Struggling with substance use can feel isolating and overwhelming, but recovery is possible, and you don’t have to navigate it alone. There are insurance providers that offer coverage for addiction. If you have Aetna insurance, you may be relieved to know that comprehensive addiction treatment is within reach. Since the implementation of the Affordable Care Act in 2014, health insurance policies have been required to cover treatment for mental health conditions and substance use disorders, and Aetna has embraced this responsibility with compassion and commitment to its members’ well-being.
Understanding Aetna Insurance and Your Benefits
Aetna Insurance was started in 1853 and has grown over the years. It is now a part of CVS Health Corporation and provides health insurance to nearly 40 million people. This longstanding healthcare provider recognizes that addiction should be treated as the medical condition it is, with just as much care and seriousness as any other health condition.
As you assess your needs for substance use disorder treatment, it should be comforting to know that your Aetna plan is crafted for supporting you in your recovery journey. Aetna reveres the courage it takes to seek help, so their benefits are structured for accessible and affordable treatment for their members.
What Aetna Covers for Addiction Treatment
Aetna plans provide coverage for substance use disorders, and Aetna will cover all or some of your drug rehab treatment, depending on your specific plan and the types of services you seek. Your coverage typically includes a start-to-finish continuum of addiction treatment services geared for every need of your recovery journey.
Medical detoxification, usually the initial phase of addiction treatment, is covered under most Aetna plans. This process helps you safely withdraw from substances while managing potentially harmful withdrawal symptoms, all under medical supervision. This phase sees you through 24/7 medical monitoring and FDA-approved medications to ensure safety and foster relief from discomfort.
Inpatient treatment programs: For those requiring intensive, 24/7 care, Aetna covers inpatient residential treatment programs that may provide up to six weeks of comprehensive care, though the exact duration depends on your individual needs and treatment plan. These programs provide a structured atmosphere where you can be fully devoted to recovery and away from every day distractions and triggers. The home-like environment enables you to fully engage with the therapeutic work with the help of compassionate professionals who understand your unique journey.
Outpatient Treatment Programs: Aetna also covers outpatient treatment programs for up to 12 weeks, providing flexibility for individuals who need to balance work, family, or educational responsibilities while receiving treatment. These programs include intensive outpatient programs and partial hospitalization programs, providing different degrees of support based on your specific needs. Outpatient care enables you to take what you’re learning from the program to your daily life with the luxury of continual professional support.
Individual Therapy: Therapy is the key pillar of effective addiction treatment, and Aetna’s coverage includes individual therapy sessions with licensed clinicians who specialize in addiction treatment. Coverage also includes group therapy sessions, which bring peer support and connection through shared experiences. These therapeutic relationships become fruitful sources of guidance and understanding as you journey on the road of recovery.
Family Therapy: Aetna recognizes that addiction impacts entire families, so plans cover family therapy sessions. Family therapy facilitates regrowing trust, improving communication, and providing family members the tools they need to support your recovery journey. This therapy strategy brings relational healing into the recovery journey, which means healing for the family as well.
Medication-Assisted Treatment: For those dealing with alcohol or opioid addiction, Aetna covers medication-assisted treatment (MAT). MAT delivers FDA-approved medications with counseling and behavioral therapies to provide a thorough recovery approach. This evidence-based treatment is deployed because some addictions benefit from both medical intervention and therapeutic support.
The kind of substance you are struggling with usually does not preclude you from getting treatment. Health insurance companies like Aetna have formally recognized addiction—like alcoholism, cocaine addiction, benzo addiction, etc.—as a disease that requires specialized treatment like any other medical condition. This means that your Aetna insurance will cover treatment for alcohol, opioids like heroin and fentanyl, benzodiazepines like Xanax and Klonopin, common stimulants like cocaine, methamphetamine, and Adderall.
If you’re in need of treatment for substance abuse, you should not have to worry whether your specific substance is covered as this can add more stress and shame. Insurance companies like Aetna understand this, so they relieve the burden and stigma by typically avoiding substance-specific coverage. Coverage variables are mainly in the kinds of treatment and how much you have to pay, not specific substances.
Types of Aetna Health Plans and Coverage Levels
Aetna offers several types of health plans, each with different coverage structures that can impact your out-of-pocket costs for addiction treatment.
