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Cigna Insurance Coverage for Drug and Alcohol Rehab

Written by: Goeffrey Andaria, Mental Health Writer

Reviewed by: Dr. Carl Williams, Ph.D., LCADC

Substance abuse disorder is reaching epidemic levels in the United States, with 20.4 million people suffering from drug and alcohol abuse within the past year. With such high numbers of addictions, it is no surprise that Cigna provides coverage for various treatments that assist people suffering from drug and alcohol abuse.

Cigna is a health insurance company that serves over 170 million clients worldwide, with 18 million clients using Cigna as an insurance provider. While Cigna can cover all or some of your drug and alcohol abuse treatments, coverage will vary based on many factors, including state of residence, behavioral health deductibles, etc.

This post discusses what you need to know about Cigna's health insurance coverage for drug and alcohol rehab.

Cigna group health insurance plans

Treatment covered under Cigna health insurance

Outpatient and IOP rehab

Inpatient and Residential rehab

Detoxification and Partial Hospitalization (PHP)

Getting help at Rolling Hills Recovery Center

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Co-Insurance

Deductibles

Co-Payment

Typically, co-insurance percentage range from 20% to 40%, and the insurance company clears the rest.

The amount you pay out-of-pocket for treatment before the health plan starts helping with payments.

Co-pay is a fixed amount you must clear (usually when you receive treatment) for covered treatment services.

Cigna Group Health Insurance Plans

According to the National Institute on Drug Abuse, only 10.3% of persons suffering from substance abuse disorder seek treatment, which shows how challenging it is for people to seek treatment.

One of the primary reasons behind the low number is the cost associated with drug and alcohol rehab. To offer coverage for drug and alcohol rehab, Cigna has partnered up with different rehab facilities throughout the US to provide a wide range of treatments.

While many factors go into deciding the correct form of coverage for your specific drug abuse disorder, the company offers the following group health insurance plans through an employer:

Cigna Open Access Plus (OAP): The plan offers nationwide access to a network of doctors and hospitals, the option to select your primary care provider, discounts, and no referral requirements.

Cigna EPO: These plans offer a specified number of hospitals and doctors that you are allowed to visit. EPO premiums are lower than Cigna HMO, but the deductibles could be much higher. Services received outside the specified hospitals and doctors will not be covered unless its an emergency.

Cigna HMO: This plan requires the client to utilize the network of doctors and hospitals within a given network. HMOs offer high deductibles but have lower monthly premiums, and you can also choose a primary care physician who helps coordinate your care.

Cigna PPO: The plan offers you a vast network of hospitals and doctors whom you are required to use. PPO premiums are typically higher than HMO, but the deductible could be lower or higher depending on location.

Cigna Sure Fit and Indemnity Plans: This is a customizable plan for employees and employers and is only available in specific service areas. Cigna Indemnity Plans (Network Savings Program) allows employees to visit any health care practitioner or hospital and see any specialist without any referral.

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Treatment Covered Under Cigna Health Insurance

If you or a family member is covered under Cigna health insurance, you have several options available to pursue alcohol and drug abuse rehab treatment. The following are some drug and alcohol rehab treatment options available under Cigna health insurance.

Outpatient and IOP Rehab (Deductibles, Co-Payments and Out-of-Payments)

Cigna health insurance plans cover at least some of the costs of outpatient drug and alcohol rehab, including different therapies. In this example, we'll look at the cost breakdown at an in-network outpatient facility under the Cigna OAP plan for a client residing in Indiana:

Unlike inpatient coverage, you don't have to pay an overall deductible. You only have to pay $50 as a co-payment when visiting the facility.

The out-of-pocket limit is $2000, which can only be achieved if the outpatient service lasts 40 days or more. You could also reach the limit if the cost of other services is added to the total.

The OAP plan includes a $175 deductible for prescription drugs depending on the type of medication. The co-payment will range between $20 and $70. However, the plan will not be effective if expenses are accrued outside the Cigna outpatient network.

The coverage you receive depends on the state of your residence, the length of rehab, and your health insurance plan level. Additionally, the cost of rehab treatment will vary from person to person based on the program type attended and the services received.

Open Access Plus

Cigna covers many addiction treatment services.

Rolling Hills Recovery Center accepts a variety of Cigna insurance coverage.

Medically Reviewed:

Dr. Carl Williams Ph.D., LCADC

Rolling Hills Recovery Center

Executive Director

Dr. Williams presently serves on the board of Directors for two non-profit service organizations. He holds a Master’s degree in Human Services from Lincoln University, Philadelphia, Pa, and a Ph.D. with a concentration in Clinical Psychology from Union Institute and University. In Cincinnati, Ohio. He is licensed to practice addictions counseling in both New Jersey and Connecticut and has a pending application as a practicing Psychologist in New Jersey.

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Inpatient and Residential Rehab (Deductibles, Co-Payments and Out-of-Payments)

The Cigna Group covers some of the costs for inpatient and residential rehab treatments for drug and alcohol abuse. For example, here is how the cost of treatment for a resident of Wichita, Kansas using the Cigna Connect 6500 EPO plan will be shared at the Cigna network inpatient facility:

You will have to pay the $6500 annual deductible before Cigna starts covering drug and alcohol rehab costs.
Once you clear the annual deductible, you will still have to pay 50% of the remaining costs before reaching the out-pocket-limit of $8150.
Cigna will cover the remaining treatment costs if you meet all these requirements.

In this example, 50% of the remaining costs apply to prescription drugs unless you have already reached your out-of-pocket limit. Since this is an EPO plan, seeking treatment outside the Cigna network could mean no rehab coverage.

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Detoxification and Partial Hospitalization (PHP)

40% to 60% of individuals who receive addiction treatment often fall back to substance abuse, which is why detox is vital to treatment. Drug and alcohol treatment usually involves detox services, which can be agonizing, uncomfortable, and sometimes life-threatening. On top of the two main treatment options, Cigna health insurance can also cover partial hospitalization, but it will vary depending on your coverage policy and location.

Cigna covers ambulatory detox, which is provided on an outpatient basis and is meant for individuals who are highly interested in recovery but require medical treatment to manage withdrawal symptoms. It also covers inpatient detox, primarily for individuals requiring 24-hour intensive medical care. Inpatient detox could also be used among people addicted to certain drugs such as sedatives, alcohol, and some opiates.

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Get Drug and Alcohol Rehab Treatment From Cigna Partnered Rolling Hills Recovery Center

With Cigna's massive reach in the healthcare industry, Rolling Hills Recovery Center accepts coverage from Cigna. As a premier addiction rehab center in New Jersey, we are dedicated to your recovery journey and success by promoting healing, hope, and the tools required to live a life free from addiction.

Feel free to contact us today to find the help you deserve.