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Did you know that in 2020, 1 in 15 adults in the US experienced both a mental illness and a substance use disorder? It was a challenging year for many people and the aftereffects of surviving a pandemic seem to keep piling up. 

Maybe you’ve been struggling with depression for a while, and life has become too much in the past few years. Or you have started self-medicating with alcohol or drugs to help cope with the stress of COVID. If you or a loved one is struggling with mental health and/or substance abuse issues, please know, that you are not alone! There is help and hope. 

Behavioral health care includes treatment for mental health, substance abuse, and co-occurring disorders, which is when you are struggling with both. Trying to figure out the managed care system by yourself can add additional stress. Here are tips for navigating Cigna Rehab Coverage to get the help you need for behavioral health care. 

Hope spelled on top of map concept image for behavioral health treatment.

Find Out Your Cigna Insurance Coverage for Rehab

Due to a law passed in 2008 called Mental Health Parity, insurance companies including Cigna must provide the same benefits for mental health and substance abuse disorders that they do for medical conditions. This is good news for you as a Cigna member. 

Call the customer care number on the back of your Cigna insurance card and ask what your behavioral health benefits cover. Be sure to ask about what levels of care are covered, if there are any coverage limits, and if your plan offers case management services. 

Some Cigna insurance plans offer behavioral health case management services. A case manager is a licensed professional (Registered Nurse, Licensed Social Worker, or Licensed Counselor) who can work with you to ensure you get the care you need. If your plan offers this, then it is highly recommended that you ask for the service. 

Finding Providers with Cigna Rehab Coverage

Your insurance company will contract with certain providers at a pre-set rate. These are known as in-network providers. If your plan has out-of-network benefits, this means you can see any provider that you want, but you may have to pay additional out-of-pocket costs.

When you call Cigna’s customer care, they will give you a list of in-network providers and quote you the benefit of costs for out-of-network providers. What you end up paying should be transparent with your Cigna rehab coverage.

If you are seeking inpatient services and already have a provider in mind, make sure they are licensed by your state and nationally accredited by an organization such as the Joint Commission (JCC). 

Learn About Behavioral Health Levels of Care

Behavioral Health care has different levels of care for mental health, substance abuse, or both. The treatment you need will depend on the severity of your symptoms. The basic structure of levels of care for behavioral health varies slightly between mental health and substance abuse, but here is a general overview of the levels of care.

  • Inpatient Hospitalization: For substance abuse, someone needing medically managed detox will need inpatient care. For mental health, a person who is a threat to themselves, others, psychotic, or deemed to have a grave disability will go to the hospital for stabilization.
  • Residential Treatment (RTC): Residential treatment is a longer-term program that can last from a few weeks to a few months. People with substance abuse disorders can also receive what is called sub-acute detox at an RTC and then stay at the facility to complete the residential program. 
  • Partial Hospitalization (PHP): PHP is a day program where you get treatment during the day and can either go home at night or possibly board at the PHP. If you board at a PHP, generally your insurance will not cover this and will only pay for the day’s treatment. During PHP, you will attend therapeutic groups and individual therapy, see a medication provider, and may participate in additional therapies such as Equine-assisted Therapy or art or music therapy. PHP is generally anywhere between 5-7 days a week and the duration depends on your progress.
  • Intensive Out-Patient (IOP): IOP is similar to PHP as far as treatments that are provided, yet it is a less intense program. IOP generally is about 3-4 hours a day, 3-5 days a week. 
  • Outpatient: Traditional outpatient services are individual therapy and medication management. Subsequent outpatient services include Transcranial Magnetic Stimulation (TMS) and Electroconvulsive Therapy (ECT), which are both used to treat mental health disorders such as medication-resistant depression. 

Health insurance concept image.

Work with Your Treatment Provider To Get the Most Benefit from Your Cigna Insurance Coverage

Depending on the language in your Cigna insurance plan, some of your treatments may need what is called pre-certification. This is something your treatment provider should do, but be sure to ask them about it. 

Asking for help when you are battling mental health or substance abuse is not easy. Your main focus when you are seeking behavioral health treatment should be on your recovery. You are worth it and not alone.

For additional information on behavioral health treatment, contact Mending Fences.