Rehab Centers that Accept Cigna Insurance

When it comes to paying for rehab, insurance coverage makes a big difference. What’s covered depends on your plan type, how your benefits work and whether the facility is in-network or out-of-network. Your insurer may also require prior authorization or documentation of medical necessity.

On this page, you’ll learn about Cigna rehab coverage, including how to verify your benefits, what it means for a facility to be in-network vs. out-of-network and how to get an estimate of your potential out-of-pocket costs.

Cigna may cover drug and alcohol rehab, but it depends on what type of plan you have. For example, a health maintenance organization (HMO) may require you to use an in-network rehab center, while a preferred provider organization (PPO) might cover out-of-network care. Exclusive provider organizations (EPOs) and point-of-sale (POS) plans have different network requirements.

Cigna out-of-network rehab coverage can help you get addiction treatment even if an in-network facility can’t meet your needs. Regardless of network status, you may need to meet medical necessity criteria, obtain a referral or receive prior authorization for rehab services. Cigna rehab coverage also depends on the status of your deductible and out-of-pocket maximum.

Cigna usually splits behavioral health benefits into two categories: inpatient and outpatient.

Your plan may cover these services:

• Detox
• Inpatient/residential care
• Medication-assisted treatment
• Therapy and counseling
• Aftercare planning

In the United States, health insurance companies are required to cover mental health and substance use disorder services the same way they cover medical and surgical care. This is known as mental health parity. Therefore, your Cigna plan may cover addiction treatment as one of its required benefit categories.

No two people have the same needs, so rehabs use a variety of treatment methods. Cigna may cover some of the options below.

Medical detox helps stabilize your body before you begin counseling and other rehab services. Cigna may cover this type of care, but some plans require prior authorization. You may also need to provide proof of medical necessity or complete a length-of-stay review after the first few days.

Inpatient rehab comes with around-the-clock care, so it’s in Cigna’s highest cost category. Your plan is likely to need prior authorization, and Cigna may also require a continued stay review to determine if you still need this level of care.

Opioids are used to treat moderate to severe pain, but they’re also addictive. Medication-assisted treatment (MAT) is used to treat opioid addiction. MAT combines medication with counseling and other behavioral therapies, so Cigna may cover medications under your pharmacy benefits and other MAT components under your behavioral health benefits.

Cigna plans typically have a formulary, or a list of approved medications, to follow. MAT may cost more if you need a medication in a higher tier, or if you take a medication that isn’t on the formulary. Some plans may also require prior authorization for MAT.

Cigna rehab coverage may include these evidence-based services:

• Individual therapy
• Group counseling
• Medication management
• Family therapy

Your plan may require you to demonstrate continued medical necessity. Some plans also require prior authorization for certain evidence-based services.

Someone who has a substance use disorder accompanied by at least one other mental health condition is said to have co-occurring disorders (AKA dual diagnosis).

Common examples of mental health conditions include:

• Anxiety
• Depression
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Eating disorders
• Schizophrenia

Many facilities don’t treat separate health conditions, but they may offer support for individuals with dual diagnoses. Cigna typically covers these services under your behavioral health benefits, but you may have to demonstrate medical necessity.

Cigna may cover medically appropriate aftercare, but coverage for step-down care varies. Depending on your plan, you might qualify for partial hospitalization or intensive outpatient care.

In many cases, Cigna excludes sober-living placement from its behavioral health benefits. However, coverage varies based on your plan and location.

Rehab providers are either in-network or out-of-network:

• In-network. In-network providers accept negotiated rates, so it typically costs less to choose an in-network rehab.
• Out-of-network. Out-of-network providers don’t have to accept Cigna’s discounted rates. This usually results in higher out-of-pocket costs. You may also be subject to balance billing, which is when you have to pay the difference between the billed rate and the approved amount.

Some of the services you receive may involve outside providers. For clarity, make sure the rehab explains who will bill for each service when you request benefits verification.

These cost-sharing requirements can affect your out-of-pocket costs when using Cigna rehab coverage:

• Deductible. You must pay your deductible before your Cigna plan covers any part of your care.
• Co-pay. A co-pay is a flat fee paid for each service (e.g., $25 per therapy session).
• Coinsurance. Coinsurance is a percentage of the approved amount. For example, if you have 20% coinsurance, you’d have to pay $20 for a service with an approved amount of $100.
• Out-of-pocket maximum. Your out-of-pocket max is the most you’ll have to pay for covered services in 1 plan year.

If you need MAT for an opioid use disorder, there may be separate pharmacy costs. Your total cost of care also depends on:

• Level of care changes
• Admission timing
• Length of stay
• Benefit period

Cigna offers employer-sponsored, Marketplace and Medicare insurance plans. Your plan may be one of the following:

• HMO. A health maintenance organization requires referrals and doesn’t cover out-of-network care.
• PPO. Preferred provider organizations don’t require referrals. Your plan may include some coverage for out-of-network services.
• POS. Point-of-sale plans may cover out-of-network care, although the out-of-pocket costs are usually higher. These plans also require referrals from a primary care provider.
• EPO. Exclusive provider organizations don’t require referrals. There’s also no out-of-network coverage available for non-emergency services.

You can find your plan type in one of these locations:

• Member ID card
• Online insurance portal
• Summary of Benefits and Coverage

DIY Verification Steps (Member)

1. Call the customer service number on the back of your insurance ID.
2. Determine if your preferred rehab is in-network or out-of-network.
3. Ask about the authorization requirements for your level of care.
4. Inquire about potential out-of-pocket costs, such as co-pays, deductibles and coinsurance.
5. Find out if there are any coverage limits, such as medical necessity reviews or a limit on the number of days you can stay.

It’s faster to have your preferred rehab verify benefits for you. To do this, provide the name of your insurer and your member ID number. An admissions representative can verify your benefits and determine the facility’s network status.

Verification doesn’t guarantee that Cigna rehab coverage applies to a particular service. Your insurance company makes the final decision.

Don’t get discouraged if coverage is limited or denied. Cigna has an appeals process, so find out the reason for the denial, ask for the list of required documentation and consider a peer-to-peer or clinical review if necessary.

If the rehab is out-of-network with your plan, ask about a single-case agreement. This is a one-time arrangement that allows you to receive out-of-network services at in-network rates.

Seeking treatment is one of the best things you can do for yourself. Help.org makes it easy to understand your Cigna benefits and find a rehab that meets your clinical needs and preferences.

Call or fill out the form to get help narrowing down your treatment options. You’ll need your group number, insurance ID number and plan type.