Open-Access Plans
Aetna Open-Access plans are a type of health insurance plan, often HMOs or PPOs, that give members more freedom to see doctors and specialists within the Aetna network without a referral. Key features include direct access to network providers, the option to select a primary care physician (PCP) but without the requirement to get a referral for specialists, and typically a copay for services.
Copay-Only Plans
Aetna offers copay-only plans that can help make addiction treatment more predictable financially. Copay-only plans will guarantee that your costs after paying your deductible are only copays, with primary care physician visits and generic drugs covered before you hit your deductible. This structure can help you budget for treatment costs more effectively.
High-Deductible Health Plans (HDHPs)
An HDHP has a higher deductible than a typical health plan. That means you pay out of pocket for your medical expenses until you reach a certain amount. Then, your plan begins to pay.
Savings tip: An HDHP has a lower premium. That means you pay less every month for your plan. HDHPs also cover many preventive services and screenings at no cost without having to meet your deductible.
In-Network vs. Out-of-Network Coverage
The difference between providers in-network and out-of-network is important to understand in order to maximize your Aetna benefits and minimize how much you pay out of pocket.
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Selecting an in-network facility unlocks the full potential of your Aetna coverage. Certain Aetna plans feature exceptional benefits for in-network inpatient care—including 0% coinsurance once your deductible is satisfied. In practical terms, this means treatment could be fully covered after you’ve met that initial threshold.
Let’s break down the financial advantage with a real-world scenario: A treatment program lists at $15,000. However, through Aetna’s in-network agreements, that same program is available at a contracted rate of $10,000—an immediate $5,000 reduction. After your deductible is paid, a typical plan with 20% coinsurance means you’d contribute $2,000 of that $10,000 negotiated amount, rather than facing the full $15,000 price tag. That’s substantial savings simply by staying within your network.
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When it comes to seeking treatment from out-of-network providers, the coverage landscape becomes considerably more complex and variable. Your benefits will depend heavily on two critical factors: your geographic location and the specific Aetna plan type you’re enrolled in. Different regions have different provider networks, and plan structures—whether you have a PPO, HMO, or EPO—will dramatically impact your out-of-network options.
One crucial financial consideration with out-of-network care involves what’s known as balance billing. Here’s how this works: While your provider may charge $15,000 for treatment, Aetna determines payment based on what they define as the “reasonable and customary” rate for services in your area—let’s say that’s $10,000. Even if your plan covers 60% of out-of-network costs, that 60% applies only to Aetna’s approved $10,000 amount, not the provider’s actual $15,000 charge. This means you could be responsible for both your coinsurance portion and the $5,000 gap between the two amounts.
Before pursuing out-of-network treatment, it’s essential to contact Aetna directly to understand your specific plan’s out-of-network provisions, confirm whether balance billing applies, and calculate your potential total out-of-pocket expenses. This proactive step can prevent unexpected financial surprises and help you make an informed decision about your care options.
Understanding your Aetna benefits can help you plan effectively and alleviate the financial stress of this aspect of addiction treatment. Coverage depends on your policy and whether you have met your deductible during treatment.
Think of your deductible as the initial investment in your healthcare each year—it’s the upfront amount you’ll cover entirely on your own before your Aetna benefits activate. After satisfying this yearly threshold, your insurance coverage begins to share the financial burden according to your specific policy structure.
Even after your deductible is fulfilled, most plans incorporate additional cost-sharing mechanisms. You may encounter fixed fees for specific services—known as copayments—which remain constant regardless of the actual service cost. Alternatively, your plan might use a percentage-based system called coinsurance, where you pay a predetermined portion of each bill while Aetna covers the remainder. Some policy designs also require per-admission fees that vary depending on the type of care you’re receiving.
Aetna policies include a critical protective feature: the out-of-pocket ceiling. This represents the absolute maximum you’ll spend on qualifying healthcare expenses during any plan year. Once your cumulative payments—including deductibles, copays, and coinsurance—reach this cap, you’ve crossed the finish line. From that point forward until your plan year resets, Aetna assumes full financial responsibility for all eligible services at 100% coverage, eliminating any additional costs for covered care.
How to Verify Your Aetna Benefits
Prior to treatment, it’s critical to verify your specific benefits and learn what your plan covers. Here’s a simple guide for accessing this information:
Online Portal
You can find details about your Aetna rehab coverage by logging on to Aetna’s member portal. This online resource breaks down, with detailed information, the benefits of your specific plan, which includes substance abuse treatment coverage.
