Does Cigna insurance cover Alcohol and Drug Rehab?

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In the United States, almost all health plans are required to provide some level of coverage for essential health benefits, which includes treatment for substance use disorders.1 As such, your Cigna health insurance plan may provide coverage for alcohol and drug rehab.

Cigna is an international health insurance company, providing healthcare solutions in 30 different countries, including the United States of America.2 Due to the vast number of different plans that may be offered through Cigna, it’s important to learn more about your specific health plan to understand the breadth of coverage it may offer.

Rehab centers can often check your coverage for you based on basic insurance information that you provide to them, which could include your or the subscriber’s personal information, your plan type, policy number, and group or member ID. You can also call the number on the back of your insurance card for more information about your specific health plan and to find covered facilities near you.

What is Cigna Insurance?

Cigna has been providing insurance solutions for more than 225 years.3 It first began in 1792, when prominent citizens formed the United States’ first marine insurance company, called the Insurance Company of North America (INA).3 “1792-1870”

Two years later, in 1794, the company became incorporated and sold its 1st life insurance policy. 3 “1792-1870” Nearly 100 years later, INA was there to help Chicagoans recover after the 1871 October Chicago Fire, as it was only 1 of the 51 insurance companies out of the 202 total insurance companies, to pay its claims out in full. 3 “1871-1945” It was there in 1906, as well, paying all claims it received following the fires related to the San Francisco earthquake, totaling $4,772,000. 3“1871-1945”

It wasn’t until 1912 when then-presidential candidate Theodore Roosevelt proposed funds be created to help Americans afford healthcare costs.3 “1871-1945”  Connecticut General, the subsidiary of now-Cigna that offered life insurance, created its first group accident insurance policy that same year, and 7 years later, in 1919, Connecticut General offered its first group accident and sickness contracts, its first endeavor in employee health insurance. 3“1871-1945”

It wasn’t until 1950 that Connecticut General wrote its first major medical health insurance policy, to help individuals pay for major accidents. 3“1950-1980”  Four years later, the company released the first comprehensive health insurance plan, combining group health and major medical insurance into 1 policy.3“1950-1980”

In 1982, Cigna became the company’s name, after the merger of Connecticut General and INA. 3“1981-1997”  Since then, the company has continued to evolve and make strategic acquisitions to expand its plan networks and offerings to fully support its mission of helping members lead healthier lives.

Cigna Plans

Cigna offers a variety of different plans across the many countries and markets it covers. All in all, Cigna serves 190 million customers in 30 different countries.2 In the United States, Cigna offers a variety of plans in different markets.4Shop plans” tab

Individuals and families may purchase plans on the Health Insurance Marketplace Exchange through Cigna, which are the Affordable Care Act (ACA) Marketplace plans, annually from November 1 through December 15 each year.5 Each state may have different requirements surrounding plan types and costs, but typically, they follow the metals level of coverage structure as offered through HealthCare.gov.5

Cigna also offers group health plans, which are plans offered through your employer.6 Most plans are subject to the ACA’s mandates but may also be subject to various state-issued regulations and mandates.6

Plans issued by your employer will vary, as employers typically have options to choose from in plan design and construction, but Cigna offers a variety of different plan designs, including Cigna Open Access Plus (OAP), Preferred Provider Organization (PPO), LocalPlus®, Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO), Medical Indemnity, Medical Network Plans, and SureFit® Plans.6

You can generally only sign up for plans through your employer during the annual open enrollment, or outside of that if you qualify for a special enrollment period, such as starting a new job, expanding your family, or experiencing another qualifying life event.6

Finally, Cigna also facilitates plans for the Medicare Advantage market in 26 states and Washington, D.C., and Medicare prescription drug plans (Medicare Part D) in all 50 states, Puerto Rico, and Washington, D.C.2 “Our strength” Outside of medical plan coverage, Cigna also offers dental insurance plans and other supplementary insurance plans. To find out whether your plan through Cigna covers addiction treatment, call the number on the back of your insurance card.

What will Cigna insurance cover?

Every Cigna plan will provide varying types of coverage regarding healthcare services, including addiction treatment. The best way to figure out what is or is not covered under your plan is to call the number on the back of your insurance card. You could also log in to your Cigna online account and review your summary of benefits and coverage (SBC), which could detail what is and is not covered for your plan.

Regardless of what your plan may or may not cover, your provider may recommend 4 types of addiction treatment for your path to recovery. These types of treatment are:

  • Inpatient or residential rehab. If you’re in an inpatient or residential rehab program, you will live at the facility for the duration of your care, where you will receive round-the-clock, medically supervised care.7, Pg 8, “What types of treatment programs are available?” Para 2,
  • Outpatient rehab or therapy. If you’re in an outpatient rehab program, you will go to a facility 1 or 2 times weekly, or less frequently, where you’ll receive therapy or counseling. You do not stay overnight with this type of program.7, Pg 10, Para 2
  • Intensive outpatient programs (IOPs). If you’re in an IOP, you’ll go to a facility for outpatient care (e.g., therapy or counseling) for a minimum number of hours each week, which is usually 9 hours of care. No overnight stay is required with this type of treatment.7, Pg 10, Para 3
  • Partial hospitalization programs (PHPs). If you’re in a PHP, which is commonly known as a day program, you’ll generally attend 4–8 hours of care per day, multiple days a week. No overnight stay is required with PHPs.7, Pg 10, Para 1

As a general reminder, just because these 4 types of addiction treatment are listed here does not guarantee that you will be recommended to receive these types of care. Similarly, it is not guaranteed that your Cigna plan will provide coverage in any capacity for the above-listed treatment methods. Call the number on the back of your Cigna health insurance policy card to learn more about the coverage afforded to you under your policy.

