Our dedication lies not just in treating symptoms but in addressing the root causes, offering a holistic approach that integrates the best of therapeutic practices with the warmth of community support.
Does Aetna Cover Addiction Treatment?
Yes. Many Aetna plans cover outpatient addiction treatment, and Encore Outpatient Services is in-network with Aetna. Your specific coverage and costs will depend on your plan.
Aetna Coverage for Addiction Treatment in Arlington, VA
Aetna covers all levels of care offered at Encore, including our Intensive Outpatient Program (IOP) and General Outpatient Program (GOP). Individual services, psychiatric medication services, and evaluations are also included in our in-network Aetna services.
Encore is in-network with Aetna PPO and POS plans. Your benefits and out-of-pocket costs depend on your specific plan, and some Aetna plans require prior authorization. We verify these details before admission so you know how your benefits apply to treatment and what costs you may be responsible for.
How We Help You Understand Your Aetna Benefits
Before you begin treatment, we review your Aetna benefits and explain how your plan applies to care at Encore. This includes your expected costs, coverage limitations, and any authorization requirements.
Benefit Verification
We verify your Aetna benefits using your member ID number and date of birth. We also need a copy of your insurance card before or on the date of admission.
Understanding Your Costs
Admissions explains any remaining deductible, copay or coinsurance, out-of-pocket responsibility, and coverage limitations under your plan.
Authorization Support
Some Aetna plans require prior authorization. When they do, our verification team handles the authorization process and any needed reviews or appeals.
Treatment Built Around Your Individual Needs
The right level of care depends on your individual needs. Our team looks at your substance use, mental and physical health, treatment history, life circumstances, and other factors that may affect recovery. This assessment helps us determine the amount of structure and support that is appropriate for you.
For some people, that may mean starting in our Intensive Outpatient Program, which provides more structured treatment during the week. Others may be appropriate for our General Outpatient Program, which provides ongoing therapy and support with less treatment time. Encore’s in-network Aetna services include both levels of care.
Your treatment recommendation is based on your clinical needs, while your Aetna benefits determine how that care is covered. As you progress, our clinical team monitors your needs and adjusts your treatment plan when appropriate. Should your level of care change, we can review how your benefits apply to the next stage of treatment.
If you need services outside the care we provide, our team can coordinate with other providers and community resources. If a higher level of care is needed, we can help connect you with a provider that offers that level of treatment.
When Aetna Authorization Is Required
Some Aetna plans require prior authorization for treatment. We confirm whether authorization is needed before admission and handle the process with Aetna when it applies.
Our team helps manage the insurance requirements that may affect your care, including:
- Checking your plan requirements
We determine whether your Aetna plan requires authorization for the recommended treatment. - Handling the authorization process
When authorization is required, our verification team works with Aetna to complete the process. - Keeping you informed
We explain the authorization requirements that apply to your plan so you know what to expect before treatment begins. - Responding if care is not approved
If Aetna does not authorize the level of care our clinical team recommends, the process does not necessarily stop with the initial decision. - Submitting reviews and appeals
Encore can submit reviews and appeals when Aetna does not authorize recommended care.
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Frequently Asked Questions About Aetna
Yes. Encore is in-network with Aetna for both IOP and GOP services. Our clinical team determines which level is appropriate based on your needs, while your Aetna benefits determine how that care is covered.
Yes. Encore's in-network Aetna services include individual services, psychiatric medication services, and evaluations. The services included in your treatment are based on your individual clinical needs, while we verify how your Aetna benefits apply to that care.
No. Your Aetna plan may still require a deductible, copay, or coinsurance, even when your care is in-network. Our admissions team reviews your remaining deductible, out-of-pocket responsibility, and coverage limitations before treatment so you know how your benefits apply.
Your clinical needs still guide our treatment recommendation. If Aetna does not authorize the recommended level of care, we can submit reviews and appeals rather than changing the recommendation solely because of the initial insurance decision.
Yes. We can verify your benefits using your Aetna member ID number and date of birth before treatment begins. We then explain your coverage, expected costs, and any limitations so you can make an informed decision about moving forward.
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