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Aetna Insurance Coverage for Drug Rehab in Missouri

On this page, you will learn about Aetna of Missouri coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
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Aetna of Missouri COVERAGE FOR DRUG AND ALCOHOL REHAB PROGRAMS

Provider Overview

Aetna Missouri: Rehab & Detox Centers in MO That Take Aetna Insurance

Missouri, also known as the “Show Me” State, is home to about 6,168,187 people.1, 2 In Missouri, Kansas City is the largest city by population, with about 505,272 people living there.3 Behind Kansas City, St. Louis (292,047 people), Springfield (168,911 people), and Columbia (125,181 people) are the next largest cities.3

From 2015 to 2016, there was a 35% increase in opioid overdose deaths, reaching 908 deaths in 2016, placing Missouri at 19th in the nation for opioid overdose deaths.4 According to the St. Louis County Prescription Drug Monitoring Program, there are 95 painkiller prescriptions per 100 people in Missouri, and more than 1,000 people are treated each day in emergency departments for misuse of prescription opioids.5

What’s more, of the Missouri adults over the age of 18, 25.1% reported binge drinking in the past month and 11.45% reported illicit drug use in the past month.6, Table 14 and Table 1 respectively From 2017 to 2019, about 7.1% of the state’s total population aged 12 or older (364,000 people), reported past-year substance use disorder7, pg 26

As these statistics show, substance use and addiction are prevalent throughout the state—meaning that if you are struggling with substance use or addiction, you’re not alone. Many Missourians got treatment at MO rehab facilities in a single-day count in March 2019, revealing a total of 19,996 people in treatment. 7, pg 27 Getting treatment, however, can come at a cost. Fortunately, if you have a health insurance plan, like Aetna of Missouri health plan, you may be able to use your insurance to cover the cost of care.

Aetna of MO plans vary in the types and breadth of mental health and detox benefits, so it’s important to check your benefits before seeking care. Regardless, there are rehab and detox centers in MO that may take your Aetna of MO health insurance. Click here to find a Missouri rehab and detox center that takes Aetna insurance.

Does Aetna of Missouri Insurance Cover Inpatient Alcohol and Drug Rehab Centers?

Aetna of MO health plans varies in the amount and types of coverage they provide for mental and behavioral health services, including inpatient alcohol and drug rehab center coverage. Despite this, most Aetna of Missouri health plans provide coverage in some capacity for MO rehab facilities and MO detox centers, including inpatient programs. This means that you may be able to use your Aetna of MO health plan to fully or partially cover the costs of rehab, depending on your plan’s details and network.

The best way to check your benefits and coverage is to call the number on the back of your Aetna plan card to speak to an Aetna of MO representative. They’ll help you learn more about your plan details, including what may or may not be covered. You can also go online to your Aetna of Missouri member portal.

Some rehab centers, such as the American Addiction Centers facilities with treatment centers across the country, can work with you directly to verify your benefits for you. You can call the AAC confidential helpline at 888-730-1995 to speak with a real person who can walk you through your coverage details over the phone.

What Is Aetna of Missouri?

“Aetna of Missouri” isn’t a specific plan that you have. Rather, it refers to the various plans across the markets Aetna services within the state of Missouri. Aetna is a multinational insurance company that has been providing insurance products since 1853, and health insurance plans specifically since 1899. 8, “1853-1873” and “1895-1915” Today, more than 39 million people across the United States have health insurance coverage or are served by an Aetna health product.9

There are a variety of health products provided by Aetna, including health plans from the private (individual and family) market, employer-sponsored (group health) plan market, Medicare, and Medicaid plan markets.9 Aetna also provides health solutions via their medical management plans, pharmacy and dental plans, and behavioral health programs.9

What Substance Addiction Does Aetna MO Rehab Treatment Centers Cover?