Does Cigna Insurance Cover Inpatient Mental Health Treatment Facilities?

The Affordable Care Act (ACA), which is a federal healthcare reform law, requires almost all health plans in the United States, which may include some plans offered by Cigna, to provide coverage in some capacity for mental and behavioral health services.1 Specifically, your Cigna health plan may be mandated by the ACA to provide some level of coverage for healthcare services such as substance use disorder treatment (e.g., rehab), behavioral health services, and inpatient mental and behavioral health services.1

What this means for you is that no matter what type of treatment you may need, including treatment at an inpatient mental health treatment facility, your plan may be required to provide coverage in some capacity. So, whether you may need stand-alone heroin rehab or treatment for a co-occurring disorder, you may be able to have some coverage for such services. If you are not familiar, a co-occurring disorder is what it is known as when someone has both a substance use disorder and mental illness at the same time.8

Although it is not believed that having a mental illness or substance use disorder causes the other condition, experts suggest that you are twice as likely to develop one condition if you have the other at some point in your life.8 Because of this believed interconnected belief, experts recommend a tandem approach to treatment, where each condition is treated at the same time.8 “What should I do?” To find out how your plan provides coverage for dual diagnosis, which is another name for a co-occurring disorder, call the number on the back of your insurance card.

How Long Does Cigna Insurance Cover Rehab?

The length of time that a Cigna mental health coverage under your policy covers rehab will depend on your specific policy. Every plan will cover treatment and lengths of treatment differently, and your plan may include cost-sharing elements such as deductibles, copays, and coinsurance which can affect coverage and out-of-pocket costs.

Similarly, coverage for rehab programs may also depend on your plan, the type of treatment you need and the extent of coverage you need, and the facility at which you receive care. Call the number on the back of your card to find out more about your specific coverage.

With that being said, Cigna may not cover the full extent of rehab your provider may recommend for your situation. It’s important to note that in these cases, you may need to prioritize following the treatment path set forth by your mental health provider versus what is covered by your plan. This is because one of the most effective aspects of successful rehab involves staying in treatment for a long enough period of time.

Every person is different, but most experts agree that remaining in treatment for at least 90 days improves overall outcomes.9, bullet 5 Longer treatment times tend to prove more effective, but every person is different. Your provider may recommend shorter or longer times of treatment, depending on your situation. Work with your provider to determine what is best for you.

What if my Cigna policy does not cover rehab?

Your Cigna policy may not fully or partially cover the costs associated with rehab. If this is the case for your treatment journey, you need to know your options for how to pay for rehab. Depending on the rehab facility you choose to attend, there may be financing or scholarship opportunities available to you. These options may be able to help you offset some of the out-of-pocket costs associated with treatment. Regardless, be sure to prioritize getting the treatment you need today rather than pushing it down the road.

Cigna In-Network vs. Out-of-Network Rehab Centers

In today’s times when healthcare costs seem to only increase, being a wise consumer of healthcare is of the utmost importance. Knowing the difference between in- and out-of-network providers is a key component in keeping your healthcare costs as low as possible. Depending on the health plan that you have, you may be limited to receiving coverage for your treatment if you attend an in-network provider.

In-network providers are those who agree to accept pre-negotiated rates for covered services under your specific Cigna plan.10 Out-of-network providers are not contracted with your plan and, as such, can charge you the full price, which tends to be higher than the in-network discounted rate.10

Staying in-network tends to be more affordable than seeing out-of-network providers, which underscores the importance of finding a covered provider whenever possible. To do this, you can call the number on the back of your card, use the Cigna Find a Doctor tool, or work with rehab facilities directly.

Cigna Approved Rehab Centers 

American Addiction Centers (AAC) has various rehab facilities around the country that provide drug and alcohol addiction treatment. If you have a Cigna insurance plan, the following AAC facilities accept Cigna for drug and alcohol addiction rehab.

  • AdCare Rhode Island: With various facilities located in Rhode Island, AdCare provides innovative, quality, and cost-efficient addiction treatment. Its integrated system of care offers an inpatient treatment center in North Kingstown and a network of outpatient offices throughout Rhode Island. AdCare’s continuum of care includes detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, inpatient and outpatient services, and tele-health.
  • Sunrise House Treatment Center: Located in Lafayette Township, New Jersey, Sunrise House provides treatment for people suffering from substance abuse from a medical and holistic standpoint. With various evidence-based therapeutic interventions, personalized care is provided through detox, residential treatment, dual-diagnosis treatment, and outpatient services.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are rehabs near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by Cigna insurance.

Check Cigna Insurance Coverage for Addiction Treatment

If you or a loved one requires addiction treatment, and you have Cigna insurance, you may be wondering how to check your coverage. American Addiction Centers is here to simplify the process. If you call our confidential helpline, you can speak to a real live person who can help you check your benefits right while you’re on the phone. You can also enter your information in the form below to instantly verify your benefits.

In addition to helping you learn more about your plan, the AAC staff can help you find out whether your Cigna plan is accepted at any of the AAC facilities across the country. They can also help you find a local, covered, in-network facility to help you get the addiction treatment you need.

Will my insurance pay for treatment?
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