If you have Aetna or Cigna insurance and you are exploring addiction treatment, this guide shows you how to verify benefits step by step. You will learn how to read your insurance plan, what to ask your insurance providers, and how to avoid unexpected out-of-pocket costs before starting an addiction treatment program.
For direct help determining your benefits at Santé Center for Healing in Argyle, Texas, you can verify your insurance online or call 866.238.3154. Our expert team is ready to assist you in understanding your coverage and guiding you through the verification process to ensure a smooth start to your recovery journey.
Does health insurance cover rehab?
Insurance coverage for rehab center services may include medical detox, inpatient rehab, outpatient services, and therapy. Under the Affordable Care Act, most private insurance plans and small group health plans must cover mental health services and substance abuse treatment as essential health benefits, which means health insurance companies have to pay for at least a portion of your treatment. However, each insurance company sets specific rules for cost sharing and authorization.
Why verifying coverage is crucial for addiction treatment
Confirming coverage before your first appointment protects your health and your finances. Verifying details with your insurance provider helps you understand outpatient vs. inpatient rehab coverage, deductibles, co-pays, coinsurance, and any coverage limits. This can prevent delays, avoid unnecessary out-of-pocket expenses, and support coordinated care once you receive treatment.
It also clarifies whether your preferred treatment center is in network, how prior authorization works, and whether there are utilization review checkpoints. In many plans, insurance pays for services after you meet the deductible, or you share costs through coinsurance up to your maximum out-of-pocket amount.
For help with verifying insurance, call our team at 866.238.3154, or start insurance verification online.
Step-by-step guide to verify your Aetna or Cigna insurance coverage
1. Gather information and materials
- Your insurance ID card (for your member ID and group number)
- Your personal details (date of birth, address, and ZIP code linked to your policy)
- Any recent letters or emails about coverage, preauthorization, or claim denials
- The name of the treatment center and type of program (inpatient, outpatient, medical detox) you want to ask about
- A notepad or phone notes app to record the representative’s name, call reference number, and what you discussed
2. Contact your insurance provider
- Call the Member Services number on your insurance card.
- If your plan lists a separate line for Behavioral Health or Substance Use Services, use that one to reach the right person faster.
- When connected, say something like: “Hi, I’m calling to verify my benefits for behavioral health treatment, specifically addiction and mental health services. I’d like to know what’s covered and how much total out-of-pocket costs I can expect to pay.”
3. Ask about coverage and costs
- Coverage Basics:
“Does my plan cover treatment for substance use and mental health services?”
“Are residential/inpatient care, outpatient treatment, and detox programs included?” - Network and Authorization:
“Is [treatment center name] in-network?”
“Do I need prior authorization or a referral for rehab treatment?”
“How long does authorization take once it’s requested?” - Costs and Billing:
“What are my deductible, copays, and coinsurance for these services?”
“Are my costs different for in-network vs. out-of-network care?”
“What is my maximum out-of-pocket? How close am I to my deductible and MOOP for the year?”
4. Record what you learn
- The representative’s name
- The date and call reference number
- The answers you received about coverage, costs, and authorizations
5. Confirm details in writing
- Ask the representative to send a written summary of your benefits or post it to your online member account.
- Save your notes and any documents for future reference; you may need them if coverage questions come up later.
Once you have gathered your notes and received written confirmation from your insurance company, you’ll have a clear picture of what’s covered and what your financial responsibilities may be. From here, you can take the next step: connecting with a treatment provider to discuss program options and start the admissions process with confidence.
Next steps
Aetna insurance and Cigna insurance typically cover rehab services as essential health benefits when they are medically necessary, and when the rehab provider is in-network, but each insurance plan differs in its exact addiction treatment coverage.
When you are ready, contact Santé Center for Healing in Argyle, TX, to review your approvals and schedule care. Call 866.238.3154 or contact us online so our team can guide you through your next steps toward recovery.