Cigna Rehab Coverage for Drug and Alcohol Addiction Treatment

You may be wondering, ‘does Cigna cover rehab?’ There are several tiers and options available when you choose Cigna health insurance benefits. Available plans and the coverage these policies provide may vary based on:

• The state you live in. Cigna provides coverage in:²
  • Arizona
  • Colorado
  • Florida
  • Illinois
  • Kansas
  • Missouri
  • North Carolina
  • Tennessee
  • Utah
  • Virginia
• Your employer. When you choose Cigna insurance through your employer, you typically choose from the following options:³
  • Health Maintenance Organization (HMO) plans. HMO plans typically limit your coverage to medical professionals who contract with Cigna.
  • LocalPlus® plans. These plans are cost-effective options that limit coverage to services provided in your locality or any LocalPlus Network area.
  • Open Access Plus (OAP) plans. These plans allow you to choose a primary care provider (PCP) and do not require a referral for in-network professionals. Out-of-network coverage is not provided except in emergencies.
  • Preferred Provider Organization (PPO) plans. PPO plans allow you to receive treatment outside of the Cigna-recommended network. However, taking this route usually results in a higher deductible or coinsurance percentage. You may also have to submit these claims yourself.
• Whether you have a customizable plan. These may include:³
  • Cigna SureFit® plans. These plans are available in select areas and are customizable to help meet the needs of employees and employers.
  • Indemnity plans (Network Savings Program). Employees on this plan are allowed to visit any licensed provider or facility and can see a specialist without a referral.
• Whether you have a government-funded plan (such as Medicare or Medicaid). There are minimum government-mandated levels of coverage, but Cigna offers options to add additional benefits. For example, Medicare Advantage plans and prescription drug plans.⁴ Medicaid coverage may vary substantially between states.⁵

Here are some terms that are also important to understand:

• Deductible: This is the annual amount you must pay before Cigna will begin covering expenses.⁶
• Copayment: Once you reach your deductible, you’ll still have to pay a small amount each time you visit the doctor or need medication (e.g. $20 each time you see the physician).⁷ In some instances, your deductible may not apply to your copayment amount.
• Coinsurance: This is the percentage of the total cost you’ll pay when you need treatment (e.g. 20% of the cost of a stay at the hospital).⁸
• Out-of-pocket limit/maximum: This is the maximum amount you’ll have to spend per year. It includes deductibles, copayment, and coinsurance. Once you hit this amount, insurance covers the rest.⁹ Often, this will be the total amount you end up owing for inpatient or outpatient treatment.

It’s important to reach out to your provider to check your insurance coverage before you enter any form of rehabilitation treatment.

Cigna health insurance will cover detox, inpatient rehabilitation, and outpatient treatment in most cases (though this may change depending on your specific plan and circumstances). If you need inpatient or outpatient treatment for a mental health, behavioral health, or substance abuse problem at a Cigna network facility, you may have to pay for costs such as the deductible, copayment, coinsurance and prescription medications (if you require medication-assisted treatment).^10,11

You should follow your employer’s medical plan requirements and schedule an appointment with a doctor, counselor, therapist, or treatment hospital. You can also work with these individuals or groups when coordinating your treatment, care, or referral. Your Cigna plan documents include details about treatment that may require prior approval by Cigna before you can begin.

If needed, your inpatient and outpatient treatment may be combined with follow-up case management services. Cigna offers coaching and support programs, as well as referrals to local community support groups and online resources.^10,11

If you want to find out if you are covered for treatment at Cigna rehab facilities, there are several ways to check your Cigna drug and alcohol rehab health insurance benefits. You can:

• Check your insurance paperwork that was provided when you were hired by your employer.
• Call the Cigna customer service line.
• Log into the myCigna website or App. If you have not registered already, do so by providing your:
  • Name and date of birth.
  • Zip code.
  • Social security number (SSN) or Cigna Subscriber ID number/policy number (found on your Cigna Insurance benefit ID card).

In most cases, Cigna insurance provides coverage for drug and alcohol addiction and mental health services, provided you have an insurance plan through your employer or a government-funded plan such as Medicare or Medicaid. However, this may not be the case with certain customizable plans.

The resources below can help you learn more about your Cigna substance abuse treatment coverage levels, how to get your insurance company to pay for drug and alcohol rehab, and how to pay if you don’t have insurance.

Recommended Drug and Alcohol Rehab-Related Articles

Whether you’re looking for a specific type of rehab treatment, substance-related information, or additional guides, there are a number of resources available.