Cigna Coverage for Drug and Alcohol Rehab

What Is Cigna Insurance?

Cigna is a worldwide health service company dedicated to helping people improve their health and well-being. With coverage extending to individuals, families, and employer groups, Cigna provides a wide range of health insurance plans designed to meet diverse needs.

Cigna's mission emphasizes affordable, accessible healthcare—including comprehensive behavioral health services for substance use disorders and mental health conditions. The company's Behavioral Health division specifically supports individuals seeking recovery from drug and alcohol addiction, offering resources, education, and treatment coverage.

Does Cigna Cover Addiction Treatment?

Yes. Cigna insurance covers drug and alcohol rehab treatment. This coverage is mandated by the Affordable Care Act (ACA), which requires all health insurance plans to cover mental health and substance use disorder services as essential health benefits.

Additionally, the Mental Health Parity and Addiction Equity Act requires insurance companies to provide equal coverage for behavioral health treatment as they do for medical and surgical care. This means Cigna cannot impose more restrictive limitations on addiction treatment than on other medical conditions.

Types of Addiction Treatment Covered by Cigna

Cigna plans typically provide coverage for a comprehensive range of addiction treatment services:

• Medical Detoxification — Acute inpatient detox for safe withdrawal management
• Inpatient/Residential Treatment — 24/7 care in a structured residential environment
• Partial Hospitalization Programs (PHP) — Intensive day treatment with overnight home stays
• Intensive Outpatient Programs (IOP) — Structured treatment several times weekly
• Traditional Outpatient Treatment — Ongoing therapy and support services
• Individual Therapy — One-on-one counseling sessions
• Group Therapy — Peer support and skill-building in group settings
• Family Therapy — Involving loved ones in the treatment process
• Medication-Assisted Treatment (MAT) — FDA-approved medications combined with therapy
• Medication Management — Ongoing monitoring and adjustment of medications
• Mental Health Treatment — Services for co-occurring disorders like depression and anxiety

Understanding Cigna Plan Types

Cigna offers several plan types, each with different structures for accessing care and managing costs:

Preferred Provider Organization (PPO)

• Large network of healthcare providers
• No requirement to choose a primary care physician
• Can see specialists without referrals
• Flexibility to use out-of-network providers at higher cost
• Generally higher premiums but more freedom in provider choice

Health Maintenance Organization (HMO)

• Must choose a primary care provider from local network
• Requires referrals to see specialists
• Generally lower costs when using in-network providers
• Out-of-network care typically not covered except in emergencies
• Lower premiums than PPO plans

Exclusive Provider Organization (EPO)

• Network of participating providers
• May require choosing a primary care provider
• Out-of-network care generally not covered except emergencies
• No referrals needed for specialists within network
• Costs between HMO and PPO plans

Point-of-Service (POS)

• Combines features of HMO and PPO plans
• Must choose a primary care provider
• Requires referrals for specialists
• Can see out-of-network providers at higher cost
• Lower in-network costs than PPO

Cigna Coverage Tiers: Bronze, Silver, Gold, and Platinum

Cigna offers marketplace plans in four metal tiers, each representing different cost-sharing structures:

Bronze Plans

Coverage Structure: Cigna pays 60%, you pay 40%

• Lowest monthly premiums
• Highest out-of-pocket costs when you need care
• Higher deductibles that must be met before coverage begins
• Best for: Healthy individuals who rarely need medical care and want catastrophic coverage

Bronze Plan Rehab Coverage

• Inpatient rehab: Typically 0% coinsurance for in-network after deductible is met (Cigna pays 100%)
• Outpatient services: 0-50% coinsurance depending on state
• Out-of-network: May or may not be covered, varies by state

Silver Plans

Coverage Structure: Cigna pays 70%, you pay 30%

• Moderate monthly premiums
• Moderate out-of-pocket costs
• Moderate deductibles
• Best for: Those who need regular medical care and want balanced cost-sharing

Silver Plan Rehab Coverage

• Inpatient rehab: 30-50% coinsurance for in-network after deductible
• Outpatient services: May have coinsurance or copays per visit
• Out-of-network: May or may not be covered, varies by state

Gold Plans

Coverage Structure: Cigna pays 80%, you pay 20%

• Higher monthly premiums
• Lower out-of-pocket costs when you need care
• Lower deductibles
• Best for: Those who use healthcare frequently or have ongoing medical needs

Gold Plan Rehab Coverage

• Inpatient rehab: 20-50% coinsurance for in-network after deductible
• Outpatient services: Small coinsurance or copay per visit
• Out-of-network: May or may not be covered, varies by state

