At Sana Lake Behavioral Wellness Center, we know how difficult it is to suffer from behavioral health issues. Furthermore, the last thing a member needs to focus on is their insurance. It can be complicated, and shouldn’t stop someone from entering treatment.
Our partnership with Cigna shows our commitment to helping members heal and experience long-term recovery. Our treatment programs combine traditional and holistic therapies to heal the mind, body, and spirit. This combination allows members to find recovery for life.
As a global health organization, Cigna has over 86 million customers around the world. Their mission is to provide affordable healthcare for basic needs. These needs include substance use disorder (SUD) and other behavioral health disorders.
Although coverage depends on a member’s plan, recovery services may include:
Treatment coverage from Cigna will vary depending on the plan and the state the member lives. Preauthorization is typically a requirement for SUD and mental health treatment. Preauthorization, or prior approval, is when Cigna determines if treatment is medically necessary. If a member doesn’t receive the required prior approval, they may have to pay all treatment costs.
Members may also need to meet a deductible or pay a co-payment. A copayment is a flat rate members pay for services. A deductible is the amount members pay before Cigna pays for services.
One way to avoid paying the full cost of treatment is by choosing an in-network provider. These providers have contracts with Cigna to provide services at a set fee. These fees are generally less than the costs for someone without insurance. However, out-of-network providers do not have set pricing with Cigna. As a result, members will pay more for their services.
Medically necessary is a term used by doctors. It refers to whether treatment is a must. Cigna works with doctors to find the right care and length of treatment. However, members and doctors create a treatment plan with behavioral goals. Although behavioral disorders need lifelong care, insurance only pays for specific treatment lengths.
When trying to find treatment for behavioral health issues, it’s essential to know the difference between in-network and out-of-network provides. If members don’t know the difference, it can cost them money. Above all, members should know what it means for treatment coverage.
An in-network treatment center means the center has a contract with Cigna. This contract is an agreement to accept a discounted rate for treatment. As a result, members attending an in-network center will likely pay very little in treatment costs.
However, out-of-network treatment centers don’t have a contract with Cigna. So if a member seeks treatment at a non-contracted center, they likely pay the full treatment cost. At the same time, just because a center takes Cigna doesn’t mean they are in-network. For this reason, members should check with Cigna for in-network treatment centers.
Cigna started their Behavioral Health division to support members who suffer from SUD. It provides articles, tools, and podcasts for members and their families. Also, the Behavioral Health division now includes an educational series.
Cigna’s education series provides free information on the physical and emotional signs of SUD. Even though this series provides information, it’s not meant to replace the care of a doctor. Members should always consult with professionals about treating SUD.
Benefits and coverage will vary depending on a member’s Cigna plan. For example, the bronze plan – Cigna’s lowest plan – has lower premiums. But, it has higher deductibles and out-of-pocket expenses. However, gold and platinum plans have higher premiums with lower deductibles.
The out-of-pocket expenses and services Cigna covers for SUD depend on the member’s plan and state they reside. At Sana Lake BWC, our staff helps members receive the coverage they deserve along with the best treatment for SUD. Members can also call BCBS directly to get treatment coverage options.
While some Cigna plans require members to see in-network providers, not all plans require it. However, out-of-network providers will increase out-of-pocket costs. But, if members still choose an out-of-network treatment center, they may have to pay the whole bill.
Also, many out-of-network treatment centers require pre-certification. Cigna then reviews the request against nationally recognized guidelines. Cigna then determines what services are covered under the member’s plan.
A member’s insurance coverage and out-of-pocket costs vary depending on their plan and where they live. The following is a general breakdown of cost by plan types.
Outpatient services Cigna typically covers therapy, medication-assisted treatment, and intensive outpatient treatment. Coverage estimates include:
Dealing with SUD and other mental health disorders is challenging. But, when a member is stuck at home, it’s even more difficult. However, Cigna offers telehealth services so members can receive behavioral health treatment from home.
Members can see licensed providers when, where, and how is best for them. Cigna Behavioral Health gives members access to video-based services and quality care.
Telehealth services include diagnosis and treatment of behavioral health issues, including:
If the pandemic taught people one thing, it is the importance of caring for their mental health. Cigna is there to help whether a member is feeling isolated and lonely or coping with financial stress. Featured resources include:
A member’s information on SUD and mental health treatment are always confidential. It only exceptions include:
Sometimes, Cigna insurance doesn’t cover the full cost of treatment. But, that shouldn’t stop someone from receiving treatment. But, if there is still a balance after Cigna pays, there are options available to pay the balance. Some payment options include:
In America, the healthcare system recognized alcohol use disorder (1956) and addiction (1987) as legit medical conditions. Afterward, Cigna and other insurances followed suit. While some policies had benefits, they were limited to one or two times a year.
In 2008 however, the Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted. This act requires companies to offer behavioral health benefits. Above all, they must provide mental health treatment that’s comparable to physical medical care.
In 2010, The Affordable Care Act, or ObamaCare, expanded behavioral health benefits to include SUD treatment. In addition, addiction was taken off the list of pre-existing conditions list. As a result, addiction is not a reason to deny care. In short, Cigna is required by law to cover some or all of behavioral health treatment.
When you or a loved one is tired of suffering from addiction and mental health issues, the last thing you want to do is read your insurance policy. At Sana Lake BWC, we have a great working relationship with Cigna, and we can help determine your coverage.
To get the most out of your Cigna policy and behavioral health treatment, contact us today.