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Aetna Texas Health Insurance Coverage for Rehab

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

Provider Overview

Aetna Texas: Rehab & Detox Centers in TX That Take Aetna Insurance

Texas, commonly known as the Lone Star State, is home to 29,527,941 people.1 This statistic makes it the second-largest state in the country by population, and it’s also the second-largest state in the country in terms of geographical area.2

Texas, which was the 28th state to become part of the union in 1845, extends about 1,000 miles from north to south and east to west.2 What’s more, 5 of the nation’s top 15 most populous cities are in Texas, including the state’s capital of Austin and Houston, Dallas, San Antonio, and Fort Worth.3, “United States file”

Like other states in the south and across the country, substance use, including heroin use, is prevalent in the Lone Star State. From 2018 to 2019, 1,360,000 Texan adults (i.e., those over the age of 18) experienced past-year substance use disorder.4, pg 1 Of that same age group, past-month illicit drug use was reported by 1,877,000, past-month binge alcohol use was reported by 5,551,000, and past-year alcohol use disorder was reported by 1,038,000.4, pg1

As you can see, substance use disorder and addiction are common in the state of Texas, so if you’re struggling, you’re not alone. One of the first steps on the path to recovery is to enter a rehab or detox center for treatment, which can come at a cost. Fortunately, if you have insurance, including a Texas Health Aetna plan, you may be able to use your health insurance plan to cover all or some of the costs of rehab or detox.

For a list of rehab and detox centers in TX that take Aetna Insurance, click here.

Does Texas Health Aetna insurance cover Inpatient Alcohol and Drug Rehab Centers?

Your Texas Health Aetna insurance may fully or partially cover inpatient alcohol and drug rehab centers. Coverage details will depend on your specific plan and the center where you receive your TX drug rehabilitation or detox services. Finding Texas Health Aetna substance abuse providers doesn’t have to be hard, and neither does verifying your coverage details.

TX rehab facilities can often check your coverage based on the information that you provide them. For example, all American Addiction Centers facilities can check whether your Texas Health Aetna insurance covers inpatient alcohol and drug rehab centers near you. You can reach out to AAC through various channels, including phone through the confidential helpline, chats, or filling out the SSVOB form.

Alternatively, to learn more about your specific plan or to check whether your Texas Health Aetna substance abuse treatment coverage extends to inpatient alcohol and drug rehab centers, you can call the number on the back of your insurance card.

What is Texas Health Aetna?

Texas Health Aetna isn’t just one health plan—but rather a phrase used to refer to the many different health plans that Aetna sponsors in Texas. Aetna is one of the largest health insurers in the country, providing coverage to about 39 million people across all states in the open healthcare model.5 Aetna is unique in that it provides health insurance products in every single market, including the Medicare and Medicaid markets, private individual and family market, as well as medical, pharmacy, and dental plans, behavioral health programs, medical management plans, and employer-sponsored health plans.5

Because Aetna services all of these insurance markets, there are a wide variety of plans and plan networks offered in the state of Texas. Use the Aetna Texas online directory to check and see how many rehab centers are in-network with your Aetna Health Texas plan.6 Networks are specific to each individual plan, therefore, it’s impossible to say how many rehab centers are in-network with every plan.

Aetna has been in the insurance market since 1853 but sold its first health insurance solution in 1899.7, “1853-1873” 7, “1895-1915” Over the past 123 years, Aetna has been working to ensure its members have the top-tier quality plans they deserve.

What Substance Addiction Does Aetna TX Rehab Treatment Centers Cover?

Aetna TX rehab treatment centers may cover a variety of substance addictions. This could include addiction to common substances, such as alcohol, cocaine, heroin, crystal meth, opioid, marijuana, and prescription drugs. Call the number on the back of your insurance card today to learn more about the substance addiction that your specific Texas Health Aetna health and rehab coverage may include.

How Much Does Texas Health Aetna Cover (Addiction Treatment)?

How much your Texas Health Aetna plan covers treatment for substance use, or addiction will vary based on your specific plan, your location, and the health care provider. Despite these variances, it’s essential to know some of the most common treatment types, which Texas Health Aetna may fully or partially cover:

  • Inpatient programs. With an inpatient program, a patient lives at a facility, staying for days, weeks, or months, where they can receive round-the-clock medical supervision and care, which could include medical detox.8, Pg 8, “What types of treatment programs are available?” Para 2, 9 This type of program may also be recommended for those just beginning their addiction treatment, as it provides more structure and support than other types of treatment.9, pg 8 para 1
  • Outpatient programs. An outpatient program is typically recommended for patients with less severe addiction or who only need ongoing care for managing their treatment.9, pg 6 With outpatient programs, patients usually visit the facility once or twice a week, but they don’t stay overnight.8, Pg 10, Para 2
  • Intensive outpatient programs (IOP). An IOP involves a patient receiving treatment at an outpatient facility, which means they don’t need to stay overnight. Treatment takes place in several sessions each week.8, Pg 10, Para 3
  • Partial hospitalization programs (PHP). Also known as a day program, a PHP involves a patient going to a facility for 4-8 hours multiple days per week but not staying overnight.8, Pg 10, Para 1

Remember, not every treatment will be covered under your plan. Be sure to check with your Aetna Health Texas insurance plan representative to verify your benefits and coverage.

Does Texas Health Aetna Insurance Cover Mental Health Treatment Facilities?

