Does Your Cigna Policy Cover Rehab and Substance Abuse Treatment?

Does your Cigna insurance policy cover offer substance abuse coverage for addiction treatment? Let’s find out. 

If you’re like most people entering treatment, insurance coverage is a huge concern, and with good reason; high-quality, effective drug and alcohol treatment isn’t inexpensive. Unfortunately, it isn’t always easy to determine precisely what services your insurance plan will cover.

Cigna does cover substance abuse treatment, and states that their approach is to provide every person with access to quality, patient-centered care, and consistent, meaningful outcomes. 

Cigna offers many benefits that can help individuals who are suffering from substance abuse and behavioral health problems. However, sorting through your Cigna insurance plan may be a little overwhelming and may leave you wondering if you will be able to take advantage of the benefits this insurance company has to offer. There’s no need to worry, however, because our knowledgeable team here at 1st Step Behavioral Health will help you navigate through your policy to find out what will be covered by your plan.

Cigna and Addiction Treatment: Transparency in Coverage

According to Cigna’s Standards and Guidelines — Medical Necessity Criteria for Treatment of Mental Health Disorders, published in April 2020, Cigna uses guidelines and practices established by entities such as the Institute of Medicine, the American Society of Addiction Medicine, and the American Psychiatric Association to determine medical necessity and to define the most appropriate treatment for each person.  

Cigna’s individual and family medical plans vary, and what Cigna pays for substance abuse treatment depends on your specific policy. However, all insurance companies are required to provide a summary of your coverage and benefits. If you have questions, call the treatment center or rehab, or contact Cigna’s customer service. 

Cigna and Drug Rehab Programs: Exactly What Does My Insurance Cover?

If you have Cigna insurance, you may be covered through an employer or school, direct purchase, the healthcare marketplace, or through Medicare. Depending on your plan, Cigna may pay all or part of treatment and levels of care, including:

  • Inpatient treatment services
  • Inpatient detox
  • Outpatient treatment services
  • Partial hospitalization (Cigna: PHP)
  • Mental health services
  • Confidential therapy
  • Access to addiction treatment specialists
  • Referral services and follow-up case management

Keep in mind that coverage varies from plan to plan, and you may need prior approval from Cigna before you begin treatment. Call the treatment center, or check your insurance documents for the exact details of your coverage. 

Cigna’s Behavioral Health Division

One of the benefits of having Cigna health insurance is that this company offers educational resources to help people to learn more about mental and behavioral health as well as addiction. Their Behavioral Health Division is instrumental in providing individuals and their families with seminars, podcasts, and other helpful tools. 

These resources can be helpful to those who are dealing with addiction and those who have loved ones who are suffering from this issue. Individuals can learn more about the signs, symptoms, and effects of addiction and receive advice and direction through these resources.

Many times, people who struggle with mental and behavioral health problems feel concerned about whether or not their insurance companies will cover their mental health care and treatment. But, Cigna works to provide coverage for those who need behavioral health care. 

However, this insurance company offers coverage for some care options while not covering others. For example, individuals who choose to go through aromatherapy to treat a behavioral or mental health disorder may not receive coverage from Cigna because this treatment approach is considered experimental.

Cigna Coverage for Medical Detox

A medical detox program may be necessary before the addiction treatment process begins. Many substances, such as cocaine or benzodiazepines, can produce serious and intense withdrawal symptoms. This is why it’s extremely important for individuals to avoid detoxing from and substance use without the guidance and supervision of clinical professionals. Quitting substance use “cold turkey” (abruptly) can be very dangerous and even fatal. Thankfully, many Cigna insurance plans cover medical detoxification programs.

Of course, as with treatment for addiction and mental health, the specifics of your plan’s coverage will depend on the type of plan you have and the type of detox center. The type of program you enroll in might determine whether or not you get coverage. For example, your policy may cover a traditional detox program but not a rapid detox program.

Cigna Insurance Terms You Should Know 

The financial information associated with insurance tends to be confusing, but it’s essential to have a basic understanding of the terms used in your contract with Cigna. You’re likely to see the following:

A deductible is the amount of money you must pay each year before your Cigna substance abuse coverage kicks in. Amounts vary depending on the plan, but you can find specifics on the Declaration page of your insurance policy. Cigna notes that the deductible may or may not count towards your out-of-pocket maximum, depending on the plan.  

