Does Cigna Cover Addiction Treatment?
Taking the leap to get treatment for an addiction or a substance use disorder can be overwhelming for a person. The cost of these treatments can be one more reason a person waits to get help, but many insurance plans provide some level of coverage for addiction and substance use disorder. Cigna Insurance offers a range of treatment options through its various plans. This article will walk you through the different levels of coverage, what to expect from your benefits and how to seek coverage for treatment.
About Cigna Insurance
Cigna Insurance is a multinational health insurance company supporting the health of over 95 million people. Cigna makes health care more affordable by covering access to a range of treatments available through its network of providers. This includes many providers and treatments for addiction and substance use disorders as well as for other mental health concerns like general anxiety disorder or major depressive disorder. Check today to see your level of coverage and your options for substance use disorder treatment.
What is Addiction Treatment
Addiction and substance use disorders carry a tremendous amount of stigma that can make their treatment more difficult. Ultimately, addiction is a disorder of the brain that is characterized by repeated and compulsive engagement with a rewarding stimulus. At its core, this is a biological process that is induced by repeated exposure to an addictive stimulus.
Addiction can affect anyone, and it can be behavioral as well as substance induced. Varying forms of behavioral addictions are recognized by different medical authorities, including gambling addiction, shopping addiction, food addiction, video game addiction and sex addiction. This is in addition to more traditional substance addictions like alcohol, nicotine, opioids or amphetamines.
Addiction can be devastating to not only the individuals suffering from it but for their families and communities as well. The economic cost of addiction is greater than the cost of diabetes and all cancers combined and accounts for 20% of all deaths in the United States each year.
You don’t have to battle this disease alone. See how Cigna can help make addiction treatment affordable and accessible for you or a loved one.
How Does Cigna Rehab Coverage Work?
Cigna offers a variety of coverage levels that vary by state and choice of plan. Individuals seeking addiction treatment will often need to request preauthorization or prior approval from Cigna before beginning treatment. Preauthorization is the process of an insurer determining that a treatment you’re seeking is a medically necessary cost. It is important to make sure that you have been granted preauthorization before starting your treatment, or else you could be stuck with the full costs.
Depending on your plan and the level of coverage it provides, you may be required to meet a deductible, copayment, or coinsurance if the services are not fully covered by your insurance plan. Deductibles are common to many plans and are the amount paid out of pocket for covered services before insurance coverage kicks in. A copayment is a flat fee paid out of pocket whereas coinsurance is a form of cost sharing where you pay a set percentage of the costs. Make sure you understand all of the details around what you may owe. Your provider and Cigna can both help answer questions on what is due during the preauthorization process.
Additionally, seeking addiction rehab treatment from in-network providers can save you significant money. In-network providers are ones that have negotiated rates with your insurance company ahead of time. As a result, they will often offer better prices for patients belonging to that insurer. If you seek treatment with an out-of-network provider instead, you may not only have higher fees charged, but your insurer may not cover the costs at all. Make sure you understand which providers are in-network or out-of-network before engaging their services.
Cigna Employee Assistance Program for Drug and Alcohol Abuse
In addition to covering treatment from their in-network providers, Cigna also provides Employee Assistance Programs for employers that purchase insurance coverage through them. EAPs offer licensed clinicians who can speak with you about your addiction or substance use disorder. They can help walk you through the different kinds of treatment available to you and answer any questions you may have. Most EAPs make these clinicians available through in person meetings, phone calls or online live chats.
What Will Cigna Insurance Cover?
The kinds of treatment covered by Cigna will vary based on the specific plan that you or your employer have subscribed to. They may include inpatient and outpatient rehab programs alike. The following is a list of addiction and substance use disorder programs that may be covered by your Cigna plan.
Outpatient rehab programs are treatment plans that take place in clinics at hospitals, specialty mental health facilities, therapists’ offices, or health department and community clinics. Patients do not live at these facilities, spending time there only for specific treatment sessions. This means that you can live at home and continue going to work or school during the duration of treatment.
These treatment programs most closely resemble traditional therapy and counseling services, and they may include both individual therapy and group therapy. A typical outpatient rehab program will start with several sessions per week and can last for months or years. Depending on the progress of the patient, the frequency of sessions may be decreased, or your provider may recommend that you consider a more intensive program.
