Aetna Rehab Coverage for Addiction Treatment in North Carolina

Find out if addiction treatment in North Carolina is covered by your Aetna Health Insurance Policy – or verify your insurance coverage with Southeastern Recovery Center now.

Aetna Insurance Coverage for Addiction Treatment in North Carolina

One of the biggest obstacles that people face when seeking addiction treatment is the cost. For many North Carolina residents, trying to figure out the financial aspect of mental health and addiction treatment is the biggest deterrent to actually getting treatment. According to the National Alliance on Mental Illness, of 452,000 adults in North Carolina who did not seek treatment for their mental health, 44.8% did not due to financial constraints.

As a part of the Affordable Care Act (ACA), also known as Obamacare, provisions were included that aimed to improve access to mental health services and insurance coverage for mental heath conditions. Addiction, categorized under the broader term “substance use disorder” (SUD) in diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association, or the International Classification of Diseases (ICD-10) published by the World Health Organization.

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What is Aetna Healthcare?

Aetna is one of the oldest and largest health insurance companies in the United States, with a history dating back to the 19th century. Here’s a brief timeline of its history:

Types of Aetna Plans Available

Aetna offers a variety of health insurance plans to meet the diverse needs of individuals, families, employers, and other groups. The specific plans available may vary depending on factors such as location and eligibility. Here are some common types of Aetna plans:

  • Health Maintenance Organization (HMO) Plans: HMO plans typically require members to choose a primary care physician (PCP) and obtain referrals from the PCP to see specialists. These plans often have lower out-of-pocket costs but require members to use network providers for covered services.
  • Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility in choosing healthcare providers. Members can see any healthcare provider, but they usually pay less when they use network providers. PPO plans typically do not require referrals to see specialists.
  • Exclusive Provider Organization (EPO) Plans: EPO plans are similar to PPO plans but have more restrictions on out-of-network coverage. Members typically must use network providers for all covered services, except in emergencies.
  • High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs): HDHPs have higher deductibles than traditional health plans, but they often come with lower premiums. Members can pair an HDHP with an HSA, a tax-advantaged savings account used to pay for qualified medical expenses.
  • Point of Service (POS) Plans: POS plans combine features of HMO and PPO plans. Members choose a primary care physician and can receive referrals for specialist care, but they also have the option to see out-of-network providers at a higher cost.
  • Medicare Advantage Plans: Aetna offers Medicare Advantage plans, also known as Medicare Part C, which provide all the benefits of Original Medicare (Parts A and B) plus additional benefits such as prescription drug coverage (Part D) and vision or dental coverage.
  • Medicare Supplement (Medigap) Plans: These plans help cover some of the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance. Medigap plans are designed to work alongside Original Medicare.

These are just a few examples of the types of Aetna plans available. It’s important for individuals to carefully review plan options and consider their healthcare needs and budget when selecting a health insurance plan.

Important Terms to Know When Reviewing Your Aetna Insurance Coverage

Sometimes looking at your Aetna insurance policy can look like it is written in a foreign language – especially if you are already overwhelmed by the process of looking for addiction treatment in North Carolina. There are some key terms you need to be aware of when determining what is covered by your policy – something that your addiction treatment facility will be able to help you with if you are unsure.

Aetna Insurance Coverage for Addiction Treatment in North Carolina

Copayment (Copay): A fixed amount that you pay for covered healthcare services at the time of service. Copayments are typically defined for specific services or prescription drugs, and the amount can vary depending on the type of service and the terms of your plan.

Deductible: The amount you must pay out of pocket for covered healthcare services before your insurance plan starts to pay. Deductibles can vary depending on your plan, and some services may be covered before you meet your deductible, such as preventive care.

Coinsurance: The percentage of costs you pay for covered healthcare services after you’ve met your deductible. Coinsurance typically applies after you’ve reached your deductible and is a shared cost between you and your insurance plan.

Out-of-Pocket Maximum (OOP Max): The most you have to pay for covered services in a plan year. Once you reach your out-of-pocket maximum, your insurance plan pays 100% of the allowed amount for covered services for the rest of the plan year.

Network: A group of doctors, hospitals, and other healthcare providers that have contracted with your insurance company to provide services at a discounted rate. There are two main types of networks:

In-Network: Providers who have agreed to accept negotiated rates with your insurance company. Using in-network providers typically results in lower out-of-pocket costs.

Out-of-Network: Providers who have not agreed to the negotiated rates with your insurance company. Using out-of-network providers may result in higher out-of-pocket costs, or the services may not be covered at all.

Prior Authorization: Some services or treatments require prior authorization from your insurance company before they will be covered. This means your doctor must get approval from your insurance plan before providing the service or treatment.

Formulary: A list of prescription drugs covered by your insurance plan. Formularies typically categorize drugs into tiers, with different cost-sharing amounts for each tier.

Preventive Care: Healthcare services that focus on preventing illness or detecting health problems early when they are easier to treat. Preventive care is often covered at no cost to you under most insurance plans, including Aetna plans.

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Getting Help with Your Aetna Insurance Coverage for Addiction Treatment in North Carolina

As one of the oldest insurance companies in the country, Aetna services millions of patients each year – but it doesn’t mean that terminology and verifying benefits has gotten any easier. When you are looking for addiction treatment, the biggest worry you may have is how the financial part of it works, but don’t worry, Southeastern Recovery Center is here to help. 

Our staff is trained in handling your Aetna insurance coverage questions and we even offer online verification of benefits. We try to make the process as easy and as transparent as possible – that way you aren’t held back by the cost of addiction treatment in North Carolina.

If you are ready to get started, give Southeastern Recovery Center a call to get started verifying your Aetna insurance coverage for addiction and mental health treatment.

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