Introduction to Cigna Insurance Coverage
One of the most-used insurance providers is Cigna, a health services company that insures treatment between 180 million providers and patients.
If you have Cigna health insurance (or you’re thinking about choosing Cigna for your provider), you’re probably thinking about treatment options and costs already.
It’s smart to start thinking about how to pay for drug rehab treatment as soon as you can. Having a plan in place can speed the process along and get you into recovery faster.
About Cigna Insurance Coverage
We can’t tell you what treatment coverage your own plan offers—the specifics are often different from plan to plan. But we can give you the answers to your biggest questions about Cigna insurance coverage.
These are the questions we hear the most about Cigna insurance plans:
Will My Addiction Treatment Be Covered By My Cigna Insurance Plan?
First: we can’t predict what your addiction treatment coverage looks like, and we can’t say for 100% certainty that you’re covered without seeing your plan. Always call the Member Services number on your Member ID card if you have questions about coverage!
However, the Affordable Care Act of 2010 made it illegal for insurers to discriminate or refuse to cover treatment based on pre-existing conditions. Substance use disorder is considered a pre-existing condition, so it’s protected for as long as the Affordable Care Act is active.
What does that mean for you and your treatment coverage?
As long as you have a long-term policy (short-term policies are excluded, but those are rare), you’re very likely to have your addiction treatment covered (in part or fully) by Cigna, or any other insurance provider.
That’s not a guarantee, of course. Every Cigna plan is different, so you may find that the treatment you want isn’t on the list of what’s covered. You may need to change your rehab plans to choose an in-network provider or insurance-approved treatment option.
Always check with Member Services to find out what your plan covers. They can give you details specific to your plan that you can’t find anywhere online.
How to Check Cigna Addiction Treatment Coverage
It can be hard to navigate insurance benefits, so it’s common to be unsure about your exact coverage (even if you know it’s covered to some extent).
It’s important to know your coverage details before you enter treatment so you don’t end up with any surprise bills or find out at the last moment that your treatment isn’t covered.
Luckily, you can check your addiction treatment coverage with Cigna in a few different ways.
- Calling your chosen treatment center: The Admissions office of your treatment center typically handles insurance for you. That can include confirming your coverage before you enter treatment. They’ll also help you meet any prerequisites for getting treatment covered, like referrals or pre-authorization.
- Checking with Cigna Member Services: You’ll find a phone number for Member Services on your Cigna insurance card. Call this number to ask questions about your insurance plan, including coverage for addiction treatment.
- Logging into myCigna: MyCigna is the online portal for members to access coverage and claims information. You can use this portal for self-service without calling a number, but it can be a little difficult to navigate if you’re not familiar with it.
How Does Cigna Rehab Coverage Work?
Once you learn the specifics about coverage for your particular plan, you can start the process of actually getting covered.
Most of the time, you need to get prior authorization or precertification before entering treatment if you want to get covered. (Some Cigna plans may not require this, but it’s the norm with nearly all long-term plans.)
A prior authorization is a decision by your insurance provider (in this case, Cigna) to cover your medical treatment or service, in this case addiction treatment. You may need to document or establish that your substance use disorder requires treatment.
In most cases, you’ll start by getting a referral from your primary care doctor or a specialist (such as a psychiatrist). That referral signifies to Cigna that treatment for substance use disorder is medically necessary so they can cover it.
Once Cigna authorizes coverage, you can enter treatment and your rehab’s admissions office handles the rest of the billing process.
In some cases, your Cigna plan may cover 100% of your substance use disorder treatment. In others, you may be responsible for a copay or coinsurance, or a patient-covered portion of the treatment cost.
Before entering treatment, you’ll receive a financial responsibility summary that outlines what your insurance covers and what portion you’ll be responsible for covering. This helps you understand what to expect in terms of cost.
Do Cigna Insurance Plans Cover Addiction Treatment?
Most long-term Cigna health insurance plans do cover addiction treatment (still, always check to make sure that’s true of yours!)
However, that coverage is often different from plan to plan. For instance, two different kinds of plans that are common are HMO and PPO.
HMO stands for Health Maintenance Organizations. With this type of plan, you can only get coverage if you attend treatment with an approved provider in their network.
These plans tend to have lower deductibles and lower copays, so their coverage is less flexible but more affordable.
PPO stands for Preferred Provider Organization. With a PPO, you get more flexibility about what providers you can use. You can choose a provider that is in- or out-of-network for your Cigna plan, and get it covered either way.
The difference is that the deductible and copays tend to be higher, so the coverage is more flexible but also more costly.
Service and Costs
Cigna Coverage for Detox Rehab Treatment
Before treatment, the cost of detox can run $250 to $500 per day. However, that won’t be the final cost that you pay out-of-pocket in most cases.
That means as long as a medical detox program is approved by Cigna, you can probably expect detox to be covered-as long as you don’t have a plan that’s exempt from the Affordable Care Act, like a temporary plan.
The actual amount that Cigna covers depends on your plan, whether you choose an in-network provider, and other factors.
