Aetna Insurance Coverage for Gambling

Last updated on November 4th, 2019

(Please note: strives to provide you with the most updated information on each carriers’ addiction insurance coverage but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. is an informational site only and is not affiliated or sponsored by Aetna.)

Does Aetna Insurance Cover Treatment for Gambling Addiction?

Gambling addiction, while not covered by all insurance carriers, is offered as treatment for those who gamble compulsively, to the point where their gambling is problematic and uncontrollable. As such, it is offered by some carriers like Aetna Insurance as a part of the mental health coverage. The types of services provided by Aetna Insurance for gambling treatment vary according to the provisions of each policy.

Type of Rehabs Aetna Will Pay For

Depending on the type of insurance coverage outlined in your Aetna policy, gambling addiction treatment can take place at a rehabilitation center specializing in gambling addiction treatment services. Outpatient programs allow the policyholder to continue living and home and participating in normal daily activities while receiving treatment, while inpatient services are designed to take the individual out of their normal daily environment (thus removing them from the environment which may serve as a trigger). Aetna insurance allows for the use of both types of rehab services, depending on the extent of the problem, recommendations from professionals and, of course, the provisions of the policy.

How Much of the Cost of Rehab Is Covered by Aetna?

There is no one “right” answer regarding how much of the cost for treatment at a rehab center is covered by Aetna Insurance. Much of this depends on the specific provisions of your health insurance policy. “Depending on the type of insurance coverage outlined in your Aetna policy, gambling addiction treatment can take place at a rehabilitation center specializing in gambling addiction treatment services.” However, Aetna negotiates with credentialed behavioral health care providers that are designed to meet the needs of policyholders while helping to save money. Policyholders are encouraged to seek services in the in-patient network first. However, there are circumstances in which a policyholder can seek services from an out-of-network service provider. To determine the reasonable, customary or prevailing charge, Aetna looks at information from FAIR Health, Inc., a not-for-profit company, determining the 80th percentile for charges for similar services in that particular geographical region. The portion of the prevailing charge Aetna will pay is listed in your health insurance policy. Further, any co-insurance payments or deductibles are also listed specifically in the policy.

Can I Pay Above What My Insurance Will Provide to Receive Treatment?

Like most insurance companies, Aetna will allow for individuals receiving treatment to pay additional costs which exceed the amount the insurance company will pay. For example, if the cost of one treatment or service totals $150 and the provisions of your policy allows for 70 percent of the bill to be paid, then Aetna will remit $105 for payment to the service provider and the provider would then, in turn, send a bill to the policyholder for the remaining $45 to cover the bill.

Inpatient Addiction Treatment vs. Outpatient Therapy

doctor talking to patient Inpatient addiction treatment facilities operate around the clock — 24 hours-per-day — and have medical staff available at all times, in additional to behavioral therapists and counselors. Meals, lodging and social activities are provided for those seeking treatment at inpatient centers, and this type of treatment provides the most comprehensive of therapies for those seeking to overcome their gambling addictions. For a brief period of time, work, family, home life and other influences are left behind, offering the individual the opportunity to focus their attention solely on treatment and recovery. Outpatient therapy, on the other hand, is far less expensive because the person receiving therapy does not live at the facility during the time he receives treatment. Outpatient services are varied in that some treatment services require participation for the majority of the day, while others require less contact with the facility. Of course, the need for various outpatient treatment services is assessed once the person is determined to need help overcoming his addiction. Outpatient therapy is best for those with short-term challenges with addiction, while the more comprehensive inpatient treatment is recommended for those with long-term addictions or those who have received a dual diagnosis.

Should I Choose a Residential Rehab Center?

Those electing to participate in a residential rehab program generally do so because they have relapsed from earlier treatments or because they need to focus on overcoming one or more addictive behaviors. The right answer is different for every person simply because each condition is very different. Both your recommending doctor and behavioral therapists can help you determine the best treatment option for you.

Will Aetna Pay for Local Rehab and Out-of-State Treatment?

Aetna pays for local rehab treatment and has a number of local service providers in-network to help policyholders. They do offer out of network treatment options, and in some cases policyholders can seek services from health care providers offering treatment in another state. Check the details of your policy, though, and check with the rehab facility first before scheduling.

Does Aetna Pay for Private or Luxury Treatment?

private treatment Luxury treatment and private treatment services offer services in secluded areas. These facilities feature amenities, gourmet meals prepared by professional chefs, adventure therapy options and holistic programs. They are often sought out by high profile public figures, such as politicians, professional athletes and celebrities. Aetna Insurance might pay for private or luxury treatment options, depending on your policy.

What Does Executive Treatment Offer Over Other Rehabs?

Executive treatment options are perfect for business executives who need to step away from their daily routines but cannot leave their responsibilities at work. Executive treatment allows the individual to connect long enough to tend to their responsibilities at work, while allowing them the environment, privacy and time to also focus attention on their recovery efforts.

What Treatment Lengths Will Aetna Pay For?

Aetna pays for one month, two month and three month programs as well as other treatment options. Recommendations from the health care providers and behavioral therapists play a role in determining the length of stay, and the provisions of your policy will dictate the amount of treatment coverage the policyholder is entitled to.

What If I Have No Insurance?

Individuals with no insurance can still get help overcoming gambling addiction. Many well-established rehab centers have not only earned a stellar reputation for helping their clients overcome addiction, but many have created their own financing department and payment plans. There is never a reason for any person to neglect the coverage they need, as payment options are offered at various levels to ensure affordability. Some centers also offer services on a sliding scale for individuals unable to afford their treatment.

Using Our Helpline to Determine Your Aetna Rehab Options

We understand that insurance policy language can be verbose and confusing at times. Our helpline has been established to assist you in understanding the rehab options available through their Aetna policy. Simply contact our helpline at 1-888-716-9806 during business hours; our team will be more than happy to go over your policy with you to determine the rehab options available.


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