Aetna of MO plans generally provides some type of coverage for substance addiction, regardless of the type of substance in question. This means that Aetna of MO plans may cover the cost of substance addiction treatment for substances like alcohol, cocaine, heroin, crystal meth, opioid, marijuana, and prescription drugs. Call the number on the back of your Aetna MO plan to learn more about your specific Aetna plan’s coverage details.

How Much Does Aetna of Missouri Cover (Addiction Treatment)?

The exact details surrounding how much Aetna of Missouri plans cover addiction treatment will vary based on your specific plan. Despite this differing coverage amount, Aetna of MO may cover some or all of the cost of the following treatments:

  • Inpatient/residential rehab—Patients in an inpatient program or residential rehab typically stay at a facility 24/7 for the duration of their treatment (e.g., days, weeks, or months) to receive the medically supervised care that they may need.10, Pg 8, “What types of treatment programs are available?” Para 2, 11, pg 8, para 1
  • Outpatient rehab/therapy—Patients in an outpatient program or outpatient therapy program typically visit a facility once or twice a week to receive therapy or counseling, but return home after their session.10, Pg 10, Para 2
  • Intensive outpatient programs (IOP)—Patients in an IOP typically need to attend a minimum number of hours of care each week, where they’ll receive more structured care than they would in a standard outpatient program setting.10, Pg 10, Para 3
  • Partial hospitalization programs (PHP)—Patients in a PHP program, which is commonly referred to as a day program, typically attend sessions at a facility for a set number of hours per day (e.g., 4-8 hours), multiple days per week. There is no overnight stay required with this program.10, Pg 10, Para 1

What may be involved in your care, if you enter any of these programs, may vary based on the recommended course of treatment on your journey. Additionally, it is not guaranteed that your Aetna of MO plan will fully or partially cover the costs of these types of treatment. Please verify your benefits with the rehab center directly or Aetna of MO before seeking care when possible.

Does Aetna of Missouri Insurance Cover Inpatient Mental Health Care Facilities?

Almost all health plans in the United States, which include Aetna of MO plans, are required by federal law—the Affordable Care Act—to provide some level of coverage for mental health and substance abuse services, as they’re deemed to be essential health benefits.12 This means that your Aetna mental health coverage benefits must include some level of coverage for inpatient mental and behavioral health services, substance use disorder treatment (e.g., MO detox and MO drug rehabilitation), and behavioral health treatment.12

Mandated coverage can help ensure that those who need co-occurring disorder treatment or only stand-alone rehab for drugs like heroin can get the care they need and that the cost of this care may be fully or partially offset by insurance. Co-occurring disorder treatment refers to the coordinated approach by professionals to treating an individual’s mental health and substance use disorder conditions, which are occurring simultaneously. 13, para 2 Both a mental health and substance use disorder can exacerbate the other, which is why getting treatment for both conditions is imperative to recovery.13

How Long Does Aetna of Missouri Insurance Cover Inpatient Alcohol and Drug Rehab Program?

The length of time that your Aetna of MO insurance plan may cover inpatient alcohol and drug rehab programs will vary depending on the plan you are enrolled in. To learn more about your plan’s coverage details, please call the number on the back of your Aetna of MO plan card.

It’s important to note that, regardless of what your plan’s coverage details allow, remaining in treatment for an appropriate amount of time is connected to successful recovery outcomes. Specifically, many mental health experts believe that remaining in treatment for at least 3 months can help reduce or totally stop the usage of substances and improve outcomes.14, bullet 5

What if My Aetna of Missouri Policy Does Not Cover an Inpatient Drug Rehab Program?

It is possible that your Aetna of MO plan may not fully or partially cover the costs of addiction treatment, including an inpatient drug rehab program. Coverage is solely based on the plan that you have, its network stipulations, where you receive care, and your overall plan design. Call the number on the back of your insurance card to learn more about plan details, or call the rehab facility directly and ask for help verifying your benefits.

If your Aetna of MO plan doesn’t partially or fully cover the cost of rehab, do not panic. Depending on the rehab center at which you receive your care, there may be alternative payment options, such as special financing opportunities or scholarship opportunities to help you pay your portion of the cost of treatment. Be sure to ask an admissions navigator what the facility’s payment options include.

