Does Cigna Cover Rehab?

Using Cigna for Treatment Programs in New Mexico

Cigna Insurance covers 15 million clients globally, providing coverage for a vast array of services. Many customers of Cigna have questions regarding insurance coverage for addiction treatment, such as “Does Cigna cover rehab?”

Many policyholders of Cigna insurance question whether their provider pays for stays in rehab. This is an important question, considering the importance of recovery and how pricey treatment can be.

Does Cigna Cover Rehab for Drugs and Alcohol?

Icarus Behavioral Health is proud to offer affordable, effective care options as an out-of-network provider for their Cigna clients.

When a client is having difficulty getting the professional help they need, someone from Cigna will step in and help coordinate care and ensure the member can access the resources necessary to stay clean and sober. The ACA requires insurance companies to provide some degree of coverage for mental health treatment, including substance use disorder (SUD) treatment (including coverage for drug and alcohol addiction).

Coverage Examples

The following section provides examples of different scenarios during treatment.

Inpatient Rehab

Cigna insurance typically offers inpatient rehabilitation at a cost plus 10%. If the patient received all their treatment at a Cigna inpatient facility, they would pay the $6,500 deductible. The customer would then be responsible for 25% of the remaining costs until they reached the out-of-pocket maximum of $8,150. At this point, Cigna would cover 90% of any remaining costs. Since this is an EPO plan, receiving treatment outside the network would result in no coverage.

Outpatient Rehab

Clients need an affordable way to help cover treatment. With Cigna OAP, they don’t have to worry about the cost of outpatient rehab. The total cost of receiving rehab in-network is capped at $2,000. Clients only must pay a $50 co-payment when arriving at treatment. This plan would also include prescription drugs, covering between $30 and $80 worth of medication.

These coverage examples vary depending on your state, the type of facility you are attending, specific treatment methods, and more. Many people question whether they can participate in out-of-network facilities.

What About Out-of-Network Rehabs?

For some people, Cigna’s in-network providers are the best option for addiction treatment. If you are unable to find an in-network provider or prefer an out-of-network facility, you may be able to work out a payment plan with our rehab facility so you can pay back the cost of treatment over time. For many PPO plans with Cigna, this will not be necessary, as such services are often fully covered.

As an ‘out of network’ Cigna rehab facility, Icarus still provides accessible and affordable mental health and addiction treatment options that few providers in New Mexico can equal.

Types of Policies for Cigna Customers

Cigna’s model is similar to Blue Cross Blue Shield in that they have bronze, silver, gold, and platinum coverage. However, they also provide the following:

• HMO: Health Maintenance Organization
• EPO: Exclusive Provider Organization
• POS: Point of Service
• PPO: Preferred Provider Organization

An HMO requires that you select a primary physician from a pool of local healthcare organizations. However, these costs are much lower than other plans or policies, assuming you obtain your services in-network.

An EPO allows you to choose from a more extensive network of providers but may or may not require that you select a primary care physician. You probably won’t receive any coverage when you want an out-of-network option with an EPO. This is with or without the pre-authorization form.

A POS plan provides in-network services at a substantially lower cost, requires a primary, and forces you to obtain referrals for any specialist. However, a POS plan means you can go in or out of network – but you’ll pay. Out-of-network is a much higher cost.

A PPO allows you to see specialists and out-of-network physicians without obtaining any type of referral.

So how does dealing with Cigna work when you have the goal of attending rehab?

How Does Cigna Insurance Work?

Suppose you have Cigna insurance and want to obtain services for substance abuse treatment. In that case, you will probably have to obtain preauthorization regardless of whether the facility is in or out-of-network. A preauthorization is when your insurance provider decides whether a medical service you’re requesting is necessary for your situation.  Icarus helps make this authorization get approved quickly and without hassle.

If you do not receive prior authorization or are rejected, you’re liable for paying for the total cost of treatment. Our Admissions staff has a relationship with Cigna that helps ensure this does not happen.

Another requirement will most likely include paying a deductible or copayment. A co-payment is a flat rate for any medical services you receive. Alternatively, coinsurance is a percentage of the total costs that you pay. A deductible is a designated amount you must pay before Cigna moves forward with service payment.

What Does Cigna Cover For Rehab Treatment?

As a Cigna customer, you can expect at least partial coverage for the following services. It is worth noting that coverage is not limited to these services, and additional benefits could exist in certain situations.

