Meritain Health is an Aetna subsidiary that serves as a TPA (third-party administrator). Often referred to as Meritain Health Aetna, TPAs administer health benefits to organizations and employers across the United States. Meritain has been managing healthcare benefits for healthcare systems, hospitals, academic institutions, and businesses since its inception in 1983.

This page examines how Meritain Aetna rehab covers at least part of the costs associated with treatment for addictions and mental health issues, highlighting the benefits provided by this TPA and Aetna subsidiary.

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Does Meritain Health Cover Addiction Treatment?

Meritain Health offers coverage for addiction treatment through Aetna’s Choice POS provider network. The scope of coverage varies depending on the type of plan. All Meritain plans provide at least partial coverage for substance abuse treatment as mandated by federal parity legislation [1]. Meritain health plan coverage for addiction treatment is offered at the same level as that afforded to other medical conditions.

Your plan type dictates baseline benefits. Out-of-pocket costs for Meritain Aetna rehab are also influenced by whether the treatment center you choose is part of the Aetna network of providers: in-network facilities result in reduced out-of-pocket costs. Your location may also affect the availability of providers and levels of coverage. Beyond this, the level of care you require, whether it is detox, inpatient, or outpatient treatment, is also associated with variable coverage parameters.

What Types of Drug and Alcohol Rehab Does Meritain Health Cover?

Meritain Health, acting as a third-party administrator, provides drug and alcohol rehab coverage across the full continuum of care when it’s deemed medically necessary. This might include detoxification services, outpatient programs, intensive outpatient and partial hospitalization programs, and inpatient (residential) rehab. Individuals with drug or alcohol addictions co-occurring with mental health conditions may also qualify for Meritain Aetna rehab coverage for dual diagnosis treatment [2].

• Inpatient rehab is the most intensive form of Meritain Aetna rehab that involves continuous clinical and emotional care at a residential facility. Coverage extends to detox services, therapy sessions (individual, group, and family), medication management, and psychiatric services. Structured daily programming is delivered over 30 to 90 days, depending on the severity of the addiction, personal factors, and plan limits.
• PHP (partial hospitalization programs) are day treatment programs that deliver highly structured care without the need for overnight stays. Sessions are held for 6 or more hours each day on 5 or more days of the week. PHP services are similar to those administered in inpatient treatment programs.
• IOPs (intensive outpatient programs) are often used as a step-down from inpatient rehab or PHPs. These programs typically involve 4-hour sessions on several weekdays, including one-to-one counseling, group therapy, family therapy, and educational sessions. IOP enables individuals to engage in addiction treatment while maintaining their everyday commitments.
• Outpatient programs involve weekly sessions to help ease the transition from inpatient or intensive outpatient rehab to independent living.
• Medication-assisted treatment receives Meritain Aetna rehab coverage when it’s clinically necessary. This involves combining FDA-approved medications with talk therapies and counseling to reduce cravings, manage withdrawal symptoms, and promote ongoing abstinence from opioid or alcohol addictions [3].
• Dual diagnosis treatment is covered by most Meritain-administered health plans when required. Integrated treatment tackles mental health and substance use disorders simultaneously.

Check Your Meritain Insurance Coverage

You should verify your Meritain Aetna rehab coverage before beginning treatment. Access the member portal through the Meritain Health website or call customer service. Gather the following information:

• Amount of annual deductible.
• Co-payment amounts for different levels of care.
• Percentage of co-insurance required.
• Annual maximums for out-of-pocket expenses.
• Requirements for prior authorization.

You can also contact your chosen treatment provider to verify your Meritain insurance coverage. This can help you plan for treatment more effectively and reduce the likelihood of unexpected costs cropping up.

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Do Treatment Centers Need to Be In-Network to Accept Meritain Health Insurance?

Network provider status affects how much you pay out of pocket when accessing your Meritain Health insurance benefits. It is nevertheless possible to choose treatment outside the Aetna POS network, although this will involve increased expenses.

In-network treatment centers have negotiated agreements with Meritain Aetna to deliver services for addiction and mental health treatment at pre-set rates. You will pay less for treatment within the network of providers, typically nothing but co-insurance or co-payments after satisfying the deductible, meaning you’ll pay just 10 to 30% of the overall costs.

Out-of-network treatment centers do not have contracts with Meritain Health, but they may accept your insurance with an increased cost-sharing burden.  Out-of-network care may involve paying up to 70% of the costs of treatment for substance use or mental health disorders. Meritain plans may not offer benefits out-of-network for all services, though.

Meritain Aetna rehab coverage may require authorization for inpatient treatment. This involves obtaining documentation of the clinical necessity of intensive therapy before initiation. Failing to get prior authorization may result in the denial of your claim.

What Are the Coverage Levels and Plans for Meritain Health?

Meritain Health administers insurance plans that include HMOs (health maintenance organization plans), PPOs (preferred provider organization plans), HDHPs (high deductible health plans), as well as some self-funded plans.

HMO plans involve choosing a primary care provider who is responsible for coordinating treatment and making referrals. These plans are associated with low out-of-pocket costs and minimal flexibility in selecting treatment providers [4].

PPO plans offer a more flexible approach, enabling you to select a provider in or out-of-network without obtaining referrals. Choosing a provider outside the Meritain Aetna network attracts higher out-of-pocket costs.

HDHP plans have high deductibles and low monthly premiums. You will pay the full costs of treatment until the deductible is satisfied. After this point, insurance benefits kick in. Many people use HDHPs in combination with an HSA (health savings account) to leverage tax advantages for healthcare.

Many employers and organizations offer self-funded plans administered by Meritain Health. These plans are flexible but may have limitations on coverage.

Do My Dependents Have Access to Healthcare?

Meritain Health insurance plans usually extend coverage for addiction treatment to dependents in line with benefits offered to primary members. Many rehab centers provide educational programming and family therapy sessions covered under Meritain Health benefits.

FAQs

Is Meritain part of Aetna?

Yes, Meritain is a TPA (third-party administrator) and an Aetna subsidiary.

What type of insurance is Meritain Health?

Meritain Health is a third-party administrator that manages health benefits for employer groups. The company utilizes Aetna’s Choice POS network of providers.

Does Meritain Health cover therapy?

Yes. Most Meritain plans cover therapy through the Aetna network, typically including individual, group, and family sessions; specifics vary by plan and in-/out-of-network status.

Get Evidence-Based Addiction Treatment with Health Insurance at Gratitude Lodge

If you need help recalibrating your life from an addiction to drugs, alcohol, or prescription medications, we can help at Gratitude Lodge in Southern California.

Begin your recovery with our supervised medical detox program to streamline the withdrawal process and prepare you for ongoing treatment. Transition to ongoing inpatient treatment at one of our Newport Beach or Long Beach rehab centers and benefit from a safe setting free of triggers or distractions. Access integrated dual diagnosis treatment if you have a co-occurring mental health disorder.

All treatment plans at Gratitude Lodge are personalized to reflect the unique aspects of all addictions and mental health issues. Therapies include:

• MAT (medication-assisted treatment).
• Family therapy.
• One-to-one counselling.
• Group therapy.
• Motivational therapies.
• Behavioral therapies.
• Holistic interventions.
• Aftercare planning.

To verify your insurance benefits and kickstart your recovery, call admissions today at 844-576-0144. 

Sources

[1] https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity

[2] https://www.helpguide.org/mental-health/addiction/substance-abuse-and-mental-health

[3] https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud

[4] https://www.ncbi.nlm.nih.gov/books/NBK554454/