Most calls to our admissions line start in the same place. Someone has decided to ask for help, or a wife or a father is asking for them. The first question is whether Aetna will cover it.
I understand why that comes first. It’s easier to ask than the questions underneath it. I’ll answer it here the way we do on the phone.
The short answer
Yes, in most cases. Most Aetna plans cover medical detox when it is medically necessary. Revive Detox is in network with Aetna, which means we have a contract at agreed rates. Your share of the bill is usually lower than it would be at a facility outside the network.
What I can’t tell you here is what your own plan will pay. Two people can carry the same Aetna card and have very different coverage because the employer or policy sets the terms. Anyone who quotes you a figure before checking with Aetna is guessing.
What “covered” means
Covered doesn’t mean free. Aetna pays its part once your plan’s rules are applied. You pay yours.
Your part starts with the deductible, which is what you pay before the plan pays anything. Some of it may already be met if you’ve had other medical bills this year. After the deductible, most plans split the cost with you. That’s called coinsurance.
The out-of-pocket maximum is the most your plan can ask you to pay for covered, in-network care in a plan year. If you’ve had a hard year medically, you may be closer to that ceiling than you think. We check all of this when we verify your Aetna benefits.
How Aetna decides
Aetna pays for detox when it is medically necessary. For substance use, Aetna says it uses the ASAM Criteria, guidelines from the American Society of Addiction Medicine, to judge what level of care a person needs.
In plain terms, the question is whether it is safe for you to stop on your own. That depends on what you’ve been taking, how much and for how long. With alcohol or benzodiazepines such as Xanax or Klonopin, stopping on your own is often unsafe. Withdrawal can be dangerous without medical care.
Most Aetna plans also require approval before or at admission. Aetna calls it precertification. We make that call. You don’t have to.
One thing that has nothing to do with insurance: if someone is having a seizure, is badly confused or can’t be woken, call 911. Don’t wait for a benefits answer.
California law is on your side
California’s SB 855, in effect since 2021, requires health plans regulated by the state to cover medically necessary treatment for substance use disorders. It also requires those plans to use criteria written by nonprofit clinical associations such as ASAM when deciding what is necessary.
There’s a catch. Many large employers pay their employees’ claims themselves and hire Aetna to run the plan. Those plans answer to federal law instead of California’s. Federal parity law still applies to most of them: a plan can’t set stricter rules for addiction treatment than it sets for other medical care.
You don’t need to know which kind of Aetna plan you have. We find out when we verify your benefits.
What happens when you call
- You give us the information on your insurance card and your date of birth.
- Our verification team contacts Aetna to check your coverage.
- Then we explain what the plan will and won’t cover, including any remaining cost to you.
There’s no charge. And asking commits you to nothing.
If your plan won’t cover care here, we’ll tell you and help you look for somewhere it will. I would sooner lose an admission than have a family find out on the third day what they owe.
If you would be paying some or all of the cost yourself, ask us about sliding-scale rates.
What the coverage pays for
Insurance is paperwork. Here, it pays for a bed in a six-bed house on La Peer Drive in Beverly Grove, between Beverly Hills and West Hollywood. Care is physician-supervised, with nurses involved throughout your stay.
We keep things intentionally small. You’re not one of many. I opened Revive in 2014 because I wanted a place I would trust with someone I love.
We are accredited by The Joint Commission and licensed by the California Department of Health Care Services.
Nobody can promise us perfect, and I won’t promise you an outcome. I can promise you a straight answer about your Aetna coverage before you commit to anything.
If you’re calling for someone else
A lot of the people who call Revive are not the patient. If that’s you, call anyway. We’ll tell you what we need to check their benefits and what the next step looks like.
You don’t have to be less afraid before you begin. Start with the insurance question if that’s the one you can ask today.
Verify your Aetna benefits online, or call (844) 467-3848. We answer 24 hours a day.
