With a world-class, substance-specific medical detox center in Portland, Maine, Pine Tree Recovery Center is among the premier detox facilities on the east coast. It is our mission to help members of the Portland community heal physically, emotionally and spiritually. This includes ensuring that anyone who wishes to use insurance to participate in treatment with us can do so. After reviewing the frequently asked questions about your Aetna health insurance plan below, call us anytime for more information, or to begin the admissions and assessment process.

Does Pine Tree Recovery Center Accept Aetna Health Insurance?

Yes. Although the limits of each individual’s coverage will vary, thanks to the federal Mental Health Parity and Addiction Equity Act of 2008, no individual health insurance plan that provides mental health or substance abuse coverage can place benefit limits on that coverage that is less favorable than limits for medical or surgical benefits. In addition, substance abuse treatment is considered an Essential Health Benefit, meaning Aetna is to treat your addiction not as a choice, but as a disease worthy of medical treatment on par with any other ailment you may face.

For those with employer-based health plans, your plan is not required by law to provide substance abuse treatment benefits – but if it does, it’s required to offer benefits on par with any other medical or surgical benefit provided. For example, annual or lifetime spending limits for your substance abuse treatment can be no less favorable than for any other medically necessary service.

With 39 million insured, Aetna is one of the nation’s leading health insurance providers and follows best-in-practice guidelines when it comes to treatment for alcohol and/or drug addiction. The Aetna Foundation has contributed millions of dollars to addressing the opioid crisis across the United States and has developed a wide range of online diagnostic tools, telemedicine, and condition management programs, although there is no equivalent substitute for in-patient substance abuse treatment.

If your Aetna plan includes Behavioral Health coverage, your benefits include support for a wide range of mental health and substance abuse concerns. The Aetna Behavioral Health benefit covers both substance abuse treatment and counseling for a wide variety of co-occurring disorders as well, including depression, anxiety and stress. Alcohol abuse and drug abuse treatment services are covered, as is the medication management associated with this treatment.

Services received through your Aetna health benefit may require pre-authorization, a co-payment or co-insurance, and may be subject to a deductible. If your Aetna plan is a Health Maintenance Organization Plan (HMO) or an Exclusive Provider Organization (EPO) you may have higher out-of-pocket expenses unless you stay within the Aetna network. If your plan is a Preferred Provider Organization (PPO) plan, your out-of-pocket expenses for care may be lower, although at the cost of a higher monthly premium.

Except where law dictates otherwise, all residential treatment center admissions, inpatient admissions or outpatient detoxification programs covered by Aetna will require a referral. Referrals are available through your primary care provider, and a Pine Tree Recovery specialist can help ensure that you receive the referral and quick access to the care that you need.

The quickest and easiest way to find out how your particular plan may ease the financial burden of your recovery, is to call a Pine Tree Treatment Advisor at (888) 693-1751. We’re here for you 24 hours a day, 7 days a week.

Will my Aetna Health Insurance Cover the Entirety of my Treatment?

The limits of your coverage are affected by several factors, including a past history of treatment for substance abuse, the details of your comprehensive and individualized treatment plan, and your policy’s deductible and co-pay requirements. Aetna offers a wide range of HMO and EPO, POS and PPO, and HDHP health insurance plans. Depending on your specific policy, substance abuse recovery services may require pre-authorization. You may be required to provide documentation that includes referrals from your primary care provider, or your history of past substance abuse treatment or mental health care.

No one should ever undergo detoxification outside of the supervision of a health professional, and your Aetna plan understands this. Recent laws have required health insurance plans in many states to reduce pre-authorization requirements in order to speed up access to medically necessary care.

While health plans are notoriously difficult to navigate, terms like premiums, deductibles, co-pay or co-insurance relate to the different types of payment for which you will ultimately be responsible. Your deductible is the amount you will pay for covered health care services before your insurance begins to pay. A copayment is a one-time charge you may be expected to pay for a particular service or product, such as medications to ease your withdrawal symptoms. Coinsurance is the percentage of any costs you will pay after your deductible has been met.

Typically, all individual health insurance marketplace and large employer-based plans meet the Affordable Care Act’s Minimum Value Standard of 60% coverage with a high deductible. Some plans may cover up to 90% of medical costs, often with no deductible – monthly premiums for these plans, however, are much higher.

An additional benefit of the Affordable Care Act’s recent classification of addiction as a disease, rather than as a choice, is that it is no longer appropriate for health insurance providers to put lifetime dollar limits on substance abuse treatment. This ensures that your individual Aetna insurance plan is there for you regardless of past treatment for substance abuse and is to cover any pre-existing conditions.

The quickest and easiest way to find out how your particular plan may ease the financial burden of your recovery, is to call a Pine Tree Treatment Advisor at (888) 693-1751. We’re here for you 24 hours a day, 7 days a week.

How Can I Find Out if My Individualized Treatment Plan is Covered?

Your Aetna policy may cover some or all of the costs associated with detoxification treatment and related medications, as well as some or all of the cost of therapeutic services as an inpatient or outpatient client. These services may include group and personal therapy, family therapy, and other aftercare programs. Aetna’s Behavioral Health Network is committed to providing you with all medically necessary care and will work closely with Pine Tree Recovery Center to manage your care from admittance through aftercare planning.

You can be rest assured that Pine Tree Recovery Center will work with you to verify your benefits. We believe in the efficacy of our services and will fight to ensure that anyone who wishes to use insurance to participate in treatment with us can do so.

The quickest and easiest way to find out how your particular plan may ease the financial burden of your recovery, is to call a Pine Tree Treatment Advisor at (888) 693-1751. We’re here for you 24 hours a day, 7 days a week.

I Have Aetna Health Insurance, How Should I Begin?

Contact a Pine Tree Treatment Advisor today to help ease your concerns and understand your insurance benefits. Contact us 24 hours a day, 7 days a week at (888) 693-1751 to answer questions about your policy and how you’re covered. All phone calls are completely confidential. Entering detox is a time of promise and hope, but it can also be a time of stress and uncertainty. Wondering how you’re going to afford your treatment can add to your worries – allow a Pine Tree Treatment Advisor to ease your concerns.