Saturday, December 15, 2018

Cigna Drug Rehab Coverage

Cigna Health Insurance Drug Rehab Coverage

Addiction is considered to be an epidemic because it harms the body and mind by altering its chemical balance, thus rendering it helplessly dependent on substances and as a result- costing many lives. But the bulk of monetary resources that are invested in this dependence are an alarming figure as it negatively impacts family members that may be relying on the addict for care and support. On the other hand, when and if, the person suffering from addiction may decide to get de-addiction treatment and sort out their lives, they will require a hefty sum of money to help themselves, which they may have lost during drug usage. Therefore, substance abuse can be easily labeled as one of the major expensive diseases in the world. Hence, in such a situation, health insurance companies like Cigna can become pivotal in helping a person cover healthcare expenses and to reclaim their lives. Drug rehabs that accept Cigna have allowed people to seek affordable treatment and gain the strength to walk the challenging road of recovery. 

About

Cigna is a globally ranked medical health insurance provider that has worked with millions of people throughout the globe to assist them in attaining the best possible medical treatments ever since 1982.  With multitudes of insurance options available for individuals, families and corporate groups, Cigna has created a large network of healthcare providers which covers several nations with the blanket of care.

As per the terms laid by the Affordable Care Act(ACA), Cigna bestows insurance coverage for substance abuse and addiction treatments as a significant component of its Behavioral Health Services Coverage. The degree of coverage may vary for different policies that they offer. But a basic insurance plan will definitely cover the essentials elements required to battle substance abuse, that is, medical detox, inpatient and outpatient drug rehabilitation (including medication and psychotherapy), dual diagnosis treatment and aftercare (psychotherapy and aftercare homes).

Types of Insurance Plans

Keeping in terms with health insurance trends in the United States, Cigna offers policies based on Preferred Provider Organization (PPO), Health Maintenance Organizations (HMO) and Health 
Savings Account (HAS). The PPO is a managed organization of doctors, treatment centers and complementing health care experts who work with an insurance organization and provide treatment at a subsidized cost to the clients that are in association with the insurance provider. Such an arrangement renders monetary ease to the clients in multiple ways as the Network that is subsequently formed in this process not only provides discounted treatment services but is constantly supervised by the insurance provider to ensure quality treatment. Thus, Cigna In-Network drug rehabs are a step towards allowing value based care with accountability for treatment.

A PPO insurance policy offered by Cigna allows outpatient services along with partial hospitalization (PH), inpatient and intensive outpatient program (IOP) which may require prior authorization. That is, the representatives at a Cigna PPO drug rehab will look into the clients’ assessment reports in order to offer insight into whether the hospitalization or IOP is the most apt step for treatment or not. All In-network service providers are covered in the insurance plan with copayments and coinsurance.

Copayments are a decided figure of money that one is supposed to shell out for health services covered under insurance. That is, when a client opts for a service costing about $100, they are expected to pay a fixed amount, for example $15, when taking on the treatment and rest of the $85 will be paid by Cigna. Even if the treatment costed $200, the client is only required to pay $15, while the rest will be taken care of by their Cigna plan.   In case of Coinsurance, the client pays a precise percentage of the fee of the health services they opt for. That is, if the client is expected to pay 20%, then in case the treatment service costs $100, they will be asked to pay $20 and incase the treatment is for $200, the client will have to give away $40 worth.

An HMO is similar to PPO in terms of the health care providers’ network formation; but while the PPO will cover a portion of the treatment costs in case a client opts for an out-of-network healthcare provider, HMO will not allow this option to its clients. Exceptions can be made but that would require special authorization where Cigna will determine whether that particular out-of-network treatment option is the most viable and appropriate option to initiate the process of healing or not. Thus, while In-network heath care options will be duly covered, the opting of out–of-network service providers will push a client towards more ‘out-of-pocket costs, that is, in many areas the client will have to manage the payments all by themselves. A policy like Cigna Connect Flexis a fine example of the HMO plan.

The HAS allows people to save money especially for taking care of their medical expenditure with specialized taxation exemptions. A policy like Cigna Local plus HSA gives better coverage to In-network care providers though it tilts more towards outpatient services. For inpatient treatment, the client may require to submit for special permission.

Initializing Treatment

There can be two ways to approach initialization of treatment. First, when a person makes the life defining choice of opting for treatment, they look at various resources to seek the most appropriate treatment center providing them an abundance of holistic treatment possibilities to pick from. Once they make a choice, they are invited to the treatment center for an assessment that will shine some light on their mental and physiological history, providing a base to form a treatment plan on. Once the healthcare providers of the treatment center present the client with what they believe to be the best plan of action for them, the client can check in with the representative of Cigna, who have their own assessment team made up of insurance professionals as well as healthcare professionals. This team at Cigna will make a judgement based on what all can be covered in the clients insurance package and how much will it genuinely help the client with the ideal cost setup. Based on  what Cigna will present the client with, they can determine how much of their treatment will be covered and how much they will have to pay for themselves keeping in mind that they need to walk a lengthy stride on the path to recovery and take several steps to become sober once and for all.