Platinum Plans

Coverage Structure: Cigna pays 90%, you pay 10%

• Highest monthly premiums
• Lowest out-of-pocket costs when you need care
• Lowest deductibles
• Best for: Those with significant medical needs or who want maximum coverage

Platinum Plan Rehab Coverage

• Inpatient rehab: 10-30% coinsurance after deductible
• Outpatient services: Minimal coinsurance or copay requirements
• Out-of-network: Some plans cover at higher coinsurance rates

Key Insurance Terms You Should Know

Understanding insurance terminology helps you navigate your Cigna coverage:

Deductible

The amount you pay out-of-pocket for covered services before Cigna begins paying. For example, if your deductible is $2,000, you pay the first $2,000 of covered services, then insurance coverage kicks in according to your plan's coinsurance structure.

Copayment (Copay)

A fixed amount you pay for specific services. For example, you might pay a $50 copay for each therapy session, regardless of the actual cost of the service.

Coinsurance

The percentage of costs you pay after meeting your deductible. For example, with 20% coinsurance, you pay 20% of costs and Cigna pays 80%.

Out-of-Pocket Maximum

The most you'll pay in a year for covered services. Once you reach this limit, Cigna pays 100% of covered services for the rest of the plan year.

In-Network vs. Out-of-Network

In-network providers have negotiated rates with Cigna, resulting in lower costs for you. Out-of-network providers haven't negotiated rates and typically cost significantly more—or may not be covered at all, depending on your plan.

Pre-Authorization (Prior Authorization)

Approval from Cigna required before receiving certain services. Most substance use disorder treatment requires pre-authorization. Without it, you may be responsible for the full cost of treatment.

How Cigna Rehab Coverage Works

Pre-Authorization Requirements

Cigna typically requires pre-authorization for inpatient and residential addiction treatment. This process involves:

1. Your treatment provider submitting a request to Cigna
2. Cigna reviewing the request against medical necessity criteria
3. Cigna approving, denying, or requesting additional information
4. Authorization granted for a specific number of days or level of care

Important: Failing to obtain required pre-authorization may result in denial of coverage, leaving you responsible for the full cost of treatment. At BriteLife Recovery, our admissions team handles all pre-authorization requirements on your behalf.

In-Network vs. Out-of-Network Coverage

Using in-network providers significantly reduces your out-of-pocket costs:

In-Network Benefits

• Negotiated, lower rates for services
• Lower or no deductibles
• Lower coinsurance percentages
• Predictable costs

Out-of-Network Considerations

• Higher deductibles (often double in-network amounts)
• Higher coinsurance percentages
• May have separate out-of-pocket maximums
• Some plans don't cover out-of-network care at all
• You may need to pay upfront and seek reimbursement

Medical Necessity Criteria

Cigna determines coverage based on whether treatment is "medically necessary." For substance use disorder treatment, medical necessity is typically established through:

• Clinical assessment by a licensed professional
• Documentation of substance use disorder diagnosis
• Treatment plan aligned with nationally recognized guidelines (such as ASAM Criteria)
• Appropriate level of care based on severity and needs

What Is Evernorth?

Evernorth is Cigna's health services brand and a wholly-owned subsidiary of Cigna Corporation. Evernorth aims to provide flexible healthcare solutions for health plans, employers, and government organizations.

If your insurance card shows Evernorth instead of Cigna, you still have access to Cigna's provider network and behavioral health services. Evernorth coverage for addiction treatment works the same way as traditional Cigna plans. Simply let BriteLife Recovery know you have Evernorth insurance when you contact us, and we'll verify your benefits.

Cigna's Behavioral Health Resources

Beyond insurance coverage, Cigna offers additional resources through its Behavioral Health division:

Education Series

Cigna provides free educational seminars covering:

• Physical, mental, and emotional signs of addiction
• Guidance for individuals in recovery
• Resources for family members
• Articles, tools, and podcasts on addiction topics

Note: While these resources provide valuable information, they do not replace professional medical care or addiction treatment.

Employee Assistance Programs (EAP)

Many employer-sponsored Cigna plans include EAP services offering:

• Free, confidential counseling sessions (typically 3-8 sessions)
• Referrals to addiction treatment providers
• Work-life balance resources
• 24/7 crisis support

How BriteLife Recovery Works With Cigna

At BriteLife Recovery, we understand that navigating insurance coverage can feel overwhelming when you need help immediately. Our admissions team specializes in working with Cigna insurance and can guide you through every step.

