Does Cigna Cover Drug and Alcohol Rehab?
The Cigna Group / Evernorth Behavioral Health
Checked against public plan documents on
Usually yes, but the decision is not made by Cigna. Behavioural health for Cigna members is administered by Evernorth Behavioral Health, which requires prior authorisation for every inpatient and residential admission and reviews substance use admissions against The ASAM Criteria. Two things then decide your bill: which Cigna network is printed on your card, because several of them pay nothing outside the network beyond emergencies, and whether the facility actually obtained that authorisation. An in-network facility that fails to obtain it is not allowed to bill you for the resulting denial. That is written into its own contract with Evernorth.
The short version
- Coverage lives in your plan, not your insurer — two people holding Cigna cards can have entirely different benefits
- Prior authorisation decides most denials — admission without it is among the most common reasons a claim is refused outright
- Network status is per service, not per facility — a centre can be in network for outpatient and out of network for residential
- 83.4% of US facilities accept Medicaid — and 40% use a sliding fee scale: our count of 10,233 facilities
Six questions that decide your bill
Ask these of member services, and write down the reference number of the call. Every answer below changes what you actually pay.
Which number on the back of my card is the behavioural health line, and is it different from the medical one?
Evernorth is a separate administrator with its own network, its own authorisation queue and its own appeals unit. The medical line cannot answer level-of-care questions, and a facility that says it verified benefits with Cigna may have called the wrong one.
Which Cigna network is my plan on: OAP, OAPIN, PPO, EPO, HMO, POS, Network Open Access, LocalPlus, LocalPlusIN, Connect or SureFit?
Cigna’s own plan summary shows that most of those cover nothing out of network beyond emergencies. Until you know which one you hold, a facility saying it accepts Cigna tells you nothing about your bill.
Has the facility already obtained prior authorisation from Evernorth for this level of care, and what is the authorisation number?
Evernorth requires prior authorisation for all inpatient and residential admissions under every one of its utilisation management models, and assigns a number when it approves. No number means no approval yet.
What is the initial authorisation length, and when is the first concurrent review?
Residential care is authorised in review intervals rather than as a block of days. Knowing the review date lets you prepare for it instead of hearing about it after a denial.
Which criteria set will be applied to my review?
Substance use levels of care are reviewed against The ASAM Criteria. Mental health reviews use the MCG guidelines, or LOCUS and CALOCUS-CASII if you are in California or New York. The assessment supporting your admission has to be written in the language of whichever one applies.
Am I being asked to sign a self-pay or financial responsibility form, and what exactly does it cover?
Evernorth does not accept a form signed at admission that merely anticipates a possible future self-pay arrangement, and no such agreement can be applied retroactively. Read what you are signing before you sign it, not after the bill.
If authorisation is denied after I admit, who carries the bill?
For an in-network facility the answer is not you, when the denial follows its own failure to obtain authorisation. Ask the question before admission and note who answered it.
Does my employer’s plan include the Cigna employee assistance programme, and what does it cover?
An EAP self-referral is confidential from the employer by design, the access standard for a routine appointment is two business days, and it is often the fastest way to get a clinical assessment in hand.
What is the same whoever your insurer is
Three things work identically across every private plan in the US, so they are explained once, in full, on the insurance overview rather than repeated here:
- Your plan type changes the rules more than your insurer does — whether you hold an HMO, PPO, EPO or POS decides more about your bill than the name on the card does.
- If the claim is denied: what actually works — the internal appeal, then the independent external review, and the deadlines that apply to both.
- What federal law requires, and what it does not — what the federal parity law requires of your plan, and the four things it does not do.
Everything else on this page is specific to Cigna.
Evernorth, not Cigna, decides a rehab admission
Evernorth Behavioral Health is a subsidiary of The Cigna Group and is the behavioural network for Cigna Healthcare customers. That is not a branding detail. It means a separate provider network, a separate phone line, a separate authorisation queue and a separate appeals unit from the medical side of the same card. When a facility tells you it has verified your benefits with Cigna, the useful follow-up is which line it called and who confirmed the level of care.
What Evernorth decides, and what your plan document decides
Evernorth applies clinical criteria to decide whether the care is medically necessary. It does not write your benefit. Its own administrative guidelines put it plainly: in the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the individual plan document, meaning the group service agreement, evidence of coverage, certificate of coverage or summary plan description. So there are two separate questions with two separate answers. Is this medically necessary, which Evernorth decides, and is it a covered benefit at all, which your plan document decides. A denial can come from either, and the remedy is different for each.
The free front doors most members never use
If your employer buys the Cigna employee assistance programme, it sits in front of the benefit rather than inside it. You contact it directly, you get a code before the first session, and Evernorth’s guidance is explicit that on a self-referral the employer is given no information about the contact. The access standard for a routine EAP appointment is two business days, which is faster than most intake queues. Separately, Evernorth runs six coaching and support programmes, two of them for substance use and for opioid and pain management, staffed by case managers trained in motivational interviewing. Neither of these replaces treatment. Both can produce the clinical assessment that a prior authorisation request needs.
