If you have Cigna insurance, you are not alone. Cigna is one of the largest health insurance companies in the US. This health insurance provider is present in 16 states and holds 2% of the market.
People enrolled in Cigna’s insurance policies have access to health benefits, as well as dental, vision, and supplemental health services. But did you know you can also get coverage for behavioral health services?
Behavioral health encompasses mental health conditions, including substance use disorders (SUDs). The Comprehensive Wellness Centers of South Florida accept Cigna.
What mental health and addiction services will your insurance policy cover at our facilities? We will guide you through the answers to this question and more in this complete guide. Keep reading to learn more.
Cigna specializes in employer-sponsored health plans. The company also provides Medicare and Medicaid Advantage benefits. Importantly, Cigna covers rehab and mental health treatment, which are essential health benefits.
All Cigna plans offer some coverage for SUDs and other mental health conditions. The exact amount of Cigna insurance coverage you get depends on the type of plan you enroll in. It also depends on the insurance tier you choose.
The type of health insurance plan you choose will determine your deductible and coinsurance costs. It will also determine other factors, such as requirements for specialist referrals.
Cigna offers the following options for insurance:
Take Cigna’s EPO plan as an example. EPOs only cover in-network care, but you don’t need a referral to see a specialist. EPOs fall between HMOs and PPOs on the insurance policy spectrum.
That means you will pay mid-range monthly premiums in exchange for lower costs at the point of care. You must meet a deductible for your full insurance benefits to kick in.
In 2021, the deductible for Cigna’s EPO plan for individuals was $8,550. The deductible for families was $17,100. Once you meet the deductible, you pay $0 for inpatient and outpatient behavioral health services.
Within each of the above health plans, there are different tiers. These tiers explain approximately how much the plan pays versus your out-of-pocket costs. The tier you choose will also determine your monthly premium.
As with all marketplace insurance plans, Cigna offers four tiers: Bronze, Silver, Gold, and Platinum. Bronze plans tend to cover the least amount of costs but have lower premiums. Platinum plans cover the most and have high premiums.
Bronze plans feature the lowest monthly cost of insurance. When you receive care, you have to pay 40% of the cost, and Cigna will cover the remaining 60%. That is the lowest amount of coverage Cigna provides.
Silver plans cost a bit more per month. But when you receive health services, you only pay 30% of the cost. Cigna will cover the remaining 70%.
Gold plans have the second-highest premiums. The benefit is that you pay less at the point of care. 20% of your medical costs are your responsibility, while Cigna will pay for 80%.
Platinum plans have the highest monthly premiums. In exchange, you only have to pay 10% of your annual healthcare costs. Cigna covers 90% of the cost of care.
Yes, Cigna’s health insurance plans cover substance abuse treatment in inpatient and outpatient settings. You may have to attend a program that is in-network. Again, it depends on the exact policy you hold.
In general, inpatient treatment (also known as residential care) will cost you more out of pocket than outpatient services. That is because you must pay to live at the facility where you receive treatment.
Otherwise, many Cigna plans provide benefits for the following drug and alcohol rehabilitation services.
Detox is a critical first step for many people entering rehab. This service helps people safely quit using drugs. It may include detox medication management, where the facility uses FDA-approved drugs to treat withdrawal symptoms.
It is important to detox under the supervision of a medical professional. That is why this service typically takes place in an inpatient setting. If you detox at an in-network treatment center, Cigna will cover part of the cost.
Many Cigna plans require pre-authorization for inpatient treatment. That means your primary care physician needs to determine that inpatient services are medically necessary for your condition.
When you receive pre-authorization, Cigna will cover the majority of inpatient services. This includes your stay at the facility, therapy, and some medications (e.g., anti-craving drugs).
PHP stands for partial hospitalization. These programs are similar to inpatient treatments, but they offer more flexibility. You do not have to live at the facility where you receive care, which can also lower costs.
Most PHPs require participants to spend 25–30 hours at the facility each week. You can return home at night. Most Cigna insurance policies offer at least some coverage for this type of treatment program.
Cigna covers some of the costs for outpatient treatments. These treatments may include group therapy, 12-step meetings, and SMART Recovery programs. Your plan may also provide benefits for anti-craving drugs and aftercare.
A specific type of outpatient treatment program Cigna also covers is the IOP. IOPs are intensive outpatient programs that are one step down from PHPs. You do not live at the facility, and you spend 15–20 hours per week in treatment.
Co-occurring disorders are also known as dual diagnoses. It is unfortunately common for SUDs to co-occur with other mental health conditions. Holistic treatment involves treating the symptoms of both disorders.
Cigna will cover some of the costs of dual diagnosis treatment. You may receive services for your SUD first. Then you can work with a therapist to address the mental health condition that could be exacerbating your addiction.
Yes, Cigna’s behavioral health benefits can help you pay for mental health care. This includes inpatient care received at a residential facility and outpatient treatment programs.
Disorders Cigna may cover include but are not limited to:
If you receive the following services for your mental health condition, your insurance will help cover the cost.
Most Cigna plans give you access to a network of mental health providers. These providers can administer therapies like CBT and DBT. Seeing in-network providers ensures that you get the most out of your benefits plan.
If you need inpatient mental health treatment, your insurance plan will cover therapy received at a treatment center. Depending on your plan, you may need pre-approval that the treatment is medically necessary for your condition.
Therapy and prescription medication are the top two treatments for mental health conditions. During an inpatient program, a professional may prescribe medication for your disorder.
In that case, Cigna will cover medications. Cigna divides drug benefits into three tiers. Tier 1 gives you access to generics and is the least expensive option. Tiers 2 and 3 help cover preferred and non-preferred brand-name drugs, respectively.
Cigna also provides coverage for non-residential services. This includes traditional outpatient programs, as well as PHPs and IOPs. Covered services may include individual therapy, group therapy, and prescription drugs.
However, there are some types of mental health therapies Cigna will not cover. We discuss the behavioral health services Cigna does not provide benefits for next.
Cigna will not cover services that are not medically necessary, alternative therapies, or luxury rehab programs. Here’s what you need to know about each of these.
Cigna only provides coverage for people who need treatment. That means you typically have to have a mental health or addiction diagnosis to qualify for benefits.
Cigna only provides coverage for traditional types of therapy like CBT and DBT. It will not help pay for alternative therapies like music or art therapy, acupuncture, or massage.
Another type of non-medically necessary care Cigna does not cover is stays in high-end rehab centers. You must attend an approved Cigna program to receive benefits. Comprehensive Wellness Centers accept Cigna insurance.
Comprehensive Wellness Centers in Florida accepts Cigna insurance. Check your benefits package to learn more about your coverafe mental health and substance use disorder treatment.
Do you need treatment for addiction or a mental health disorder? Comprehensive Wellness Centers have locations across South Florida. Verify your insurance today to find out which services your policy covers.