Our Cigna Insurance Verification Process

When you contact BriteLife Recovery, we will:

1. Verify your Cigna benefits — We contact Cigna to confirm your coverage, deductibles, copays, coinsurance, and out-of-pocket costs
2. Determine in-network status — We clarify whether BriteLife is in-network with your specific Cigna plan
3. Obtain pre-authorization — We handle all required authorizations before treatment begins
4. Explain costs in clear terms — We provide a detailed breakdown of your expected financial responsibility
5. Explore all options — If coverage is limited, we discuss payment plans and alternative arrangements

This verification process is completely free and confidential. Most verifications are completed within hours.

BriteLife's Treatment Programs

BriteLife Recovery offers comprehensive addiction treatment at our facilities in Pennsylvania, New York, South Carolina, and New Jersey:

Medical Detoxification (PA, NY, SC)

• 24/7 medical supervision during withdrawal
• Medication management to ease symptoms
• Psychiatric evaluation
• Preparation for continued treatment

Residential Treatment (PA, NY, SC)

• Immersive care in structured environments
• Individual and group therapy
• Medication-assisted treatment (Suboxone, Naltrexone, Vivitrol)
• Nature-Informed Therapy with certified clinicians
• Adventure Recovery programming
• Holistic wellness services (yoga, acupuncture, breathwork)
• Family therapy and education

Intensive Outpatient Programs (NJ and other locations)

• Structured treatment several days per week
• Flexibility to maintain work or school
• Evidence-based therapies
• Continuing care after residential treatment

BriteLife's Unique Approach

What sets BriteLife apart is our trauma-informed, connection-based philosophy. We treat addiction as stemming from disconnection—from self, from others, and from meaning. Our integrated approach addresses:

• Biological Health — Medical care, medication management, holistic wellness
• Mental Health — Individual therapy, trauma treatment, psychiatric services
• Social Health — Process groups, interpersonal healing, family therapy

How to Check Your Cigna Coverage for Rehab

Method 1: Call Cigna Customer Service

Call the number on the back of your Cigna insurance card and ask about:

• Coverage for substance use disorder treatment
• Your deductible and whether you've met it
• Copayments or coinsurance for addiction treatment
• Out-of-pocket maximum
• Pre-authorization requirements
• In-network treatment facilities in your area
• Out-of-network coverage availability

Method 2: Check Your Cigna Online Account

1. Visit www.cigna.com
2. Log in to your member account
3. Review your benefits and coverage details
4. Check your deductible status and claims history
5. Search for in-network behavioral health providers

Method 3: Contact BriteLife Recovery

Our admissions team can verify your Cigna benefits on your behalf—typically within hours. This free service provides:

• Detailed explanation of your coverage
• Clear breakdown of expected costs
• Information about in-network status
• Pre-authorization assistance
• Answers to all your questions

What If My Cigna Plan Doesn't Cover Enough?

If you face high out-of-pocket costs or limited coverage, several options may help:

Single Case Agreement

If BriteLife is out-of-network with your Cigna plan, we can request a single case agreement—a one-time exception allowing out-of-network care at in-network rates. These agreements are based on factors like:

• Lack of appropriate in-network providers
• Specialized treatment needs
• Clinical recommendations
• Medical necessity documentation

Payment Plans

BriteLife offers flexible payment arrangements for costs not covered by insurance:

• Extended payment plans
• Healthcare financing options
• Sliding scale fees in some cases

State and Community Resources

Additional funding may be available through:

• State drug and alcohol programs
• Community mental health centers
• Nonprofit organizations
• Employer assistance programs

Why Insurance Coverage Matters

Access to covered addiction treatment saves lives. Research shows comprehensive treatment improves outcomes including:

• Higher rates of sustained recovery
• Reduced overdose risk
• Improved physical and mental health
• Better employment and financial stability
• Restored relationships
• Reduced criminal justice involvement

The Substance Abuse and Mental Health Services Administration emphasizes that treatment must be accessible and affordable. Insurance coverage removes financial barriers that prevent many people from seeking help.

Taking the Next Step

Understanding your Cigna coverage is important, but the most critical decision is choosing to seek help. Addiction is a treatable medical condition, and recovery is possible with appropriate support.

At BriteLife Recovery, we believe healing happens through reconnection—to yourself, to others, and to meaning. Our trauma-informed, evidence-based treatment addresses the root causes of addiction while providing compassionate medical and clinical care.

We work with Cigna insurance to make treatment accessible. Contact BriteLife Recovery today to:

• Verify your Cigna benefits at no cost
• Receive a clear explanation of your coverage
• Learn about our treatment programs
• Discuss available treatment dates
• Take the first step toward recovery

Don't let confusion about insurance delay getting help. Recovery begins with a single phone call.