Customer Service
You can call Aetna’s customer service line to get personalized information about your benefits. Have your member ID card handy when you call, and ask specifically about:
- The status of your deductible and whether you’ve met it
- Copayment or coinsurance amounts for different kinds of treatment
- The treatment facilities that are in-network in your area
- Pre-authorization requirements for treatment
- Limits on coverage depending on different levels of care
Let Live Again Detox do the work
Admissions specialists at many reputable addiction treatment centers will verify your benefits for you. This service helps clarify your coverage and allows you to focus on what matters most: your recovery.
The Mental Health Parity and Addiction Equity Act ensures that insurance coverage for substance use disorder treatment is equivalent to coverage for other medical conditions. This means that Aetna cannot impose more restrictive limitations on addiction treatment than they do on different medical treatments.
Your rights under mental health parity include equal coverage for substance abuse treatment and other medical conditions, the same copayment and deductible structures, equivalent coverage limits and treatment duration, and access to the same network of providers. This means that seeking help for addiction should feel no different from seeking help for any other health condition, because that’s precisely what it is.
How Mental Health Fits with Your Insurance
With your rights guaranteed under mental health parity, Aetna typically covers dual diagnosis treatment because they recognize that addiction often begins with mental health. This kind of treatment addresses both mental health and addiction, providing a more comprehensive level of care. Dual diagnosis, which is sometimes referred to as co-occuring disorders, means that there is a mental health disorder present with a substance use disorder. This is usually a vicious feedback loop as one can spur the other.
As a few examples, someone who experiences depression may drink alcohol to numb the pain. A person who struggles with anxiety may seek Xanax use to calm down and develop a dependency on it. Opioids are often sought out for PTSD to help avoid painful memories and relieve stress. People with bipolar disorder have been found to have polysubstance use to mitigate the different emotional extremes they experience.
It’s estimated that over a third of adults who have a substance use disorder have a co-occuring, diagnosed mental health disorder, too. With the severity and ubiquity of dual diagnosis, effective addiction treatment must include treating these underlying causes, like depression, anxiety, bipolar disorder, and PTSD. Most insurance plans take this into account in order to make sure you get the treatment that you need. We understand that coverage can be confusing, so we help you understand your benefits and explore your available treatment options. Call to verify your benefits and see how dual diagnosis treatment can fit into your treatment options.
Aetna commits to ongoing support through its Continuing Care programs. These comprehensive programs include continued individual and group therapy sessions to help sobriety stay strong and overcome challenges as they come, continued monitoring and adjustment of medications used in medication-assisted treatment programs, specialized relapse prevention programs tailored to help you spot triggers and execute coping strategies, and coverage for participation in structured programs beyond treatment like support groups and recovery programs. This continuity of care ensures your recovery thrives beyond completing your initial treatment program.
Finding In-Network Treatment Providers
It’s important to confirm that Aetna works with any prospective rehabilitation before committing to treatment. You can find in-network treatment providers through Aetna’s online provider directory, which allows you to search for addiction treatment facilities in your area that accept your insurance. Many treatment centers also list the insurance plans they accept on their websites or will verify your benefits over the phone, making it easier to understand your coverage before beginning treatment. Additionally, your primary care physician or mental health professional may be able to refer you to in-network addiction treatment providers who understand both your medical history and your insurance benefits.
What to Do If You Don’t Have Insurance or Need Additional Coverage
There are options to obtain or improve your insurance coverage if you don’t have insurance or your current coverage is insufficient. If you’ve experienced certain life events, then you may be qualified for a special enrollment period. This allows you to enroll in insurance or change your current plan outside of the annual open enrollment period. These qualifying events include losing existing health coverage, getting married or divorced, having a baby or adopting a child, moving to a different area, or experiencing changes in income that affect your eligibility. Keep in mind that if your employer offers health insurance, you can enroll within your company’s open enrollment period or after you’ve experienced a qualifying life event. Your state’s health insurance marketplace may have insurance that you’re eligible to purchase, and these can include subsidies to help it be more affordable.
Tips for Maximizing Your Aetna Benefits
To maximize your Aetna insurance for addiction treatment, make sure to go with in-network providers, which will get you the most benefits and reduce as much out-of-pocket costs as possible. Read through your specific plan documents thoroughly or reach out to customer service to better understand your benefits, limitations, and expenses. Make sure you do the pre-authorization process if it’s a requirement in your plan because this could result in denied claims which would delay your treatment. Detail all treatment-related expenses in a record-keeping strategy that works for you. This can come in handy for tax deductions and reimbursements. Remember that you can always appeal a claim being denied, and collaborating with your treatment provider can help clarify any denials, plus they can provide additional documentation if it’s needed.