For patients not seeing enough progress from typical outpatient rehab, your care provider may recommend considering an intensive outpatient program. Intensive outpatient programs, or IOPs, often meet three days per week for a total of 10 to 20 hours of therapy per week. These programs are meant to provide you with extra support than regular outpatient programs.
IOPs are often intended to be shorter in duration, ranging from one to three months, but this varies by patient need. After the IOP is completed, the patient would typically move to a typical outpatient program with weekly therapy. This is intended to help provide accountability and ongoing support as the patient makes the new lifestyle changes a permanent adjustment in their life.
While IOPs require a much larger time commitment, the patient still generally lives at home and can work or go to school if their schedule allows them.
For patients struggling to make progress from IOPs alone, partial hospitalization programs may be recommended. Partial hospitalization programs, or PHPs, can be thought of as a full-time job’s worth of treatment every week. PHPs usually meet five days a week for most of the day. While you are still living at home during this time, nearly all business hours are spent at the PHP facility. Like IOPs, these programs consist of both group and individual therapy. These programs are ideal for those struggling with more severe substance use disorders but either benefit from or are safe in their home environment. After a PHP is completed, a patient may move to an IOP or typical outpatient program to continue their long-term treatment.
Inpatient or Residential Rehab
The most comprehensive form of substance use disorder treatment is an inpatient or residential rehab program. In inpatient programs, you live at the treatment facility 24 hours a day. These facilities provide addiction therapy as well as medical care. If you need to detox from a substance, these facilities can ensure that you do so under medical supervision and with treatment for any withdrawal symptoms.
Inpatient programs can be a good choice for patients who need to be removed from an environment that triggers substance abuse, whether that’s easy access or a stressful home life. These programs typically last four to six weeks, but in some cases, they can last for months if the patient requires it. Like the other programs, those discharged from an inpatient program will often move to a less intensive form of outpatient treatment for long-term care.
Will My Employer Find Out About My Rehab Treatment?
Generally speaking, substance use disorder treatment facilities are not allowed to disclose the identity of their patients or details about the treatment to anyone that the patient does not authorize having that information. This right to medical privacy is guaranteed by law. Any potentially identifiable health care information is considered confidential, and your health care provider is obligated by law to put in place certain procedures to protect that information.
The few times a provider can disclose your information without your consent is in the event of a court ordered disclosure, information shared with medical staff that are directly involved in your treatment or in the treatment of a medical emergency.
Types of Addictions Cigna Typically Covers
Cigna plans that include substance use disorder will cover essentially every major addiction. Many treatment facilities, including ones that accept Cigna insurance, have the capacity to treat nearly any addiction.
You should expect your substance use disorder coverage to include the following substances:
- Prescription opioids
- Prescription stimulants
- Sleep aids and sedatives
While there are programs for behavioral addiction, such as gambling or sexual addictions, you may need to consult with the specific treatment facility and Cigna to see if it is covered by your plan.
Cigna Types of Plans
The type of plan you have through Cigna can have a big impact on your level of coverage and out-of-pocket expenses related to substance use disorder treatment. You may have your plan through individual, family or employer policies. The plan may belong to one of many different types of health care management.
Depending on the type of plan you have, you will need to follow different procedures for receiving treatment. These types of plan include health maintenance organization, exclusive provider organization, point-of-care service and preferred provider organization.
Health maintenance organization plans, or HMOs, pair you with a primary care provider from a local network of providers. This primary care provider is responsible for evaluating your needs and referring you for specialty services. This means that if your plan is an HMO, you should seek an appointment with your primary care physician to get a referral before seeking substance use disorder treatment. Point-of-service, or POS, plans will also require you to seek a referral from a primary care physician.
Preferred provider organization, or PPOs, offer you access to a wide range of providers. You are not required to coordinate this care with a primary care physician and so can approach specialists without a referral. However, you should still make sure the provider is in-network to maximize your savings.
How Do I Get Started?
Your first step is establishing what kind of coverage is offered by your Cigna plan. A Cigna representative will be available to explain your level of coverage and how to seek preauthorization. They will also be able to direct you to a list of providers that are in-network.
The next step is deciding what level of treatment is appropriate for your situation, ranging from outpatient therapy to inpatient hospitalization. This is a big decision, and you may want to consult with a clinician to inform your choice. If your insurance is offered through your employer, there may be an Employee Assistance Program available to guide your decision. Otherwise, you may want to set an appointment with a therapist specializing in substance use disorder who can further evaluate your needs and recommend a program.