For patients struggling with substance abuse, finding the right treatment center can be an important part of the recovery process. Those struggling with substance abuse know that recovery is often not something that they can manage on their own. Instead, working with trained professionals who can guide patients through their complicated emotions, help them learn coping skills and face the physical ramifications of detox and recovery, can enhance the experience and care these patients receive so they can regain their health.

For many of these patients, however, cost is also an important consideration. Insurance coverage will greatly impact the amount that patients will have to pay out-of-pocket for treatment. The better patients understand their coverage, the easier it will be for them to find the care options that will fit best with their needs and their budget.

Here is what all patients and their loved ones should know about substance abuse coverage from Aetna in South Dakota.

Aetna substance abuse coverage in South Dakota

There are a number of different healthcare plans available for people in South Dakota. The plans themselves are broken down into two main categories, PPOs and TC. When patients understand what is offered under these two types of plans, it will become easier for them to make decisions about the best forms of care.

PPO Plans

Within the PPO plans, there are both preferred care and non-preferred care plans. Under the preferred care plan, patients have access to inpatient and outpatient care. For inpatient care, they will be responsible for a 30 percent coinsurance payment as well as a $500 copayment per confinement. For outpatient care they will have a 30 percent coinsurance payment. On the non-preferred plans, those rates will rise to 50 percent coinsurance for both types of visits in addition to a $500 per confinement deductible for inpatient care.

It is also important for patients to think about other potential aspects of care that might impact them. For example, they may need to be admitted to the emergency room, as substance abuse can be very dangerous for patients. For both types of PPOs, there is generally a 30 percent coinsurance rate and a $150 copay, but the deductible will be waived if the patient is admitted to the ER. There are a few PPO plans available that offer emergency room coverage for a flat copayment, which is typically about $75.

It is also common for patients to require medications at some point during their treatment. These prescriptions can be helpful for patients who need help during the detox process as well as those who might need help with a co-occurring disorder, such as depression or anxiety. Medications for the PPOs are divided into a few categories: generic drugs, formulary brand-name drugs, and non-formulary brand-name drugs. The cost per prescription varies depending upon the category. For preferred care, patients have a 30 percent copay for generic and formulary brand-name drugs and a 50 percent copay for non-formulary brand-name drugs. For non-preferred care, patients will have 50 percent of the submitted cost after the 30 percent copay for generic and formulary brand-name drugs and 50 percent copay for the non-formulary brand name drugs. Patients should work with their doctors and therapists to find medications that will improve their health while also minimizing costs.

TC Plans

Under the TC plans, patients have a flat 20 percent coinsurance rate for emergency room care, inpatient substance abuse care, and outpatient substance abuse care. This can help patients and their families budget for their costs.

When paying for prescription drugs, the payment system is similar to the PPO plans. There is a 30 percent copay for generic and formulary brand-name drugs and a 50 percent copay for non-formulary brand name drugs at participating pharmacies. If the patient’s pharmacy is not a participant in the plan, however, then patients will also owe an additional 40 percent after the previously listed copays.

For more information

Those interested in learning more information about substance abuse can trust us at DrugRehab.org to help them find the information they seek. We work to match patients and their loved ones with the latest information about treatment options and insurance coverage so they can find the right rehab to fit their needs. Reach out to us to learn more. Contact us today to get your journey towards recovery started.