What Cigna Generally Covers
Cigna plans typically cover the full continuum of substance use disorder treatment when medically necessary:
- Medical detox — covered when medically necessary, with standard deductible and coinsurance applying
- Residential rehab — covered for clinically appropriate stays, typically authorized in 7-day increments with extensions based on continued medical necessity
- Partial hospitalization (PHP) — covered as step-down from residential or as a primary level of care
- Intensive outpatient (IOP) — widely covered
- Standard outpatient therapy — covered under behavioral health benefits
- Medication-assisted treatment (MAT) — Suboxone, Vivitrol, and naltrexone are generally covered under pharmacy and medical benefits
Cigna manages behavioral health through Evernorth Behavioral Health (formerly Cigna Behavioral Health). Authorization requests for substance use treatment go through this division.
Common Cigna Plan Types
- Cigna Open Access Plus (OAP): the most common employer-sponsored Cigna plan; includes out-of-network benefits that can be used at BetterChoice
- Cigna PPO: traditional PPO with in-network and out-of-network tiers
- Cigna EPO (Exclusive Provider Organization): typically requires in-network providers; we can sometimes access through single case agreements
- Cigna Connect: narrower network, lower premiums; may require SCA for access
- Cigna + Oscar: newer joint plans in some markets; coverage varies
- Employer self-funded plans administered by Cigna: the employer sets the benefit levels, not Cigna; verification is essential
The plan type matters significantly for how coverage works at BetterChoice.
In-Network vs. Out-of-Network
Whether BetterChoice is in-network or out-of-network for Cigna depends on the specific plan; admissions confirms this with the insurer during a benefits check:
- In-network: contracted rates, lower out-of-pocket costs
- Out-of-network: some Cigna PPO and OAP plans include out-of-network benefits; the share paid, the allowed amount, any balance billing and your deductible vary by plan
- Single case agreement (SCA): when in-network access is not available, we can ask the insurer for a one-time agreement; approval is not guaranteed
The best way to find out how your Cigna plan handles BetterChoice is to verify benefits.
Prior Authorization
Cigna typically requires prior authorization (called "precertification") for:
- Medical detox (usually 5-7 days approved initially)
- Residential treatment (typically 7 days approved initially, with reauthorization based on continued clinical need)
- PHP and IOP (varies by plan)
When authorization is required, we submit the clinical information Cigna Evernorth Behavioral Health requests and keep you informed; Cigna makes the decision.
Length-of-Stay Considerations
Cigna authorizes residential treatment in shorter increments than some other carriers — typically 7 days at a time. Our clinical team submits detailed documentation at each review to support the length of stay you need. In practice, most Cigna patients receive coverage for 28-30 days of residential treatment. Longer stays require ongoing clinical advocacy.
What Cigna Will and Will Not Tell You
Cigna will tell you:
- What levels of care are covered under your plan
- Your deductible and out-of-pocket maximum (in-network and out-of-network)
- Coinsurance percentages
- Whether prior authorization is required
Cigna typically will NOT tell you:
- Whether a specific facility is recommended
- How much treatment will actually cost at a given facility
- Whether a single case agreement is possible (that is negotiated between the provider and Cigna)
We bridge that gap by verifying benefits and giving you a clear cost estimate before admission.
How to Verify Your Cigna Plan
Call us at (725) 550-5655 with:
- Your Cigna member ID (found on your insurance card)
- Group number
- Date of birth
We verify benefits within about ten minutes and call you back with confirmed coverage levels, estimated out-of-pocket costs, and recommended next steps. There is no commitment.
Privacy
Verifying benefits with Cigna creates only a standard eligibility inquiry. The information shared is the minimum necessary to confirm coverage. Cigna does not have access to clinical details beyond what is required for authorization and payment.
Contact
(725) 550-5655 198 Ebb Tide Cir Las Vegas, NV 89123