Behavioral health is a term that encompasses all types of mental illness, behavioral disorders and substance use disorders, or addictions. Rehab is an important treatment option for anyone struggling with one of these types of conditions, because it provides long-term, focused and individualized care. Cigna behavioral health rehab coverage is important to consider for anyone who needs this kind of treatment.
What Counts as Behavioral Health?
Medical terms can be confusing, especially when sorting through diagnoses, treatment options and insurance coverage. Behavioral health can refer to mental illnesses, like depression, anxiety disorders, personality disorders, schizophrenia and many others. Some childhood conditions are also a part of behavioral health, like attention deficit hyperactivity disorder, or ADHD.
Behavioral health most often refers to addiction. More formally known as substance use disorder, addiction is a behavioral and mental health condition that is characterized by out-of-control use of drugs or alcohol. While misusing substances is a choice, being addicted is not. Professional and medical treatment is necessary to help individuals overcome this disease and to be firmly in recovery with a lower risk of relapse.
Does Cigna Cover Substance Abuse Treatment?
The degree of coverage depends on individual plans, but yes, Cigna does cover treatment for substance use disorders. Some of the types of services covered are rehab for drugs or alcohol, detoxification and outpatient counseling.
Cigna also offers insurance holders important behavioral health and addiction resources. The free education series provides information about recognizing the signs of addiction as well as advice and helpful tips for both patients in rehabs and their families.
Patients with Cigna health insurance will need to find out if they meet the criteria to have rehab and other types of treatment for substance use covered. It is important for each individual to understand their plans, to know what the requirements are for coverage and to find out what any out-of-pocket costs might be.
Understanding Cigna Behavioral Health Rehab Coverage
The type of coverage a patient has for behavioral health and addiction depends on the plan purchased. It is important to understand coverage when making decisions about treatment. There are many factors to consider, including deductible amounts, whether or not treatment needs be with an in-network provider, whether coverage includes inpatient or outpatient services, if there is any coverage for after care services, and prescription drug costs and coverage.
Individuals should verify coverage and Cigna substance abuse policy before making a choice about treatment. There may be costs that have to be covered out of pocket, depending on individual plans and polices and the treatment chosen.
Cigna In-Network Providers vs. Out-of-Network Providers
One of the most important considerations to make when choosing treatment for addiction is between in- and out-of-network providers. Whether or not a patient needs to get treatment from an in-network provider depends on individual Cigna plans.
For instance, an EPO, or exclusive provider organization, is a type of insurance that requires patients only see treatment providers in the network. A PPO, or preferred provider organization, allows for treatment from providers outside of the network, but costs to the patient may be higher.
It is usually less expensive for the patient to choose treatment through an in-network provider. However, it is worth contacting Cigna to find out what is allowed and what extra costs would be. Sometimes an out-of-network rehab or therapist is the best option for a patient.
Types of Behavioral Health Treatment Covered by Cigna
Cigna substance abuse coverage includes two main types of treatment: inpatient and outpatient care. Outpatient treatment can be as simple as attending 12-step programs and support groups. However, for most people struggling with addiction, this is not enough.
Outpatient care provided by professionals is therapy or addiction counseling. Patients in outpatient treatment may have one or more sessions per week, but they don’t live in a rehab facility. They live at home and are generally able to continue with normal activities, like work and school, while going through treatment.
Inpatient treatment for addiction is also known as residential treatment or rehab. This type of care includes a stay for a month or a few months in a facility that provides 24-hour supervision and daily treatment. Inpatient treatment is best for people who have no safe place to live while getting treatment or who don’t feel confident in being able to stay sober while at home.
Both types of treatment offer one-on-one therapy for learning how to live without alcohol or drugs. Residential care, however, provides much more. Patients in rehab usually have access to medical care, alternative therapies, and family and group therapies. They benefit from a whole team of professionals with different types of behavioral health expertise.
Coverage for Aftercare Services
Aftercare is an important part of addiction treatment, and much of it is covered by Cigna insurance plans. For patients going through residential treatment, aftercare may include outpatient therapy sessions, support group attendance, check-ins back at the residential facility, job and vocational training and medical care.
This kind of ongoing treatment is important, because it provides patients with a smoother transition from the intensity of residential care to life back at home with little or no supervision. Aftercare helps to reduce the incidence of relapse and to minimize the need for additional inpatient treatment in the future.
Some of the types of aftercare that are likely to be at least partially covered by Cigna plans are outpatientsessions with Cigna therapists and potentially with out-of-network providers, prescription drugs and medication-assisted addiction treatment, and the costs of staying in a sober living house.
Cigna Mental Health Coverage
Mental health is typically included in coverage for behavioral health services. In fact, many patients have co-occurring mental illnesses and substance use disorders. The most effective treatment addresses all of the behavioral health needs of an individual. It is important to get a diagnosis that uncovers any substance use disorder or mental illness and to choose treatment services accordingly.
Cigna mental health criteria for coverage are having a diagnosis of a mental illness from a professional and recommended treatment plan. Patients who have been diagnosed are entitled to coverage for appropriate care. Like substance use disorders, this care may include residential treatment if necessary or outpatient therapy.
Types of Behavioral Health Services Cigna May Not Cover
Even with the highest level of Cigna behavioral health rehab coverage, there are some services that are not likely to be paid for by the insurance company. These will be out-of-pocket expense for the patients. Luxury rehab facilities, for instance, are probably not covered for any patient. A private room at a treatment center is also considered a luxury expense that is not typically covered.
The insurance plan will also not cover any medications that can be purchased over the counter. Many types of alternative or complementary services may also not be covered—things like yoga classes, music and art therapy, or massage.
Some of these services and treatments not covered can be beneficial. Patients should find out by contacting Cigna if coverage will be included before committing to them. Those who want to continue with services that are not covered must be prepared to pay the costs.
Finding the Best Behavioral Health Treatment
While Cigna behavioral health rehab coverage should not be the only consideration when choosing the best treatment, it should be an important one. Patients should start with in-network providers and look for a facility or therapist that is experienced and appropriate for the type of care needed. They can ask for references from previous patients and visit facilities to have a tour and to speak with staff before making a final choice.
The treatment a patient gets for addiction or mental illness is crucial to recovery and long-term wellness. It is not a decision that should be taken lightly. Each individual must choose the treatment that feels best and most comfortable but that also meets their needs and makes sense within a Cigna insurance plan and coverage level.
Using Cigna Insurance for Behavioral Health Care
In order to make the best use of Cigna insurance for getting needed treatment for addiction and other behavioral health issues, have a firm understanding of coverage. Patients should check with Cigna to confirm coverage and out-of-pocket costs. They also need to go over insurance plans with the treatment provider. These steps are important to take before committing to any treatment plan.
Most patients will not need a referral from Cigna to get treatment, but pre-authorization may be needed. Insurance holders will also need to cover any remaining deductible costs and copays associated with treatment.
Getting behavioral health treatment is so important and too often overlooked. Insurance holders have an ally with Cigna. This insurance company provides coverage options that work with most people’s needs and income levels. Working with Cigna is a crucial part of getting the best care that is also affordable.
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