Taking the First Step
If you are struggling with substance abuse or know of a loved one who is, we’re here to encourage you that seeking help is true strength, not weakness. Aetna insurance coverage is made to help you on this journey, removing the financial pressure that could get in the way of the care that you need.
Recovery is not just possible, it’s very achievable, and you don’t have to go through it alone. With Aetna’s full continuum of addiction treatment coverage, you have the freedom to pursue healing and establishing a new, firm foundation for lasting sobriety. For those in Tennessee, Live Again Detox offers all-encompassing addiction treatment services and will help verify your Aetna benefits while supporting you in every step of your recovery journey.
Now is the time to begin your recovery journey. Contact an in-network treatment provider today and get your benefits verified. This is your first, crucial step toward a fuller, healthier, substance-free life.
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Frequently Asked Questions
Yes. Aetna covers drug and alcohol rehab. All Aetna plans are required to provide coverage for substance use disorder treatment as mandated by federal healthcare laws.
The length of treatment Aetna covers depends on the setting and the individual’s recovery plan. Aetna may cover up to six weeks of inpatient and 12 weeks of outpatient care. However, extensions may be possible based on medical necessity and your specific treatment needs.
This depends on your specific Aetna plan. Open-access plans typically don’t require referrals, while other plans may require authorization from your primary care physician before seeking addiction treatment.
You can search Aetna’s online provider directory, contact treatment centers directly to verify they accept your plan, or work with Aetna’s customer service to find in-network providers in your area.
Some Aetna plans require pre-authorization for certain types of addiction treatment, particularly inpatient and residential programs. This process involves your treatment provider submitting documentation to Aetna demonstrating the medical necessity of the recommended level of care.
The pre-authorization process typically considers factors such as the severity of your addiction, previous treatment attempts, your overall health status, the presence of co-occurring mental health conditions, and your support system and home environment. Don’t let the pre-authorization process discourage you from seeking help, as treatment facilities experienced in working with insurance can guide you through this process and advocate for the level of care you need.
You have the right to appeal denied claims. Work with your treatment provider to understand the reason for denial and provide additional documentation supporting the medical necessity of your treatment.
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Medically Reviewed By:
Board-Certified Psychiatrist and Addictionologist
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Clinically Reviewed By:
Board Certified Clinical Social Worker
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Aetna. (n.d.). Behavioral health programs and plans for employers. https://www.aetna.com/services/behavioral‑health.html Provider News+6Meritain Health+6Aetna+6AnthemAetna+3Aetna+3Aetna+3
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Aetna. (n.d.). Mental health parity: FAQs for members. https://www.aetna.com/faqs‑health‑insurance/mental‑health‑parity‑faqs.html Aetna
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National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research‑based guide (3rd ed.). National Institutes of Health. https://nida.nih.gov/publications/principles‑drug‑addiction‑treatment‑research‑based‑guide‑third‑edition
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Substance Abuse and Mental Health Services Administration. (n.d.). Medications for opioid use disorder. U.S. Department of Health & Human Services. https://www.samhsa.gov/medications‑substance‑use‑disorders/medications‑opioid‑use‑disorder
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Tennessee Department of Mental Health and Substance Abuse Services. (n.d.). Find a licensed facility or service. State of Tennessee. https://www.tn.gov/behavioral‑health/licensing/find‑a‑licensed‑facility‑or‑service.html
State Licensed
Live Again Detox is licensed by the Tennessee Department of Mental Health & Substance Abuse Services, ensuring compliance with state regulations for safe, ethical, and effective addiction treatment.
The Joint Commission
The Gold Seal of Approval® signifies that Live Again Detox meets or exceeds rigorous national standards for patient care, safety, and quality.
LegitScript Certified
Live Again Detox is certified by LegitScript, confirming compliance with laws and standards for ethical marketing and patient transparency in addiction treatment.
HIPAA Compliant
Ensures patient information at Live Again Detox is fully protected under federal privacy regulations.
BBB Accredited
Demonstrates Live Again Detox’s commitment to ethical business practices and community trust.