Which Cigna network is on your card, and why it decides your bill
Cigna Healthcare sells plans on named networks, and the name is usually printed on the card. The network, not the company, decides whether treatment outside it is covered at all. This is the single most decisive fact on this page, because a facility that truthfully says it works with Cigna can still be a full-price facility for the plan you personally hold. The table below is Cigna’s own plan summary, reduced to the two columns that change what you pay for addiction treatment.
| Plan type on the card | Treatment outside the network |
|---|---|
| Cigna SureFit | Not covered, except emergency or urgent care |
| Cigna Connect | Not covered, except emergency care and special circumstances |
| HMO | Not covered, in-network only |
| POS | Covered, in and out of network |
| HMO Open Access | Not covered, in-network only |
| POS Open Access | Covered, with in-network use encouraged |
| Network Open Access | Not covered, except emergencies |
| LocalPlus | You will likely pay more outside the local network |
| LocalPlusIN | Full cost to you, except emergency services |
| Open Access Plus (OAP) | Covered at a reduced benefit level |
| Open Access Plus In-Network (OAPIN) | Not covered, except emergencies |
| PPO | Covered, reimbursed at a lower coinsurance level |
| EPO | Not covered, except emergencies |
Cigna SureFit
Not covered, except emergency or urgent care
Cigna Connect
Not covered, except emergency care and special circumstances
HMO
Not covered, in-network only
POS
Covered, in and out of network
HMO Open Access
Not covered, in-network only
POS Open Access
Covered, with in-network use encouraged
Network Open Access
Not covered, except emergencies
LocalPlus
You will likely pay more outside the local network
LocalPlusIN
Full cost to you, except emergency services
Open Access Plus (OAP)
Covered at a reduced benefit level
Open Access Plus In-Network (OAPIN)
Not covered, except emergencies
PPO
Covered, reimbursed at a lower coinsurance level
EPO
Not covered, except emergencies
Not one of those plans requires a referral for behavioural health
Every entry in that list carries the same line: referrals are not required for behavioural health services. Several of the plans do require you to select a primary care physician, and some coordinate medical care through them, but none of them puts a referral between you and an addiction assessment. If an intake worker tells you to get your doctor to refer you first, that is the facility’s own process, or a misreading of the medical-side rule. It is worth saying so, because a week spent chasing an unnecessary referral is a week of the withdrawal timeline.
LocalPlus is geography, not just a network
LocalPlus and LocalPlusIN are built market by market, and Cigna lists them as available in 34 markets across 24 states. Where the network does not reach, the Away From Home Care feature provides coverage at the in-network benefit level, temporarily. This matters specifically for addiction treatment, because travelling to a facility in another state is common, and a LocalPlusIN member who does it without checking leaves themselves paying the full cost. Check the market, not only the network name.
Accepting Cigna and covering your admission are different sentences
A facility can hold a contract with Evernorth and still be out of network for the specific plan you hold, because the networks are separate products. It can be in network and still have the admission denied, because network status and medical necessity are reviewed separately. And it can be in network for outpatient work and not for residential, because participation is service-specific. Three different failure points sit behind one reassuring sentence at the front door. Ask about each of them by name.
What your admission is actually measured against
On 27 November 2020 Cigna stopped using its own Standards and Guidelines for medical necessity and moved to externally developed criteria. Today a substance use level-of-care review is conducted against The ASAM Criteria, published by the American Society of Addiction Medicine. Mental health level-of-care reviews use the MCG Behavioral Health Guidelines, except in California and New York, where Evernorth adopted LOCUS for ages 19 and over and CALOCUS-CASII for ages 6 to 18 in order to comply with California Senate Bill 855 and the New York Office of Mental Health Part 514 regulations. If you are being admitted for a substance use disorder, ASAM is the document your assessment is being scored against.
The archived Cigna criteria are still online, and still being quoted
Cigna’s former Standards and Guidelines remain hosted as an archive, and they are detailed enough that facilities and content sites still quote them: staffing rules for residential units, assessment windows, what counts as an environmental admission. Those rules apply only to cases submitted before 27 November 2020. We link the archived file below because reading it shows you how a reviewer thinks, not because it governs your case. If you find a page describing Cigna’s medical necessity criteria at that level of detail, check the date on the document it is describing. We nearly published from it ourselves.
What an ASAM review is asking, and what defeats it
ASAM assesses a person across six dimensions rather than by diagnosis alone, and the one that decides residential admissions more often than any other is the recovery environment: what happens when the treatment day ends. The practical consequence is about paperwork. A clinical summary concluding that the patient requires residential treatment, without working through withdrawal risk, medical and psychiatric conditions, readiness to change, relapse potential and living environment, gives the reviewer nothing to approve. Ask the assessing clinician whether the assessment is written in those dimensions before it goes in, because rewriting it after a denial costs a fortnight.
