Evernorth Health Insurance Coverage for Addiction Rehab

Evernorth Health Services is a part of Cigna Corporation. The company provides a wide variety of solutions for health plans, employers, labor unions, health systems, and more. The focus is on pharmacy support and behavioral health services along with data driven benefits management.

Certain aspects of healthcare, in particular pharmacy benefits and behavioral health, are fragmented and challenging to understand. It can be hard for insurance plans and other organizations to know how to provide continuity of care with appropriate followup especially for complex health cases. Evernorth helps these plans and organizations provide appropriate care.

Cigna Corp also announced that in 2025 Evernorth will be launching a nationwide outpatient behavioral health practice which will help insurers and healthcare providers address each patient’s mental health and medical needs. You can get care online or in person. This care is already available in six states and D.C.

Does Evernorth Health Cover Addiction Treatment?

Evernorth is a benefits provider and administrator, not an insurance company, so they don’t determine what kind of care you get. However, most insurance plans are required to offer at least some coverage for mental health and substance use due to the Affordable Care Act (ACA). Evernorth can help insurance plans meet those requirements because they offer a wide variety of in person and telehealth addiction rehab and mental healthcare.

Every insurance plan is different, so be sure to talk to the insurance company or your employer’s benefits specialist to get your plan’s details before you start treatment. That way you know what to expect and don’t have any surprises when you’re focused on recovery.

What Benefits Does Evernorth Health Provide?

Evernorth has a broad suite of services that help health plans and organizations provide much needed care to their members. Not all insurance plans will have all services.

Their behavioral health services include AI guided care recommendations and licensed clinicians available 24/7/365 by phone or online on demand. They also have an expanded network of providers that includes inpatient and outpatient care along with virtual support. Evernorth provides an Employee Assistance Plan (EAP) that can refer employees to financial and legal assistance along with other resources.

They also have a Behavioral Health Navigator that gives you a live person to help you determine what you need and find a provider. They can even help you schedule an appointment and follow up to ensure you got what you needed. Finally, Evernorth has a program called inMynd that provides digital cognitive behavioral therapy (CBT) and medicaton management.

Evernorth’s CareNav+ is an app that allows members to get care coordination to help them address health issues before they become serious. It includes an AI powered care navigator that gives you proactive recommendations for medical care.

Another Evernorth service that can help with substance use treatment is a partnership with Pelago Health. They provide virtual care and one to one coaching and counseling. Pelago also has on demand CBT and specialized treatment options that can be mailed to your home.

Evernorth Health’s Advanced Opioid Management® program is focused on helping those who are prescribed opioids avoid misusing the medication. You will be educated about the risks of opioids and given drug disposal bags to ensure leftover meds aren’t misused. Patients can also get case management and a connection to a mental health hotline. As part of this program pharmacies can provide Narcan and there may be prior authorization required for some prescriptions and refills.

What Inpatient Addiction Treatment Does Evernorth Health Cover?

While your insurance company may have a contract with Evernorth for addiction treatment services the insurance company will still decide what coverage it ultimately provides.

If you need residential treatment, almost all insurance plans will expect you to get prior approval before you go. Insurance companies ask for prior approval before agreeing to cover residential treatment because they want to know that it’s the right match for the severity of your condition. They usually take several factors into account such as your health status and what substances you’re using as well as what kind of social support you have.

Depending on your clinical condition there are different inpatient services your treating doctor might refer you to.

If you’re physically dependent on a substance that can lead to dangerous withdrawal symptoms you might start with inpatient detox. The drugs that are most commonly detoxed in inpatient settings are alcohol, opioids and sometimes benzodiazepines. The length of stay usually depends on your clinical condition. Most detox admissions last between three and ten days.

If you don’t need medical detox or you’ve completed it your next stop may be residential rehab. This might be the right level of care for you if you’re getting alarmed about how dangerous your drug use is getting — either because of the situations in which you use or the health consequences it’s causing you. Residential rehab separates you from these dangerous conditions by bringing you into a controlled environment. It’s usually very structured with little free time and limits as to what can come into the facility. Days are usually spent in therapeutic groups and activities. The length of stay can vary but is usually several weeks.

What Outpatient Rehab Does Evernorth Health Cover?

Your insurance company may partner with Evernorth to connect you to some of the outpatient services described below.

If your treatment team refers you to partial hospitalization you may find that the experience is very much like residential treatment but with one major difference – you go back to your own home at the end of the day. Partial hospitalization is often used as a step down from residential rehab but you can also get admitted there directly. People who have supportive home environments may be candidates for direct admission to a partial hospitalization program.

Intensive outpatient programs (IOPs) take place for two or three days a week for a few hours. They sometimes offer evening hours. IOPs are often best for people who are still able to keep working or who are trying to get back to having responsibilities.

Standard outpatient therapy is when you find a therapist and perhaps a psychiatric medical provider and see them on a regular basis. How often you see them will be between you and your provider.

Does Evernorth Health Cover Methadone & Suboxone (MAT)?

Methadone and suboxone are both medications that are used to treat opioid use disorder. Sometimes these medications along with others get collectively referred to as MAT. MAT stands for medication assisted treatment. Medications can be used as part of detox or as a maintenance treatment. There are also medication treatments available to help people who are addicted to alcohol.

If you’re using MAT for detox you will normally get medications to help keep away the most harmful withdrawal symptoms. The medications will usually get tapered until you’re no longer physically dependent on the substance from which you’re detoxing.

MAT can also be used for maintenance if you have opioid use disorder. With maintenance therapy your withdrawal is minimized or avoided altogether by continuing to take either methadone or suboxone. You remain dependent on opioids while you’re on these medications but they don’t make you get high so you’re able to live a normal life.

Does Evernorth Health Cover Other Mental Healthcare?

Your insurance company decides what’s included in your mental health coverage. They may use parts of Evernorth’s network to help connect you with care. Most insurance companies offer mental health coverage as a result of the Affordable Care Act but there are some exceptions to the law so it’s important to verify your coverage.

Apart from what’s already been discussed other types of mental health coverage your insurance company may cover through Evernorth include services like crisis management and inpatient psychiatric treatment.

Your insurance company may also cover providers that care for people with co occurring disorders. More and more mental health service providers are integrating addiction treatment into the care they provide. That’s because it’s common for people to have both addiction and mental health challenges at the same time. Since people do better when both illnesses are treated together it’s important to find a provider who can do both.

Does Addiction Treatment Need to Be In Network?

Evernorth doesn’t set the network rules for your insurance company. Although they may provide services, the coverage for these would be subject to your insurance plan details.

Different insurance plans have different rules about whether you can see a care provider that’s outside of your network. However if getting the most out of your insurance coverage is important then you want to look for ways to stay within your network even if out of network care is available. That’s because going out of network will significantly increase your out of pocket costs. These out of pocket costs — like your deductible and copay — can get really expensive when you go out of network.

If you decide to go out of network carefully check the rules as to what your plan allows and how much they will cover.

How to Verify Coverage With Evernorth Health

The most reliable way to verify your benefits is to talk to your insurance company directly. The ways you can do that include calling your insurance company’s customer service line or logging into your online insurance account. You can also use an app if your insurer has one.

You may also be able to verify your coverage for specific Evernorth services by asking Evernorth to confirm your coverage at the time of service.