Using Cigna Insurance for Drug and Alcohol Addiction Rehab

A global health services company offering medical health insurance coverage for over 15 million people around the world, Cigna was ranked 79 on the 2016 Fortune 500 list. A large company with global partnerships and an extensive network of healthcare treatment providers, Cigna offers health insurance coverage options to employers for their employees, families, and individuals, and also provides Medicare insurance coverage to eligible individuals in nearly half of the states in the US.

Cigna has a wide range of insurance policies to choose, which differ depending on the resident state. In California, for example, Cigna offers policies in all of the “metal” levels, from bronze to silver to gold and platinum, while in Arizona, only bronze plans are offered. Typically, bronze-level policies have the lowest monthly premiums, which is what a person pays each month to keep coverage current, and the highest deductibles. A deductible is the threshold of expenses a person must first reach before insurance coverage kicks in. For instance, if a person’s deductible amount is $500, then insurance coverage will not start covering services until a person’s out-of-pocket (expenses paid on top of insurance coverage and premiums, and out of an individual’s personal money) costs reach at least $500. Platinum plans, in comparison, generally have lower deductible amounts and higher monthly premiums.

Per the Affordable Care Act (ACA), Cigna provides coverage for drug and alcohol addiction rehab as part of its behavioral health services coverage. Different Cigna insurance policies may cover addiction treatment at variable rates and levels.

What Cigna Covers for Drug and Alcohol Addiction Treatment

Cigna health insurance policies and plans can vary, and so can the coverage and services allowed. As the ACA lists substance abuse concerns under the umbrella of “essential” health benefits that must be covered at similar rates as other medical and surgical procedures, Cigna plans sold on the federal Marketplace must include coverage for behavioral health services.

In general, there are two main types of insurance policies: preferred provider organizations (PPOs) and health maintenance organizations (HMOs). A PPO will allow covered individuals to seek healthcare services from both providers that are considered “in network” and also those who are classified as “out of network,” for a greater fee. In-network providers have a partnership with Cigna that allows them to provide services for a discounted rate. An HMO will require covered members to remain in network for their medical and mental health needs.

Another form of health insurance coverage is an HSA, or health savings account. An HSA is a special tax-exempt account that people (and employers) can put money in to cover the costs of medical expenses. Employers may participate in cost-sharing for HSAs, contributing to the account for the employee’s medical expenses.

Below is a breakdown of some of the common Cigna health insurance plans and what they cover in the way of drug and alcohol addiction treatment.

  • Cigna PPO: With this plan, outpatient services and the first three office visits are covered without a copay required and before deductible kicks in. Partial hospitalization and intensive outpatient programs (IOPs) are also covered with prior authorization required. Inpatient substance abuse services are also covered with prior authorization. Services are covered more fully with in-network providers, although out-of-network services are also covered for higher out-of-pocket costs.
  • Cigna LocalPlusIN: Both outpatient and inpatient services are covered with no limitations for in-network providers; however, out-of-network services are not covered.
  • Cigna Connect Flex: Outpatient office visits and outpatient services are covered when provided by an in-network provider (not covered out-of-network) and without limitations. Inpatient services require prior authorization.
  • Cigna LocalPlus HSA: Outpatient office visits and outpatient services are covered at a higher amount for in-network than out-of-network providers and with no limitations or exceptions. Prior authorization is required for inpatient services.

Both outpatient and inpatient drug and alcohol addiction treatment may include detox services, counseling, therapy, community-based programs, workshops, support group meetings, medication management, life skills training, educational programs, relapse prevention, holistic methods, and more. Cigna health insurance plans may be able to help cover at least some of the cost of drug and addiction rehab. Actual coverage will depend on the plan held by the member.

Using Cigna Insurance for Drug and Alcohol Addiction Rehab

The best resource for determining the level of coverage, and for better understanding insurance and how to use it to pay for drug and addiction rehab, is to check with the provider Cigna directly. Call centers are open every day around the clock to help members navigate their health insurance policies. Professionals at substance abuse treatment facilities can help too.

As plans and coverage can vary from person to person, it is important to understand the ins and outs of a particular policy before entering into drug or alcohol addiction rehab. Most Cigna plans do not require members to obtain a referral for specialty services, such as substance abuse treatment; however, many plans will ask that individuals obtain prior authorization before receiving treatment in order for services to be covered. This verification process ensures that the services are deemed medically necessary before coverage is provided. HMO plans will also require that members use only contracted in-network providers for addiction rehab, while PPO plans will usually allow members to seek out-of-network care for an additional expense.

Members will be responsible for paying a copay, which is a set amount arranged for specific services ahead of time and does not count toward deductible amount, at the time services are received. In the case of addiction treatment, this copay may be required for outpatient office visits, for instance. Members will also have an annual out-of-pocket maximum amount. This means that after a certain amount of money is paid out of pocket, insurance will cover any additional eligible expenses that accrue.

Insurance policies often cover services at a certain percentage or up to an allowed amount. For example, insurance may pay for 50 percent of addiction treatment services and expect members to pay the remaining amount. In this instance, members would pay for half of their treatment costs. Other plans may cover services at 80 or 100 percent, and whatever remains is up to the individual to pay. Treatment providers may also bill for more than an allowed amount under an insurance policy. This means that if an inpatient stay is covered up to $1,500 but the actual cost is $2,000, the individual will need to pay the remaining $500.

Addiction treatment may be fully or partially covered by insurance, and this can obviously greatly help families and individuals to save money in the long run. Addiction is a costly disease, and treatment can provide savings as high as $12 to every $1 spent on care when lost workplace production, criminal and legal costs, and healthcare expenses related to drug and alcohol abuse are tallied up, the National Institute on Drug Abuse (NIDA) reports. When looking to enroll in a drug or alcohol rehab, treatment providers and insurance companies are good resources on where to start and how to use coverage to help with costs. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) hosts a behavioral services locator tool to help individuals find local treatment options.


Click below to learn about some of the major insurance providers with policies that may cover drug treatment or ancillary services.