An innovative global health service company, Cigna has customer relationships with 95 million people all over the world. In collaboration with over 1 million healthcare facilities, clinics, and professionals, Cigna’s partnerships include 108,700 behavioral health professionals and 13,900 facilities and clinics, providing medical coverage to over 15 million customers.
Cigna offers health insurance coverage for families and individuals, for employers to provide to their employees, and also Medicare coverage for people in close to half of all the states in America. In California, Cigna offers coverage plans in various levels:
Generally speaking, bronze-level plans will have the lowest monthly premiums (the amount paid to keep coverage current each month) and the highest deductibles (the amount required to pay before coverage kicks in) while the opposite is true about platinum-level plans.
Cigna offers EPO (exclusive provider organization), PPO (preferred provider organization), and HSA (health savings account) plans. An EPO requires members to see only providers that are considered “in network” (providers that Cigna contracts with to offer discounted services) while a PPO will allow members to use out-of-network providers for a higher cost. An HSA is a tax-free medical savings account that allows individuals to save money for medical expenses. This account is paired with an EPO health insurance plan under Cigna.
Insurance coverage through Cigna can vary from state to state and with each individual’s policy. The best way to understand personal coverage is to talk to the insurance provider directly. Trained professionals at a substance abuse treatment facility can offer insight and information on how to use specific insurance coverage to pay for services as well.
How to Use Cigna to Enroll in a Substance Abuse Treatment Program
The best way to find out what substance abuse treatment providers are covered through a specific insurance policy is to contact Cigna directly. The insurance provider can specify exactly which providers’ services are covered and at what rate. Cigna provides a list of designated substance use treatment providers that provide in-network care to its members. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a nationwide Behavioral Health Treatment Services Locator that helps families to find local treatment programs while also detailing what types of insurance coverage these providers accept.
Cigna does not generally require policyholders to obtain a referral before seeking specialty services, such as substance abuse treatment; however, most plans will ask for prior authorization. Preauthorization from Cigna will need to be obtained before admittance into a substance abuse treatment program in order to avoid monetary penalties. Individuals can obtain a form from Cigna and file it via fax or electronically. Policies may require that a person try an outpatient program before being authorized for an inpatient substance abuse treatment program depending on the specific circumstances.
Cigna plans can cover inpatient programs, intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), and outpatient services. Within these programs, an individual Cigna policy may cover support group meetings, group therapy sessions, individual counseling sessions, drug and alcohol educational programs, family therapy, and medical care. Depending on the specific policy that is held, the rate at which these services are covered can vary. For example, the Cigna LocalPlusIN 2250 plan covers both inpatient and outpatient substance abuse treatment services with a 20 percent co-insurance rate (the amount the member is to pay out of pocket) while the Cigna CA PPO Bronze has a $75 copay (the amount paid at time services are rendered) for outpatient office visits and 100 percent co-insurance rates for in-network providers (50 percent co-insurance rate for out-of-network providers).
Cigna plans will also have an annual out-of-pocket maximum amount. After a policyholder reaches this amount, coverage for eligible services is generally paid in full.
Both the insurance company and the chosen provider are great resources for helping individuals and families learn how to maximize Cigna insurance coverage to pay for substance abuse treatment services.