Aetna Insurance

Facing the cost of addiction or mental health treatment can feel incredibly overwhelming, but you don’t have to go through it alone. Aetna is one of the country’s most trusted insurance providers, offering coverage for a wide range of behavioral health and substance use services. At 12 South Recovery, we proudly accept Aetna insurance to help make high-quality treatment more accessible. Whether you need detox, inpatient rehab, outpatient support, or dual diagnosis care, Aetna may help ease the financial burden so you can focus on what truly matters: your healing and long-term recovery.

Aetna Insurance is one of the most trusted names in healthcare, offering coverage to individuals, families, and businesses all across the United States. Their mission goes beyond just providing insurance—they’re focused on making quality healthcare more affordable and accessible for everyone. Aetna offers a variety of plans, including those that cover essential services like addiction treatment, so their members can get the support they need to live healthier, more fulfilling lives.

Yes, Aetna does cover addiction treatment and for many individuals and families, that coverage can be life-changing. Understanding exactly what your plan includes is key, as benefits and requirements can vary based on the specific policy you have. At 12 South Recovery, we accept Aetna insurance and work closely with their team to help make sure you receive the care you need with minimal stress about costs.

Inpatient vs. Outpatient Treatment Coverage

Aetna offers coverage for both inpatient and outpatient addiction treatment programs, giving individuals flexibility to find care that best fits their needs.

Inpatient Treatment

Inpatient rehab is typically recommended for those who need a structured, immersive environment to begin their recovery. Aetna’s inpatient coverage often includes costs for room and board, individual and group therapy, medication, and daily clinical support. This type of treatment is ideal for individuals with moderate to severe substance use disorders or those with co-occurring mental health conditions.

Outpatient Treatment

Outpatient programs are more flexible, allowing patients to live at home or in a sober living environment while attending treatment sessions during the day or evening. Aetna usually covers services like individual therapy, group counseling, relapse prevention, and medication management. These programs are well-suited for individuals transitioning from inpatient care or those with milder substance use issues.

Understanding Aetna Insurance Requirements and Coverage for Addiction Treatment

If you’re considering using Aetna coverage for paying for addiction treatment, you need to know what you can expect under coverage and what you may have to do in advance. Aetna offers tremendous support for those who want recovery, but with any insurance provider, there are conditions and cost-sharing elements that depend on your own policy. At 12 South Recovery, we want to assist you in knowing all of it so that you can just recover.

What Are Aetna’s Requirements for Addiction Treatment Coverage?

To qualify for addiction treatment coverage under Aetna, the care must typically be considered medically necessary. This means a licensed healthcare provider must determine that treatment is needed for your health and well-being. Aetna generally requires that:

• The treatment is recommended by a medical or behavioral health professional.
• Services are provided by licensed and accredited professionals or facilities (such as 12 South Recovery).
• In some cases, pre-authorization is required—especially for higher levels of care like inpatient rehab or residential treatment. This means Aetna must approve the treatment plan before you begin, to ensure it aligns with your plan’s guidelines.

It’s important to review the specifics of your individual plan, as requirements can vary depending on the policy offered through your employer or marketplace.

The amount Aetna will cover depends on your plan’s benefits, deductible, co-pays, and co-insurance. Here’s what that typically looks like:

• Percentage-Based Coverage: Aetna usually pays a percentage of covered services. For example, your plan might cover 80% of the cost of treatment, leaving you responsible for the remaining 20%.
• Deductibles: You may need to meet a deductible before your coverage kicks in. This is the amount you pay out-of-pocket each year before your insurance starts paying its share.
• Co-Payments and Co-Insurance: Some plans require a co-pay (a set fee per visit), while others include co-insurance (a percentage of the service cost).

The level of care—such as inpatient vs. outpatient treatment—can also affect how much is covered. For instance, residential treatment may be covered differently than weekly outpatient therapy sessions.

If you’re considering getting into addiction treatment and plan on using Aetna insurance, getting things right beforehand can make it less complicated and less stressful. Here at 12 South Recovery, we want you to have all the information and support you can to get started with confidence. Below is what you should know before treatment.

Step 1: Review Your Aetna Insurance Plan

Before starting treatment, it’s crucial to understand exactly what your Aetna plan covers. Not all plans are the same—benefits, coverage limits, and network requirements can vary widely depending on your employer or individual policy.

Here’s what you can do:

Check Your Summary of Benefits and Coverage (SBC): This document outlines what services are included in your plan, including inpatient and outpatient addiction treatment, therapy, and medication-assisted treatment.

Call Aetna Member Services: The number is usually found on the back of your insurance card. A representative can explain your specific benefits and answer any questions about deductibles, copays, or coverage restrictions.

Get Help from a Treatment Provider: At 12 South Recovery, we can verify your insurance for you and break down exactly what your plan includes—at no cost and with no obligation.

Step 2: Understand Your Financial Responsibility

Even with insurance, you may have some out-of-pocket costs. It’s helpful to know about:

• Deductibles: The amount you need to pay before your insurance begins covering services.
• Co-Payments: A fixed fee you might pay per visit or service.
• Co-Insurance: A percentage of treatment costs that you may be responsible for after meeting your deductible.

Being prepared for these costs allows you to plan ahead and avoid surprises later on.

Step 3: Obtain Pre-Authorization (If Needed)

Many Aetna plans require pre-authorization before beginning certain types of care—especially inpatient or residential treatment. This means Aetna must approve the treatment as medically necessary before they agree to cover it.

Here’s how that usually works:

• Assessment: A licensed provider evaluates your condition and recommends treatment.
• Documentation: The treatment center submits clinical information to Aetna for review.
• Approval: Once approved, you’re cleared to start your treatment program with the assurance that it aligns with your coverage.

At 12 South Recovery, we handle this process for you, coordinating directly with Aetna so you don’t have to manage the paperwork or wait on hold.

Step 4: Begin Treatment with Peace of Mind

With your coverage in position and any prior authorizations that you require, you can proceed on the way to recovery. From detox through in-residence rehabilitation, from outpatient care through aftercare, Aetna’s coverage—with our individualized care—can make that subsequent step one of which you might take with optimism and purpose.

If you are lost or in doubt, don’t lose heart—come along with us every step of the way. Call our staff at 12 South Recovery today and let us help you begin the journey.

12 South Recovery is an addiction rehabilitation center based in Orange County and accepts Aetna insurance. We offer extensive services of addiction treatment including detoxification, inpatient treatment, outpatient treatment, medication assisted treatment, and aftercare. Our licensed medical staff negotiates with Aetna to obtain our patients proper treatment without losing their insurance benefits. Call 12 South Recovery Today!