Co-pays are set amounts that you pay up-front each time you visit a medical provider. The amount of your copay, which is printed on your Cigna ID card, is separate from the deductible amount, and you’ll be required to pay it whether or not you’ve paid the deductible.  

Coinsurance refers to a percentage of the medical bill, which you pay after you have met your deductible. For instance, you may have an 80/20 plan, which means you’ll be billed for 20 percent of covered expenses after you’ve paid the deductible, and Cigna will pay the remaining 80 percent of the bill. Although 80/20 plans are standard, your policy may designate a different percentage, such as 70/30.

Your Out-of-Pocket maximum is the most you’ll pay for medical expenses in a year. Once you’ve paid that amount, Cigna will pay 100 percent of all covered medical expenses, and you won’t need to worry about deductibles, copays, or coinsurance until the beginning of next year. 

Cigna and Drug Rehab Centers: In-Network or Out-Of-Network

Cigna advises that understanding how your plan works can help you avoid unexpected medical bills. An out-of-network treatment rehab will probably cost more than an in-network treatment center, depending on your specific plan, and whether or not it is an HMO or PPO. Cigna may pay full or partial costs of certain treatments after you’ve paid the deductible and coinsurance, or you may be responsible for the full amount.

In-network refers to treatment providers who have agreed to work with Cigna. The bill is substantially lower because Cigna and the rehab have negotiated lower rates. 

Out-of-network treatment may cost more, or it may not be covered at all because Cigna and the treatment provider haven’t established an agreement for lower rates. Out-of-network treatment may be included in some plans, but you might be required to pay higher deductibles and co-pays. 

One thing that’s important to understand is that, although Cigna insurance may be accepted by many drug rehab centers, coverage options and details will vary. The amount of coverage Cigna offers for treatment depends heavily on: 

  • The state in which a person lives
  • The type of insurance plan an individual has
  • Whether the facility is in-network or out-of-network
  • The type of treatment facility the individual plans to attend

Cigna offers various types of plans:

Bronze: For in-network inpatient treatment, there will likely be a 0% coinsurance. After you pay a deductible, your Cigna will cover the rest. Coinsurance for outpatient treatment may be between 0-50% and the plan may not cover out-of-network facilities.

Silver: Inpatient programs that are in-network may require a 30-50% coinsurance after you’ve paid the deductible. In-network outpatient facilities may require coinsurance but others may require a copay. Also, the plan may not cover out-of-network facilities.

Gold: For in-network inpatient facilities, coinsurance maybe 20-50%. For every visit to an in-network outpatient facility, a minor coinsurance percentage or copay may be required. Also, the plan may not cover out-of-network facilities.

Platinum:  Small coinsurance or copay may be required if an individual is using an in-network facility. Individuals may be able to select out-of-network rehab centers. But, they might be required to pay higher coinsurance percentages.

If you’re looking for a way to overcome substance abuse and treat any co-occurring disorders, please let us help you. Just Contact us today by calling or texting or texting (855) 425-4846.

Mental Health and Substance Disorder Insurance Coverage Parity

The Mental Health and Substance Insurance Coverage Parity Act, passed by the federal government in 2008, applies to most group health insurance plans, including Cigna. The legislation, part of the Affordable Care Act, or Obamacare, replaces legislation passed in previous years. It requires that insurance companies that offer mental health and substance abuse benefits must provide the same level of service they would cover for physical health services. For instance, a group insurance policy that covers inpatient and outpatient medical services must also cover inpatient and outpatient treatment of mental health issues or substance abuse. 

Additionally, the Act states that copays, coinsurance, deductibles, and out-of-pocket limits cannot be more than the amounts required for physical health, but there are stipulations. For instance, the law doesn’t apply to businesses with fewer than 51 employees, and may not apply to state and local government employees. However, your state may have stronger parity laws that take precedence over federal law. 

Cigna Approved Substance Abuse Facilities: Drug Rehabs that Take Cigna Insurance

Cigna partners with an extensive network of well-established treatment centers and rehabs across the United States. If you’re interested in a specific treatment center, contact the center for information about your coverage, or call Cigna’s customer service at the number listed on your Cigna ID card. Cigna’s customer service representatives are available 24 hours a day, 365 days a year. 

1st Step Behavioral Health Takes Cigna Insurance

Reviewed for Medical & Clinical Accuracy by Brittany Polansky, MSW, LCSW

Brittany has been working in behavioral health since 2012 and is the Assistant Clinical Director at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.