Rehab Centers That Accept Aetna Insurance in Washinton, DC

September 30, 2019

Thanks to insurance coverage, people in need of substance abuse treatment can now get the care they need to overcome their disease and take the first steps towards a healthy lifestyle. It is important to realize, however, that each insurance plan is unique with regards to coverage and payments.

Aetna Substance Abuse Coverage in Washington, D.C.

For potential rehab patients in Washington, D.C., Aetna offers coverage largely through employers. There are a few different types of plans: HMO plans, PPO plans, Open Access Managed Choice plans, HNOption (Health Network Option), and HNOnly (Health Network Only) plans. Within each category, there are different options that have different deductibles, premiums, and levels of coverage.

These options are generally categorized as Gold, Silver, or Bronze level plans. The higher the level of the plan, the more health care coverage patients can expect. The lower the rank of the plan, the more will be paid by the patients. They should review their exact insurance information so they know the coverage available on their own plan.

Aetna offers you a variety of tools to make it easier for you to find an Aetna network provider that meets your needs, such as the “Find a Doctor” portion of the Aetna website. When you use a network doctor, you always receive the highest portion of coverage. Since you can access information about the practitioners and what they offer in one place, you can make informed decisions about which ones will work best for you.

It is important to note that with coverage of prescription drugs is organized based upon tiers. The higher the tier, the lower the cost to the patient. You will need to review your personal insurance information to see the drug chart and where particular pharmaceuticals fall. Medications can be very important, particularly if they have a co-occurring disorder or struggle physically through the detox process. Knowing where the different drugs fall on the payment chart can help patients work with their providers to minimize cost without sacrificing care.

HMO Plans

The HMO plans have deductibles that range from $0 to over $5,000 for an individual. There is a copay due when visiting a primary care provider and a higher one when visiting a specialist. Since the rate is consistent for all doctors, it’s easier for you to budget as your prepare for rehab. Many patients find themselves spending time in the hospital before they begin their rehab. These plans generally have a flat copay for emergency room visits and a coinsurance rate for inpatient hospital stays. You will need a referral from a primary care physician under this plan.

PPO Plans

The PPO plans have deductibles that can range from $0 to $2,500, with some plans carrying a consistent co-insurance rate. Most services are rendered for a copay. Those plans that have the coinsurance rate, however, use this rate to determine healthcare costs, such as inpatient hospital stages. Many patients find it beneficial when there are copays because it make it easier to budget. With a PPO, you can choose any licensed in-patient or out-patient rehab that works well for you, but you will pay more for out-of-network care.

Open Access Managed Choice Plans

Most of these plans have deductibles that can be as high as $5,400, although there are two Gold level plans that do not carry any deductible. Several of the plans also have coinsurance, which can be from 10 percent to 30 percent. You can see any provider under this plan, although you will pay more when going out-of-network. This means if you find an outpatient program that really works well with your needs, you can pursue care without worrying about networks.

Health Network Only Open Access Plans

About half of these plan options won’t have a deductible. Those that do remain under $3,000. For most services under this plan, there is a copay, but occasionally coinsurance rates can be used. You do not need a referral under this plan, but will need to go through in-network providers. This means you will need to use Aetna’s tools to find the right inpatient rehab center that is within the network.

Health Network Option Plans

These plans come with a $0 deductible: some don’t even have coinsurance costs. The plans that do have coinsurance require 10 percent. There are copays for all services, with higher copays for specialists. For many, specialists are a critical part of making sure all potential patients have access to the care that they need to get well. Specialists are accustomed to working with substance abuse patients and understand what is needed to help them succeed and thrive. You can find specialists within this network that match your own philosophy, such as taking an alternative or traditional approach to treatment. You do not need a referral to see a participating provider, which will empower you to see these vital specialists faster.

Indemnity Plan

The Indemnity plan is for those who live outside the network service area. You are free to use any recognized provider for covered services. That means you can find the perfect inpatient or outpatient facility and provider and receive care without worrying about referrals. Most services are covered with about a 30 percent coinsurance rate after the deductible.

For many Washington D.C. residents, insurance is an important factor in being able to afford rehab. It is important to always review personal insurance information before making medical decisions and assuming coverage. Please contact us at RehabCenter.net to learn more.