To make sure Cigna covers your detox, check with Member Services for a list of detox treatment programs that are in-network.
Cigna Coverage for Inpatient and Residential Rehab Services and Costs
Before your insurance coverage kicks in, the initial cost of inpatient programs can be $14,000 to $27,000 for a 30-day residential program.
But with Cigna insurance, you’re not likely to spend that much out-of-pocket.
The Affordable Care Act protects inpatient and residential rehab programs as medically necessary for patients with substance use disorder, so it’s uncommon for residential coverage to be denied (unless you fail to follow other rules, like pre-authorization procedures).
Whether Cigna covers your inpatient rehab program largely depends on:
- Whether the inpatient or residential program is in-network or out-of-network (unless your plan is PPO, in which case it will be covered to some degree either way)
- Whether the program and provider are approved for coverage by Cigna—which depends on whether the program and facility follows best practice for safe and effective evidence-based addiction treatment.
As always, a common exception for coverage in this case is having a short-term or temporary healthcare plan. Those plans typically cover emergencies, but exclude pre-existing conditions like substance use disorder.
To learn the details for your Cigna plan’s inpatient or residential treatment coverage, check with the Member Services team. You can reach them by calling the phone number listed on your Member ID card.
Medication-Assisted Treatment Services and Costs
In most cases, Cigna should cover treatment for medication-assisted treatment. There are exceptions to the rule, as always, so you should find out the specifics for your own plan before making any decisions about paying for treatment.
Before insurance kicks in, the cost of MAT medication and appointments alone can be:
- $126 per week for methadone treatment
- $115 per week for buprenorphine treatment
MAT is more effective when it’s part of a certified opioid treatment program (OTP), which pairs medication with behavioral treatment and social support to get the fullest benefit from it.
An OTP with naltrexone treatment can cost $1,126 per month.
Remember, though, most people with Cigna insurance won’t pay the full price for medication-assisted treatment programs.
As long as you work with your insurance company and chosen rehab to make sure it’s compatible with your plan, it’s more likely than not that Cigna covers your MAT in full or in part.
That means Cigna (and other insurance companies) must pay for MAT if it’s deemed medically-necessary for someone with substance use disorder.
Check with Cigna and with your rehab to make sure that your treatment will be covered.
What Types of Addiction Treatment Are Covered By Insurance?
Cigna covers addiction treatment for any substance that falls under the substance use disorder diagnosis umbrella.
There are 9 different categories of SUD types, including:
- Alcohol-related disorders
- Opioid-related disorders, including heroin and prescription opioid drugs (like tramadol or oxycodone)
- Stimulant-related disorders, including meth, cocaine, and prescription stimulant drugs (like amphetamine or methylphenidate).
Is Alcohol Addiction Treatment Covered By Cigna Insurance?
Under the Affordable Care Act, Cigna is required to cover medically-necessary treatment for alcohol-related disorders.
Those disorders include:
- Alcohol abuse disorder
- Alcohol dependence disorder
- Alcohol use disorder
The treatment programs that your Cigna plan covers might include:
- Detox programs for alcohol treatment: Detoxing from alcohol can be medically dangerous without medical supervision. Detox programs keep you comfortable and safe with supportive care.
- Residential or inpatient programs for alcohol treatment: These programs are the first-line treatment for alcohol disorders. Your experience may include evidence-based behavioral treatments like cognitive-behavioral therapy or dialectical behavior therapy. 12 Steps is a common element, too.
- Medication-assisted treatment programs for alcohol treatment: MAT programs include the use of medications to control alcohol cravings. The most commonly-used medications include naltrexone, disulfiram and acamprosate. These programs work best if they also utilize behavioral treatment.
Your insurance probably won’t cover treatment for your alcohol-related disorder if you have a temporary policy or if you fail to follow the process for prior authorization of treatment.
Also, your alcohol rehab treatment may not be covered if the program or treatment provider isn’t in your Cigna plan’s network and you’re part of an HMO plan.
Check with Cigna beforehand to confirm what’s covered and where. Member Services can help you find out the specifics for your plan and situation.
Is Cocaine Addiction Treatment Covered By Cigna Insurance?
Cigna insurance plans usually cover cocaine addiction treatment if you have stimulant use disorder and require medically-necessary treatment.
Since the Affordable Care Act of 2010, Cigna and other insurance companies are required to cover medically-necessary treatment for people with stimulant use disorder.
(The exception is short-term plans, which aren’t required to cover people with pre-existing conditions like stimulant use disorder.)
The exact coverage (full or partial) that you get depends on:
- Your plan and policy
- Whether the treatment provider is in-network or out-of-network
- Whether the treatment itself is approved for stimulant use disorder
- Whether you have a long-term policy or a short-term one
Check with Cigna to find out exactly what’s covered under your plan. Alternately, you can check with your rehab and see if they accept your insurance. If they do, the rehab admissions team can often contact Cigna and navigate the process for you.
Most Cigna policies cover these types of addiction treatment:
- Detox: Stimulant withdrawal can be uncomfortable, and your risk of relapse is higher during that time. Detox programs can keep you safe while withdrawing from meth, cocaine or prescription stimulants.
