Is Adolescent Treatment Covered by Cigna? Your Insurance Explained
As a parent, the suffering of your children, and more importantly the ending of that suffering, becomes your entire focus. So when your child is struggling with their mental health, the last thing on your mind should be navigating the complexities of insurance coverage. Having a working knowledge of your Cigna policy and what adolescent treatment services are covered means more time spent ensuring the best care for your child.
Understanding Cigna Insurance
Cigna is one of the largest health insurance providers on the market. They offer plans that include coverage for all manner of healthcare needs including mental health and substance abuse treatment. However, as with most insurance plans, each policy is unique and coverage can vary depending on the plan, state regulations, and individual policy details. While the Mental Health Parity & Addiction Equality Act mandates that coverage for mental health and substance abuse be on par with medical and surgical coverage, it is important to have an understanding of your specific policy.
Adolescent Treatment Coverage
When it comes to adolescent treatment, Cigna generally covers a range of services. These include:
- Inpatient & Outpatient Care: Residential adolescent treatment (inpatient) and therapy/counseling (outpatient) services may be covered under your Cigna policy. The acuity of your child’s behavioral health needs will determine what level of care is appropriate but in most circumstances, both may be covered.
- Medication Management: Your policy may also extend to covering medications prescribed by a healthcare provider. There can be time, name brand vs generic, and prescriber stipulations around this coverage so it’s important to clarify with Cigna.
- Therapy Sessions: Individual, group, and family therapy sessions are commonly covered by Cigna plans.
- Substance Abuse Treatment: Coverage may include programs for substance abuse and addiction treatment.
- Specialized Programs: Some plans might cover specialized programs catering specifically to adolescents, addressing issues like eating disorders or trauma.
Factors Affecting Coverage
Not all Cigna plans are created equal. There are several common factors which may or may not affect coverage for adolescent treatment. These are:
- Plan Type: Cigna offers a variety of insurance plans. HMO, PPO, and EPO all offer varying levels of coverage. Depending on the type of plan you have, there may be regulations around the treatment that is accessible.
- Policy Details: It’s important to be aware of your deductibles, copayments, and coinsurance amounts. Each policy can have different details which could drastically affect your out of pocket responsibility and determine which treatment option is best.
- Network Providers: Make sure to check if your policy encourages using a preferred network provider. Utilizing in-network providers will dramatically lower the cost of treatment compared to out-of-network treatment providers
- Medical Necessity: The level of care and duration of treatment may both be affected by medical necessity. Consult with your Cigna policy to find out if this is the case before seeking treatment.
Steps to Utilize Coverage
- Verify Coverage: Contact Cigna or review your policy, find out which services are covered, and ascertain what, if any, out-of-pocket costs you are responsible for.
- Find In-Network Providers: Take advantage of Cigna’s online directory to find an in-network treatment provider.
- Seek Authorization if Required: Some treatment centers may need pre-authorization. If you are unsure about whether your policy requires this, call Cigna customer support or ask the treatment facility you are interested in.
- Understand Costs: Speak with both the treatment program you are interested in and Cigna about any financial responsibility that you bear. This will keep you informed and minimize surprises on the back-end.
While Cigna offers comprehensive coverage for adolescent treatment, navigating the particulars of your policy can require proactive engagement and a thorough understanding of insurance. It is best to have gain this knowledge before a mental health emergency arises. Being informed, seeking clarification when needed, and advocating for your child’s well-being are imperative to utilizing your Cigna plan effectively and guaranteeing that your loved one gets the best treatment possible.
Support and treatment for adolescents is vital to their continued healthy growth and development. If you have a loved one that is struggling, call Stonewater Adolescent Recovery Center today. Our integrated clinical team can help provide you with answers and clarity on what the next right step is.