Cigna Rehab and Heroin Detox Coverage
Cigna Heroin Detox Coverage
Cigna does provide its members with heroin detoxification coverage. Members are eligible for inpatient treatment as long as that treatment is considered a medical necessity. Certain criteria must be met to prove that medically supervised inpatient heroin detox treatment is medically necessary. Once a member is approved for medically supervised treatment, he/she should locate a facility within the Cigna network that offers patients a painless detox experience.
Levels of Substance Abuse
Levels of Substance Abuse for Inpatient Detoxification and Inpatient Acute Care
Inpatient Detoxification*
Inpatient Detoxification is frequently recommended for:
- Members who need to be medically supervised 24-hours a day to ensure his/her safety.
- Members who are dependent on some opiate-based drugs like heroin, narcotic painkillers, sedatives and alcohol. Some facilities offer painless detox, which helps make recovery from a drug or alcohol addiction more tolerable.
- Members experiencing medically complicated situations.
Inpatient Acute Care*
This type of treatment is usually short-term and is often recommended for members who have completed an inpatient clinical care detoxification treatment program using their Cigna Heroin Detox Coverage benefit.
Inpatient Acute Care is ideal for members who are experiencing decreased withdrawal symptoms, but still need 24-hour, medically supervised care and daily physician visits for treatments to stabilize their psychiatric or medical symptoms.
*Prior authorization requires the member be evaluated through a face-to-face assessment by facility staff. The facility staff will contact Cigna to request authorization and submit the necessary clinical information. Cigna will make its determination as to whether a member’s Cigna Heroin Detox Coverage benefit will be valid for medically supervised detoxification treatment based on the current guidelines used to determine medical necessity.
In-Network Providers vs. Out-of-Network Providers
Members can save a significant amount of money by receiving services from in-network providers. When a member’s Cigna Heroin Detox Coverage policy includes a preferred network of providers, he/she should stay within that Network.
An in-network provider has reached an agreement with Cigna pertaining to the amount he/she will charge for services rendered to Cigna’s members. This agreed upon charge is considered Cigna’s allowable amount for a service.
Members who receive treatment from in-network providers usually have an in-network deductible that is less than their out-of-network deductible; additionally, members are only responsible for their percentage of the allowable amount. For instance, if a member’s coinsurance is 20 percent, he/she will only have to pay 20 percent of the allowable amount once the deductible has been met.
An out-of-network provider does not have an allowable amount agreement with Cigna, which means he/she can charge a member more than Cigna’s allowable amount. The member will be responsible for his/her out-of-network deductible, coinsurance amount and may also have to pay 100 percent of the charges beyond Cigna’s allowable amount.
Individuals with Cigna Heroin Detox Coverage that are seeking assistance for an addiction to heroin should visit Cigna’s Behavioral Health website to learn more about treatment options.