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Does Cigna Cover Substance Abuse Treatment in Florida?

As with any insurance company, Cigna coverage for substance abuse varies between plans and whether the plan is individual, or employer sponsored. To find out whether your plan covers substance use disorders, please call the number on the back of your insurance card or contact us for a verification of benefits performed on your behalf, at no cost.

Generally speaking, however, if your individual or employer sponsored CIGNA plan does cover substance use disorders, you may have access to inpatient services including residential and PHP, outpatient services including regular outpatient and intensive outpatient, coaching and peer support, support groups and other online recovery resources as part of your suite of benefits.

How Much Will CIGNA Benefits Cost Me?

Out-of-pocket expenses will largely depend on the specific plan that you or your employer have chosen. Virtually every insurance plan has a cost share component. This means that a deductible, co-pay and co-insurance may all exist. Once you reach the maximum out-of-pocket expense, your insurance plan will cover all necessary medical care above that amount. When we verify your benefits, we will give you a bona fide estimate of the cost of your care including out of pocket expense. We will determine your co-pay – the fixed amount you will pay for each individual service, your deductible – the amount you are responsible for before your insurance company begins paying for covered benefits and your coinsurance which is a percentage of the cost of your care that you must pay after you’ve met your deductible.

Mental Health Parity and Coverage

CIGNA coverage for mental health and substance abuse concerns must adhere to regulations set forth by MHPAEA. This does not allow group health plans and health insurance covering mental health or substance abuse disorders to limit behavioral health benefits any more than the medical or surgical benefits on the same policy. The Affordable Care Act further amended this law to also apply to individual health insurance. Small group plans and employment related group health plans are treated slightly differently under the law, therefore clients should learn more about their benefits, should they fall into that category.

The Affordable Care Act also requires that any CIGNA plan offering dependent child benefits allow coverage for the child up to the age of 26. The child can be married or unmarried. This applies to all individual and employer plans. These regulations have improved access to substance abuse and mental health benefits to many young adults that would not otherwise have appropriate coverage.

Next Steps

The first and most difficult step is to contact a treatment center like Destination Hope. Doing so is an amazing leap forward and the beginning of a lifelong journey of recovery. We will assist with verifying your benefits and helping you understand the cost associated with your treatment. We will also work with your insurance company to approve payment for an appropriate treatment plan. If your plan is administered by your employer, we will work with you and speak to your benefits administrator or human resources manager to ensure we follow appropriate procedures. Once you been verified and pre-approved and you’re ready to enter treatment, you will work with our admission specialists to get started with your recovery.

What if CIGNA Does Not Cover Substance Abuse Treatment?

There are situations in which CIGNA plans do not cover substance use disorder treatment. Or, out of pocket expenses may be impossible to meet. We encourage you to contact us and discuss possible payment options to see how drug and alcohol treatment can be more affordable for you.

But What if CIGNA Denies My Claim?

Every service performed, regardless of if it has been pre-authorized, will go through a review process and there are times where claims are denied. Often times, these denials are a result of clerical errors on the part of the insurance company. We work with you to help ensure these errors are corrected and the services are covered. Should the denial remain, CIGNA has a comprehensive grievance policy in place that allows you, as a subscriber, to appeal the decision and have it reviewed by a qualified team of experts, including physicians and/or nurses.

How Do I File a Complaint Against CIGNA?

In the very rare case that you have to take it this far, the state of Florida regulates CIGNA and all insurance companies. Every subscriber has the option of filing a complaint with appropriate regulators in Florida, who may conduct an investigation if appropriate. More information on this can be found in the description below.at: https://www.myfloridacfo.com/division/consumers/needourhelp.htm

Good to Know

It is helpful to know that CIGNA behavioral health is the company that processes and administers claims for CIGNA.

The Bottom Line About CIGNA Coverage in Florida

In substance abuse treatment there has always being a tug-of-war between insurance companies and treatment providers. Insurance companies try to minimize their costs by reducing benefits and coverage, while treatment centers understand that the process is long and arduous and requires as much support from insurance as possible. The result is often a convoluted set of requirements and regulations that can be difficult to understand. The insurance specialists here at DH strive to take that uncertainty away by helping you verify benefits and by walking you through the insurance process to ensure proper coverage and appropriate treatment. Contact us to verify your benefits and learn more about CIGNA insurance coverage.

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