The second approach requires the client to look up in their healthcare insurance companies’ In-network healthcare providers’ list and seek out to doctors as well as treatment centers that have been approved by Cigna. The list that is presented to the client consists of treatment providers that are in the cost range of the client, geographically convenient, tested and analyzed by the experts of Cigna around their approach to de-addiction treatment. Thus, Cigna aims at providing their clients with resources to not only understand what addiction and what de-addiction treatment will look like, but also provide its clients with time tested treatment options and the best medical professionals to dispatch that treatment. Cigna drug rehab centers provide clients with opportunities to choose from a vast array of treatment options for a fraction of a cost and added benefits which will ensure that you receive treatment for full value. Cigna’s monitoring at auditing is to create certain that clients are rewarded with what they were promised.

Value Based Treatment Approach

Keeping in mind the growing rate of opioid epidemic, Cigna has been a contributor to the research and analysis of understanding as well as creating further probable tactics to tackle the issue. In the last few years, Cigna has been said to give away data from its medical claims to the American Society of Addiction Medicine that has been working in alliance with the research scholars of Brandeis University to understand how the treatments trends have been faring to curb the epidemic and prevent any relapse after the main treatment is complete. The aim has been to assess the progress of people who went in treatment and the shortcomings of the treatment plans, if any. Through comprehending what kind of a methodology can lead clients towards a relapse- free path to recovery, a handout of prescribed guidelines could come in formation, encouraging medical professionals through the nation to follow an advanced standard of treatment to battle opioid addiction. Cigna approved drugs rehabs have been the first to follow such guidelines and establishing specific value based protocols for their network of healthcare providers to follow. Therefore, Cigna made its stand in the battle against opioid epidemic by making efforts to shift focus from fee-for-service medicine, which pursues the volume of care delivered, to rewarding patient outcomes, and creating measure of performance, to ensure treatment facilities award efficient and timely care for addiction. Such a research exercise has also been credited to be beneficial in observing trends of relapse after treatment in order to identify specific markers of relapse that can be discerned at early stages and prevented.

Treatment Covered by Cigna

As per the Affordable Care Act, Cigna drug rehab coverage is entitled to pay for every aspect of treatment required to initiate recovery from substance abuse, that is, both residential (inpatient) and non-residential (outpatient) stays are required during detoxification, medical stabilization, psychotherapy (individual along with group and family psychotherapy) and aftercare (transitional living) are expected to be covered by policies created by Cigna. This coverage differs according to the state of residence, state of treatment, policy details such as type of policy, and so on. But the coverage usually ranges from about 50% to 80%. Majority of the treatment segments are covered fully or partially (coinsurance around 20%), but a few ambulatory treatment options are to be paid by the client only. 

Clients have the independence to choose their treatment centers as per their choice and convenience; though in majority of cases, clients are recommended to seek rehabs which are geographically closer to their place of residence, and that is to avoid extra travel expenses. Assessment and initial counselling sessions are covered but only to a certain extent, determined by the specifics of one’s policy. 

Cigna has very definite understanding of what entails as assessment and treatment. Along with pronounced focus on quality of treatment, such an outlook is the result of the panic cause by the overflowing use of drugs and subsequent deaths. This panic gave birth to several alternate yet desperate measures formulated to fulfill the gaps in treatment. Thus, Cigna ensures that every request for alternative forms of treatment which maybe loosely collected under the term ‘Holistic’ is assessed duly. Therefore, treatment elements such as yoga, meditation, recreational activities, alternate therapies such as acupuncture, acupressure, and others are thoroughly analyzed, on case basis, and the Cigna healthcare medical professionals assess whether the course of treatment labeled as alternative have scientific evidence to prove its efficiency in the stated context and whether it is covered under the client benefit plans.

Cigna holds criteria to ensure the eligibility of a person for a specified type of treatment. Thus, based on this Medical Necessity Criteria and their policy specifications, it is determined whether a person is eligible for a Cigna drug rehab program or not. They expect clients to be serious towards Cigna’s handpicked programs and hence, encourage scientific and medical evidence based criteria that reflect on the client’s capability to successfully absorb all the elements of the program. For example, a general conception of de-addiction always pushes people towards inpatient treatment, but it is expensive and not necessarily the most appropriate option. In such cases, Cigna always approaches with the recommendation of an Outpatient/partial or no-hospitalization program to the client. Only if all viable alternates have been exhausted will the desire of the client be honored and duly covered by the insurance.