Receiving the care you need is more important than the cost of care. Pushing treatment down the road should not be a priority. Receiving care today should be the priority.

Aetna of Missouri In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

The difference between Aetna of Missouri plan in-network vs. out-of-network inpatient drug rehab centers depends on whether the facility or provider is under contract with Aetna of MO. An in-network provider (which could mean a facility, hospital, clinic, doctor, or specialist), is one that is contracted with Aetna to provide services at a pre-negotiated rate in exchange for guaranteed payment at the negotiated rate via insurance.15 These rates tend to be less than what non-Aetna members would pay if they visited the same doctor as an uninsured or a patient whose insurance isn’t contracted with the provider.

If you visit an out-of-network provider, some Aetna of MO will not cover any of these costs, which means that you’ll have to pay for the care out-of-pocket. Ultimately, it’s more cost-effective to visit an in-network- vs. out-of-network inpatient drug rehab provider, as in-network providers are generally covered by your plan. Because out-of-network providers aren’t typically covered, you probably won’t have insurance assistance in paying for the costs of care.15

You can call the number on the back of your insurance card to check whether a provider is in-network with Aetna of MO. Or, you can log in to your member portal and use the Aetna of MO provider directory, work with a rehab center directly, or click here for help verifying your benefits and coverage. Finally, you can also call the AAC confidential helpline to find an in-network provider.

How to Find Aetna of Missouri Covered Inpatient Drug Treatment Centers in MO?

Deciding what the first step will be on your recovery journey can feel overwhelming. Fortunately, AAC is here to help, especially with finding an in-network inpatient drug rehab center in MO that accepts Aetna of MO insurance. The AAC admissions navigators are here to help you every step of the way. Whether you need help verifying your benefits and coverage or finding a covered luxury rehab center near you, the staff can work with you while you’re on the phone, providing high-quality, compassionate service so that you don’t feel like you’re on this journey alone.

There are 39 million people across the nation covered by an Aetna health plan, which means it’s safe to assume that you’re among thousands that will be using their Aetna of MO plan to finance the costs of rehab. Specific numbers of individuals who use their insurance to finance rehab are not known, but statistically speaking, it is a common occurrence. If you’re ready to begin your journey or start learning information about finding an Aetna of MO-covered rehab facility or want to learn more about the AAC’s leading rehab centers across the country, pick up the phone today and call the confidential helpline at 888-730-1995. You can also click here to find a treatment center near you.

How to Read Your Insurance Provider Card
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  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
Sources
  1. Missouri Secretary of State. (n.d.). Missouri history.
  2. United States Census Bureau. (2021, July 1). QuickFacts, Missouri.
  3. World Population Review. (2020). Top 500 cities in Missouri by population.
  4. Missouri Overdose Rescue and Education. (2017). Missouri opioid data factsheet.
  5. Louis County Public Health. (n.d.). The role of prescription drug monitoring programs as part of improved patient care.
  6. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2021). 2019-2020 National survey on drug use and health: Model-based prevalence estimates (50 states and the District of Columbia).
  7. Substance Abuse and Mental Health Services Administration. (2020). Behavioral Health Barometer: Missouri, Volume 6: Indicators as measured through the 2019 National Survey on Drug Use and Health and the National Survey of Substance Abuse Treatment Services.
  8. (n.d.). Our history.
  9. (n.d.). Aetna facts.
  10. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment. (Original work published 2006).
  11. Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment? (Original work published 2004).
  12. gov. (n.d.). Mental health & substance abuse coverage.
  13. Substance Abuse and Mental Health Services Administration. (2020, April 30). Mental health and substance use disorders.
  14. National Institute on Drug Abuse. (2018 January). Principles of drug addiction treatment: A research-based guide (third edition), principles of effective treatment.
  15. (n.d.). Network and out-of-network care.

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