- Residential or inpatient: Residential and inpatient programs are the top standard of care for stimulant use disorder. They allow you to receive 24/7 care in a recovery-focused environment.
Medication-assisted treatment isn’t proven to work for stimulant use disorder, so Cigna won’t cover it in this case (but they will cover it for opioid use disorder or alcohol use disorder).
Is Heroin Addiction Treatment Covered By Cigna Insurance?
Heroin addiction treatment is almost always covered by Cigna. That’s because the Affordable Care Act makes it mandatory for insurance companies like Cigna to discriminate against covering people who have pre-existing conditions.
If you have a short-term health policy, then that’s one of the only exceptions. These policies won’t cover pre-existing conditions.
The coverage that you can get might be full or partial. The exact amount of coverage depends on your policy and whether you’re in- or out-of-network.
Cigna might not cover your heroin addiction treatment if you:
- Don’t get a referral for treatment
- Don’t follow the prior authorization procedure
- Don’t attend a rehab within network (if you have an HMO)
- Don’t choose an approved program
The types of heroin treatment that you may be able to get covered (always double check to be sure) include:
- Detox: Heroin withdrawal can be extremely uncomfortable, and that discomfort increases the risk of relapse. Medical detox can provide supportive care, keeping you comfortable and away from temptations to relapse.
- Residential or inpatient treatment: Inpatient and residential programs offer the highest level of care for people with heroin use disorder. The experience often includes behavioral treatment, MAT, group support and counseling.
- Medication-assisted treatment: MAT is a common way for people in recovery to maintain. It’s also effective in initial treatment. For heroin use disorders, MAT may include medications like naltrexone, buprenorphine and methadone.
Call Member Services for Cigna if you have any questions about your coverage for heroin use disorder treatment. They can help you understand what’s covered and what your responsible portion is.
Is Meth Addiction Treatment Covered By Cigna Insurance?
In most cases, Cigna does cover meth addiction treatment.
If you have stimulant use disorder, stimulant dependence disorder, or stimulant abuse disorder, then the Affordable Care Act protects you under the clause for pre-existing conditions.
That means Cigna (and other insurance companies) must cover your treatment if it’s medically necessary.
In most cases, you’ll do that by:
- Establishing a diagnosis with a primary care doctor or a specialist
- Getting a referral from your primary care doctor
- Following the prior authorization process
The exact amount that Cigna covers depends on your policy and plan, whether your rehab is in network, whether the treatment is approved and more.
The types of treatment that Cigna may cover for meth addiction include:
- Detox treatment, which includes supportive care such as hydration and medications for comfort. Without detox, you’re more likely to experience a relapse.
- Behavioral treatment such as contingency management, Internal Family Systems therapy and motivational interviewing.
- Residential treatment, or inpatient treatment, both of which include behavioral treatment, counseling and other forms of treatment for stimulant use disorders.
To get the details on which treatments and which treatment centers are covered, call the phone number for Cigna Member Services on the back of your insurance card.
Is Prescription Drug Addiction Treatment Covered By Cigna Insurance?
Prescription drug addiction treatment is often covered by Cigna health insurance. That includes illicitly-used stimulant and opioid medications, such as Adderall, Ritalin, Vicodin or OxyContin.
The Affordable Care Act says that Cigna must cover treatment for pre-existing conditions if it’s medically necessary. Substance abuse treatment is medically necessary for people who have opioid use disorder or stimulant use disorder.
You may need to establish that your treatment is medically necessary by going to your doctor for a referral and participating in a pre-authorization process. In most cases, you’ll receive partial or full coverage for treatment after this.
The exception is if you have a temporary healthcare plan, which won’t cover treatment for pre-existing disorders like opioid or stimulant use disorders.
The types of treatment that are most often covered for prescription drug addiction include detox programs, residential programs, inpatient programs and medication-assisted programs (for opioids only).
Do Treatment Centers Need to Be In-Network?
A treatment center doesn’t have to be in-network for you to be eligible for coverage through Cigna—as long as you have a PPO.
PPO plans offer the flexibility to see providers in- or out-of-network. The only difference is that you’ll spend more in copays and coinsurance if you see an out-of-network provider.
If you have an HMO plan, then your treatment center does have to be in-network to receive any coverage.
Talk to Member Services to figure out whether your plan is HMO or PPO, and to determine which treatment centers are in-network if it’s relevant to you.
How Can I Pay the Costs Not Covered By My Cigna Plan?
While some plans pay for 100% of addiction treatment, most patients find that there’s some portion of the cost left to pay.
That could be in the form of a deductible; an amount of money that you must spend on your own healthcare before the insurance company will give you coverage.
Or it could be in the form of coinsurance or copays. The bottom line is, you can pay the portion that you’re responsible for by:
- Contacting your treatment center to discuss financing
- Reaching out to your local social assistance office to take advantage of local-only programs for substance use disorder treatment
- Negotiating with insurance on the bill if you have prior authorization and think that you may be able to get more coverage