Chamber of Commerce Member
Live Again Detox is an active member of the local Chamber of Commerce, reflecting its commitment to community growth and support.
ASAM Member
Membership in the American Society of Addiction Medicine reflects Live Again Detox’s dedication to science-based treatment and advancing standards in addiction care.
Psychology Today Verified
A verified listing on Psychology Today confirms that Live Again Detox provides trustworthy and transparent treatment services.
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Medically Reviewed By:
Board-Certified Psychiatrist and Addictionologist
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Clinically Reviewed By:
Board Certified Clinical Social Worker
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1. Aetna Insurance Coverage
Claim: Aetna provides behavioral health benefits, including substance use disorder coverage and mental health parity protections.
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Aetna. (n.d.). Behavioral health programs and plans for employers. https://www.aetna.com/services/behavioral-health.html
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Aetna. (n.d.). Mental health parity: FAQs for members. https://www.aetna.com/faqs-health-insurance/mental-health-parity-faqs.html
2. Addiction Treatment Science
Claim: Substance use disorders are chronic medical conditions requiring long-term, research-based care.
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National Institute on Drug Abuse. (2018 rev.). Principles of drug addiction treatment: A research-based guide (3rd ed.). National Institutes of Health. https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf
3. Evidence-Based Care Approaches
Claim: Medication-assisted treatment and behavioral therapy improve recovery outcomes.
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Substance Abuse and Mental Health Services Administration. (n.d.). Medications for opioid use disorder. https://www.samhsa.gov/resource/ebp/tip-63-medications-opioid-use-disorder
4. Tennessee-Specific Resources
Claim: Tennessee provides licensed treatment facilities and community recovery resources.
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Tennessee Department of Mental Health and Substance Abuse Services. (n.d.). Find a licensed facility or service. https://www.tn.gov/behavioral-health/licensing/find-a-licensed-facility-or-service.html
State Licensed
Live Again Detox is licensed by the Tennessee Department of Mental Health & Substance Abuse Services, ensuring compliance with state regulations for safe, ethical, and effective addiction treatment.
The Joint Commission
The Gold Seal of Approval® signifies that Live Again Detox meets or exceeds rigorous national standards for patient care, safety, and quality.
LegitScript Certified
Live Again Detox is certified by LegitScript, confirming compliance with laws and standards for ethical marketing and patient transparency in addiction treatment.
HIPAA Compliant
Ensures patient information at Live Again Detox is fully protected under federal privacy regulations.
BBB Accredited
Demonstrates Live Again Detox’s commitment to ethical business practices and community trust.
Chamber of Commerce Member
Live Again Detox is an active member of the local Chamber of Commerce, reflecting its commitment to community growth and support.
ASAM Member
Membership in the American Society of Addiction Medicine reflects Live Again Detox’s dedication to science-based treatment and advancing standards in addiction care.
Psychology Today Verified
A verified listing on Psychology Today confirms that Live Again Detox provides trustworthy and transparent treatment services.
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What Our Patients Say
Hear directly from those who have walked the path to recovery at Live Again Detox. Our patients’ stories highlight the compassionate care, effective programs, and life-changing support they’ve experienced. Let their journeys inspire you as you take your first steps toward healing.
Love and gratitude to Matt for greeting me the first night and for being so kind during check in and every night that I saw him after that (thanks for the Earl Grey tea Matt 😊), Chelsea and Leigh Anne for their group work- they both have an incredible way of sharing things they have learned that really help you heal from within and you start wanting just to soak up all of their knowledge 💜, Nurse Kelly (night shift) and Nurse Chris (days) give the best hugs and uplifting advice especially since I am a nurse and they particularly focused on not allowing me to focus on shame and guilt, but on my accomplishments and what I have to look forward to moving forward- they treated me with complete respect (love you both 🤗) All of the nurses were caring and just amazing- Stacy, Sheila, Marlene, Patricia, Kelly on day shift. Additional shout outs to my therapist Chris….. he helped me work through so many things and gave me great coping skills to use at LAD and to take with me (can’t thank you enough), Nick for morning meditations and great insight and also all of his spunk, Josue for some very interesting, informative, and inspiring conversations on Sundays, Chris (night tech) for is humor and late night conversations when some of us couldn’t sleep, and Luke for his peaceful nature.
If you need help, please call LAD! It’s a small group of people, 12 at max capacity, super caring and attentive staff, great food and soooo many snacks/drinks available 24/7, lovely facility.
