth covers a broad spectrum of addiction treatment programs, but the exact level of coverage depends on your plan details, state regulations, and whether you use in-network providers.

Addiction treatment programs that Evernorth covers may include:

• Medical Detox: Supervised withdrawal to manage symptoms safely.

• Inpatient/Residential Rehab: 24-hour care in a structured treatment facility.

• Partial Hospitalization Program (PHP): Intensive daytime treatment with evenings at home.

• Intensive Outpatient Program (IOP): Several therapy sessions per week while living at home.

• Standard Outpatient Therapy: Individual, group, or family counseling on a flexible schedule.

• Medication-Assisted Treatment (MAT): Use of medications like Suboxone, methadone, or naltrexone with therapy.

• Behavioral Therapies: Evidence-based methods such as CBT, relapse prevention, and motivational interviewing.

• Dual Diagnosis Treatment: Care that addresses both addiction and co-occurring mental health disorders.

Does Evernorth Cover Mental Health Treatment?

Yes, Evernorth does cover mental health treatment in rehab, although the exact services depend on your specific plan, provider network status, and medical necessity requirements. Evernorth includes behavioral health care as part of its addiction treatment coverage, which often means dual diagnosis programs are available to address both substance use disorders and co-occurring mental health conditions such as depression, anxiety, or PTSD.

Evernorth Insurance Rehab Eligibility & Prior Authorization

Evernorth determines rehab eligibility, medical necessity, and prior authorization requirements using established clinical guidelines and recognized standards.  The primary standard for substance use disorders is the ASAM Criteria, which evaluates the severity of addiction, risk of withdrawal, co-occurring mental health conditions, and the patient’s social supports and environment. For mental health treatment, Evernorth uses MCG Behavioral Health Guidelines, which consider the intensity and type of care required to achieve clinical improvement. These guidelines help determine whether a level of care, such as inpatient rehab, partial hospitalization, or intensive outpatient programs, is medically necessary.

Prior authorization rules vary by service level. Inpatient rehab, detox, and intensive outpatient programs generally still require prior authorization, with providers submitting clinical documentation to demonstrate medical necessity, often using ASAM placement worksheets or treatment plans.

Evernorth Insurance History, Plans & Statistics

Evernorth is the health services division of The Cigna Group, established to enhance the delivery of innovative and flexible health solutions. The division was officially launched in September 2020, consolidating Cigna’s various health services under a unified brand . This strategic move aimed to accelerate the development of comprehensive health services, including pharmacy solutions, benefits management, care solutions, and data analytics, to better meet the diverse needs of health plans, employers, and government organizations. 

In 2022, Cigna Medical Group, a longstanding provider of healthcare services, rebranded as Evernorth Care Group to align with the overarching Evernorth strategy . This rebranding reflected a commitment to expanding access to high-quality care through partnerships with additional health plans and the introduction of new services, including home care and digital health capabilities.

Evernorth, the health services division of The Cigna Group, serves approximately 178 million customers across its pharmacy, care, and benefit solutions. This expansive reach includes partnerships with employers, health plans, and government programs, providing a wide array of services designed to improve health outcomes and reduce costs.

Evernorth, a division of The Cigna Group, offers a range of insurance plans and tiers designed to meet the diverse needs of individuals and families. These plans are structured to provide varying levels of coverage, allowing members to choose the option that best aligns with their healthcare requirements and financial considerations.

Evernorth’s insurance offerings typically include several plan tiers, each with distinct features:

• Bronze Plans: These plans have lower monthly premiums but higher deductibles and out-of-pocket costs. They are suitable for individuals who are generally healthy and do not anticipate frequent medical needs.

• Silver Plans: Offering a balance between premiums and out-of-pocket costs, Silver plans are often chosen by those who qualify for cost-sharing reductions and expect moderate healthcare usage.

• Gold Plans: With higher monthly premiums, Gold plans provide lower deductibles and out-of-pocket expenses, making them ideal for individuals who require more frequent medical care.

• Platinum Plans: These plans have the highest monthly premiums but the lowest deductibles and out-of-pocket costs, catering to those who anticipate significant medical expenses.