Detox

Usual recommendation for a process like detoxification is to assign oneself inpatient care and an around the clock supervision, till the time their withdrawal symptoms subside and they are ready to move forth to the next chapter of healing.  Cigna puts forth conditions for hospitalization during detoxification and conveys that only after the client goes through a clinical assessment, face-to-face with licensed medical professionals can the insurance company consider covering the client for the treatment plan. If further on after the medical assessment states that inpatient detox is medically necessary, Cigna may recommend the treatment plan for the client. This intensive level of care should be not justified by reasons such as ‘fear of withdrawal’ by the patient. In fact, presence of drugs and alcohol in blood streams without any substance associated withdrawal symptoms is also not enough to justify the need for intensive detoxification treatment. In case of severe withdrawal symptoms tilting towards life threatening diagnosis such as organ failure, complications in the heart, seizures, etc., then the client is required to apply for medical or surgical status rather than detox.

Therefore, detoxification can be only recommended in an intensive setting if specific withdrawal symptoms of the associated substance have started to show in the last few hours. That is, symptoms of opioid withdrawal such as abdominal cramps, , loss of appetite, pain in the joints, extensive sweating, diarrhea, agitation and anxiety dilated pupils, runny nose ,muscle spasms,elevated vital signs (pulse, blood pressure, temperature), irritability, insomnia, standing of the hair on the skin,rapid breathing, and teary eyes show up, the client is eligible for an inpatient detox. Client with a history of mental illness is also rendered eligible.

Cigna also has a specific list of criteria for healthcare providers. That is, a value laden Cigna drug detox is only possible if the client is given daily comprehensive care by licensed medical professionals, urgent behavioral and physical issues are being treated immediately, an individualized treatment plan for the client is ready within 24-hours of admission stating assessments results, extensive treatment plan and goals of recovery both long and short term. There should be a presence of a methodology for how to include the client’s family in the course of treatment and a dispatch plan including an extensive aftercare regime.

What is withdrawal? How long does it last?

Inpatient Treatment

Inpatient treatment consists of healing from the toxins that were once registered in the body due to drug and alcohol abuse. The aim of this stage of treatment is to mentally and physically heal and recover from the damage of substance abuse.

Cigna emphasizes on the ‘medically necessary’ in this scope of treatment as well. Thus coverage for inpatient treatment plan can only be recommended if the client has experienced a face-to-face medical assessment, performed by a licensed medical professional. This medical expert is experienced and capable of recommending if such an exhaustive level of care required is required for the existing condition of the client, if the client has visited other options of care that do not demand hospitalization or if no other option of healing is available around the client except a hospitalization.  In case the client is eligible, then before taking admission it is necessary that client is rid of life threatening withdrawal symptoms and that there is no other factor that would hamper their adequate participation in the inpatient treatment program.  If the client is in any capacity, trying to put themselves and others around them in harm, they gain the eligibility to be admitted in a restrictive inpatient treatment program.  

Cigna expects that a healthcare provider organizing an inpatient program will have the resources and capacity to actively care for the client with the help of licensed medical professionals, and factors such as taking care of urgent medical matters, monitoring the client’s vital signs and fulfilling other clinical needs like pain management, preparing an individualized treatment within 24-hours of admission conveying treatment goals along with family participation, psychotherapy goals and a discharge plan to foster care after treatment.

Should I choose inpatient or outpatient?

Medically Assisted Treatment

A medically assisted treatment plan is considered for people who have a prolonged history of opioid dependence including a brief history of treatment and then relapse. The usual course of action involves managed usage of Methadone, Buprenorphine and Naltrexone. The whole treatment plan is a combination of detoxification, medication management and medically supervised withdrawal.

To be eligible for coverage of this treatment plan, clients must meet all the medical necessities, has a history of opioid dependence that is minimum a year long, has been a diligent participant of outpatient or on-site treatment program, has a supportive environment that can foster recovery and is ready to adhere to every step in the treatment. A client struggling addiction in the state of pregnancy is also eligible for coverage.  If the client has been struggling with suicidal thought or has not been an active participant in recovery, their eligibility can be canceled. Also, if they are at any prospective risk to Methadone or Buprenorphine, they are not recommended to join the treatment plan.

Before the year 2016, a client willing to opt for a medically assisted treatment program had to undergo a prior authorization, that is, the client needs to consult with medical professionals at Cigna to discuss the risk factors and the programs’ degree of effectiveness for the client before receiving coverage. But in the wake of the every growing opioid epidemic in the United States, Cigna successfully ended the prior authorization policy for opioid treatment especially with Buprenorphine. Such, a step has successfully eliminated a major, time barrier towards treatment, allowing efficient healing.

Tobacco Kit Concession

Cigna has continued to be a key player against substance abuse and provided several minute benefits that have given unlimited relief to the people. Cigna has granted its consumers the right to attain ‘quit tobacco kits’ for free of cost. Pharmaceutical products such as Bupropion, Chantix patches, gum, Nicotrol oral and nasal inhalers are compensation free for Cigna clients. They can receive around 12 weeks of treatment products per year as a lifelong benefit with a simple prescription to achieve easy emancipation from the holds of tobacco

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