No matter how you get your Cigna coverage, it’s important to understand potential out-of-pocket expenses as you consider treatment, including drug addiction treatment. Your exact expenses depend on your plan, your treatment providers and the treatment options you choose. However, you do need to look for these common expenses and understand how they might apply:
- Deductible. This is how much you must pay before your insurance starts paying any claims. Your deductible is for the calendar year and includes any covered mental health or substance abuse treatment, medical treatment or any other services your plan would normally cover. So, if you had inpatient treatment in the hospital for appendicitis in January, for example, anything you paid for that treatment would go toward your deductible. If you then sought substance abuse treatment in July, you might have already met the deductible. However, if you haven’t met your deductible and enter drug rehab treatment, you’ll have to meet it before insurance coverage pays for any charges.
- Copay or coinsurance. This is how much you pay once you hit your deductible. Every plan has different copay amounts. The copay amounts for outpatient services might also differ from those related to inpatient options. Typically, you may owe a percentage of covered charges (as coinsurance) or a flat fee (as a copay).
- In-network vs. out-of-network providers. Some insurance plans cover more of the charges if you choose in-network providers. When considering health care providers for rehab needs, keep this in mind and look for providers that are in the network with your plan. For example, a plan might pay 80% of approved charges after the deductible if providers are in the network and only pay 50% of approved charges if you get mental health care from a provider that’s out of network.
Other factors that can impact how much mental health services, including treatment for drug abuse, might cost you if you have a Cigna insurance plan include:
- The nature of the treatment. For example, inpatient recovery options might cost more than outpatient treatment services overall. That can increase your coinsurance amount.
- The location of the mental health centers you choose. Insurance companies won’t usually cover transportation to and from treatment facilities, so keep that in mind when choosing from various treatment centers.
- Whether preauth or other requirements were met. In some cases, your insurance plan might require preauthorization, or prior approval. This means a doctor or another provider orders treatment and sends that information to the insurance company. The insurance company approves the treatment tentatively, and without this approval, it will deny future claims for that treatment. Some Cigna plans do require preauths. If you agree to treatment without the appropriate preauth, you might end up owing more than you planned.