Under the Affordable Care Act (ACA), almost all U.S. health plans, including Aetna Health Texas plans, must provide some coverage for mental health and substance abuse services, as they’re considered essential health benefits.10 Specifically, your Aetna mental health coverage must include coverage in some capacity for inpatient mental and behavioral health services, substance use disorder treatment, and behavioral health treatment.10

In addition, the ACA’s mandate states that plans cannot deny coverage based on pre-existing mental or behavioral health conditions.10 Plans cannot impose a maximum annual or lifetime spending limit on treatment for essential health benefits, such as mental or behavioral health services.10 What this means is that your health plan must provide some level of coverage for both stand-alone heroin rehab and co-occurring disorder treatment.

A co-occurring disorder refers to someone who has both a mental health disorder and a substance use disorder.11 Co-occurring disorders, also known as dual diagnosis, are relatively common. Of the 21 million Americans living with substance use disorder, 8 million also live with a mental health condition.12

Although it’s not direct causation that having a mental illness or substance abuse problem causes the other, statistically, substance abuse is twice as prevalent in those with mental illness.12 Because each condition can exacerbate the other, integrated treatment of both conditions at once is recommended.11

How Long Does Texas Health Aetna Insurance Cover Inpatient Alcohol and Drug Rehab Program?

The length of coverage for inpatient alcohol and drug rehab programs under Texas Health Aetna insurance will vary depending on your plan. Because there are many different types of Texas Health Aetna policies and tiers of coverage, the length of time covered by Aetna will depend upon your specific plan. To learn more about your specific plan details, call the number on the back of your insurance card.

Additionally, even though every person’s path to recovery is different, it’s generally accepted that extended treatment is more effective.13 Specifically, adequate treatment length is essential for good outcomes.13 In outpatient or residential programs, treatment should last at least 90 days to be considered effective or improve the odds of recovery.13

What if My Texas Health Aetna Policy Does Not Cover an Inpatient Rehab Program?

It is possible that, depending on the plan you have and where you receive treatment, your plan may not fully or partially cover the cost of your care. If this is the case, you may be responsible for paying out-of-pocket for the cost of treatment. Though this can seem daunting, some treatment facilities, like inpatient drug rehab programs or centers, may offer alternative payment options. For example, there may be financing or scholarship options available to you.

Remember, getting the treatment you need right now is critical rather than pushing it down the road.

Texas Health Aetna In-Network vs. Out-of-Network Inpatient Rehab Centers

Understanding the difference between an in-network and out-of-network inpatient drug rehab center or provider, in general, can help you keep your health care costs as low as possible. An in-network Texas Health Aetna provider is under contract with Aetna to provide their services to you (a covered member) at a pre-negotiated rate, which tends to be less than the same provider would charge a non-member.14 In exchange for offering these rates to covered members, Aetna guarantees payment to the provider at the negotiated rates.14

Depending on your plan, you may not receive coverage for visiting an out-of-network provider, which means that you would have to pay for the care at whatever rate the provider charges out-of-pocket.14 Generally, it is cheaper to see an in-network provider than an out-of-network provider.

To find an in-network provider, call the number on the back of your Texas Health Aetna plan card. Or, log in to your member portal online and use the Texas Health Aetna provider director. Another option is to work with rehab centers directly. For example, you can call the AAC helpline to ask for assistance in finding a luxury or nearby rehab center that takes your health plan.

How to find Texas Health Aetna Covered Inpatient Drug Treatment Centers in TX

If you’re ready to take the first step on your path to recovery, you may be wondering how to find a Texas Health Aetna-covered inpatient drug treatment center near you. American Addiction Centers, one of the nation’s top addiction treatment specialists, has facilities all over the country and works with various large insurers like Aetna. AAC has a leading treatment center located in Texas, the GreenHouse Treatment Center, that provides top-notch addiction treatment programs.

Using your Texas Health Aetna insurance plan to cover at least some of the rehab costs can help you get the care you need at a price you can afford. Though the number of people who use their Texas Health Aetna plan each year to finance rehab is unknown, with 39 million people covered by Aetna across the country, others likely use their Aetna insurance.5

Don’t wait any longer to find a covered inpatient drug or alcohol treatment center near you. Give the team at AAC a call through the confidential helpline and speak to a person who can check your benefits right while you’re on the phone.

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. United States Census Bureau. (2021, July 1). Quick facts, Texas.
  2. Wooster, R. A., Reddick, D. C., & McNamee, G. L. (2022, April 6).
  3. United States Census Bureau. (2021, July 1). City and town population totals: 2010-2019.
  4. Substance Abuse and Mental Health Services Administration. (2021, January 28). Texas – national survey on drug use and health: 2018-2019 state-specific tables.
  5. Aetna. (n.d.). Aetna facts.
  6. Aetna. (n.d.) Directory of Health Care Professionals.
  7. Aetna. (n.d.). Our history.
  8. Substance Abuse and Mental Health Services Administration. (2014). What is substance abuse treatment?
  9. Aetna. gov. (2017, April). Overview of substance use disorder (SUD) care clinical guidelines: a resource for states developing SUD delivery system reforms.
  10. Aetna. gov. (n.d.). Mental health & substance abuse coverage.
  11. Substance Abuse and Mental Health Services Administration. (2022, April 27). Mental health and substance use disorders.
  12. National Alliance on Mental Illness. Greenstein, L.(2017, October 4). Understanding dual diagnosis.
  13. National Institute on Drug Abuse. (2020, September 18). Principles of drug addiction treatment: A research-based guide (third edition), principles of effective treatment.
  14. Aetna. (n.d.). Network and out-of-network care.

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