• Medically assisted detox
• Inpatient Rehab Stays
• Outpatient Programs and Intensive Outpatient Rehab
• Long-term treatment
• Short-term care treatment
• Partial Hospitalization
• Sober Living Homes
• Supplemental Therapy
• Additional Aftercare Services

If you’re not a customer of Cigna but are interested in obtaining them as a coverage provider, their services are available on the ACA Marketplace. Rehab is covered as a part of essential services when you become a member this way, so you do not have to worry about whether you’re covered for rehab or not.

Cigna Insurance for Rehab In New Mexico

New Mexico is no different in joining the country in an uphill battle against substance abuse. However, New Mexico has its own set of unique challenges to deal with.

Poverty rates make things difficult; in addition to past years, the lack of rehab facilities is challenging to find, still leaving its mark. Finding quality substance abuse treatment in New Mexico was difficult until the last few years.

The already prevalent poverty rates complicate this further, leaving a wide swath of the population facing substance use disorders with little hope of treatment. One of the most significant issues in New Mexico is the massive methamphetamine epidemic, which has been a problem long before the current issue our country is facing.

New Mexico now has a full-blown public health crisis, with nearly 700 overdose deaths in 2019, nearly tripled in the previous two years. This put New Mexico at number 12 on the list for overdoses in the entire country.

What Type of Rehabs Does Cigna Cover In New Mexico?

A bright spot during this issue is that because of the state’s problems; they have stepped up in providing substance abuse treatment. This has made this area of the country one of the favorite locations for people from all over the US to travel for rehab.

One of the driving factors in this is New Mexico’s beauty. The Southwest provides a fantastic backdrop and a serene environment conducive to healing from substance abuse.

Below is a small sample of the types of services you will have access to in New Mexico with Cigna coverage:

• Intensive Outpatient Program
• Partial hospitalization
• Buprenorphine Treatment
• Methadone treatment
• Sober living houses
• Long-term residential therapy
• Medical detox
• And many more!

Dozens of rehab centers exist in New Mexico that provide efficient treatment for residents and visitors. However, one of the more preferred locations is Icarus Behavioral Therapy, a facility that plays host to clients from across the country as well as residents of Albuquerque, Santa Fe, and across New Mexico.

Icarus Behavioral Therapy for Rehab

Our robust program at Icarus gives clients options for medically assisted detox, inpatient rehab, outpatient services, partial hospitalization, medication-assisted treatment, and dozens of specific types of treatment during their stay here.

At Icarus Behavioral Health, you can expect the following highlights during inpatient treatment:

• One-on-one counseling: One-on-one therapy sessions with our substance abuse counselors give you an outlet to speak with regarding anything on your mind. Guided talk therapy allows you to get to the bottom of your challenges naturally, helping you deal with feelings under the surface you might not have otherwise dealt with.
• Cognitive-behavioral therapy: It works with clients to help them replace negative behaviors and reactions with more productive ones. Part of addiction is rooted in the way you respond to certain feelings. You react by using drugs. Cognitive-behavioral therapy replaces your responses with healthier alternatives.
• Dual diagnosis treatment: Dual diagnosis treatment occurs during the existence of co-occurring disorders. Dual diagnosis typically refers to a mental health disorder and a substance abuse issue. Co-occurring conditions usually describe two mental health disorders simultaneously, like bipolar disorder and an eating disorder.
• Holistic treatment: Holistic treatment addresses elements beyond the behavioral and mental levels. This type of treatment provides benefits for the heart, soul, and spirit. Holistic medicine can be one of the most effective ways of getting in touch with parts of you that you thought may have been lost to substance abuse. Examples include art therapy, equine therapy, surf therapy, journaling, and more.

Find a Foundation for Long Term Sobriety at Icarus Behavioral Health

With Cigna insurance providing coverage during your rehab stay, much of the stress will be removed from you regarding the financial side of treatment during your visit. This allows you to entirely focus on the most critical part – healing the mind, body, and soul.

With a combination of various types of treatment, you’ll be afforded some of the most effective options for rehab in the United States. For good reason, clients travel from around the country to attend treatment at Icarus Behavioral Health.

If you would like more information about how Icarus Behavioral Health can help you or your loved one recover and reclaim your freedom, contact a member of our Admissions team today!