Prior authorisation: whose job it is, and what happens when it is skipped
Evernorth requires prior authorisation for all inpatient and residential admissions, under every one of its utilisation management models, with no exceptions by plan. Partial hospitalisation and intensive outpatient programmes may require it depending on the plan. The duty sits with the facility, not with you: every plan type in Cigna’s summary carries the line that providers are responsible for obtaining prior authorisation for in-network services when required. When Evernorth approves, it assigns an authorisation number, which is the only proof that the conversation happened.
An in-network facility cannot pass its own failure on to you
Evernorth’s guidelines state it directly to the provider: you cannot bill patients for covered services, or for services for which payment was denied, because of your failure to comply with the provider agreement and programme requirements, utilisation management among them. Elsewhere in the same document: under the terms of your provider agreement, you cannot bill your patients for covered services that are denied due to failure to obtain prior authorisation. This matters because the bill still arrives, it looks legitimate, and most people pay it. If a denial letter says the service was denied for want of prior authorisation and the facility was in network, that is a dispute between the facility and Evernorth, and saying so in writing to the billing office usually ends it.
What a self-pay agreement has to contain to be valid
Facilities sometimes ask for a financial responsibility form at intake. Evernorth sets conditions on those. The agreement has to be obtained in writing in advance of the service with a full financial disclosure, it has to state that you are aware of the appeal process and have elected not to appeal, and it applies only to the specific level of care named in it, so a move to another level requires a new one. It can never be retroactive. A form signed at admission that merely references the possibility of a future self-pay arrangement is not accepted as proof of one, and in that case the patient must be held financially harmless. Read the form. If it is vague about which service it covers, it is doing nothing for either of you.
Emergencies, and asking after the fact
When the acuity of the situation does not allow for authorisation in advance, the instruction is to contact Evernorth as soon as possible with the diagnosis, the nature of the crisis, the alternatives considered, and the estimated length of stay and discharge plan. Requests made late are considered under extenuating circumstances, but the guidance is strict about the form: the facility has to submit both the records and a written explanation of what happened, and a submission containing only medical records will have the denial upheld. If your admission was an emergency, the explanation matters as much as the chart.
If Evernorth denies the admission
The sequence is fixed, and it is worth knowing before you are inside it. The treating clinician first requests a peer-to-peer review, a direct conversation with an Evernorth reviewer. If an adverse determination follows that call, a further review is available with a physician who was not previously involved in the case, an Evernorth-contracted board-certified psychiatrist or doctoral-level psychologist. That review can be expedited when the situation is urgent and you are still at that level of care, or taken on a standard basis, where the full medical record goes in.
Three things every denial letter has to contain
Evernorth states that all adverse determinations are communicated in writing and contain the specific guidelines on which the determination is based, naming MCG, LOCUS, CALOCUS-CASII, The ASAM Criteria or the plan coverage policy; the facts and evidence considered; and the clinical rationale. If your letter is missing any of the three, ask for it before you write anything else. An appeal is an argument that criteria were misapplied to facts, and you cannot make that argument against criteria you have not been shown or facts you have not seen listed.
Put the clinical record in before the peer-to-peer, not after
Evernorth’s own guidance strongly encourages submitting clinical information prior to the peer-to-peer review or the appeal. The peer-to-peer is a short call between two busy clinicians, and the reviewer works from what is in front of them. A treating clinician who goes into it without having sent the assessment, the withdrawal scores and the treatment plan in advance is arguing from memory against a document. This is the cheapest single intervention available to you, it is entirely in the facility’s hands, and it is worth asking whether it was done.
The clocks
A first-level appeal has to be submitted within 180 calendar days of the claim denial, unless your plan or state regulation sets something else. A second-level appeal, where one is available, has to be submitted within 60 days of receiving the first-level decision letter. Appeal timelines required by state law take precedence over both. After the internal process you can follow the health plan’s external appeals route or, in some cases, your state’s, and many states offer an expedited version when the situation is urgent and you are still at that level of care. Administrative denials, such as a service not covered or benefits exhausted, are appealable too, through a different queue.
Medication for opioid use disorder under a Cigna plan
Buprenorphine is the one medication Evernorth’s administrative guidance names and describes. Office-based buprenorphine treatment is treated as routine: both the induction phase and ongoing medication management are described as routine services that do not typically require prior authorisation. In practical terms that makes starting buprenorphine with a prescriber one of the shortest paths through this system, because the step that delays a residential admission by days is not standing in the way. Evernorth also runs case management for people on this treatment specifically, under its opioid and pain management programme.
What the same document does not say
It names buprenorphine and says nothing comparable about methadone or extended-release naltrexone. That is not evidence they are excluded, and we are not going to imply that it is. Methadone for opioid use disorder is dispensed through federally certified opioid treatment programmes, which bill differently from an office visit, and injectable naltrexone raises a question that catches people out on every insurer: whether the drug is paid under the pharmacy benefit or the medical benefit, because the approval path and your share of the cost differ between them. Ask which benefit pays, in the same call where you ask about the level of care.
Provider search: Cigna directory. Directories lag behind actual network changes — confirm by phone before you admit.
Common questions
Does Cigna cover residential rehab?
Most plans include the benefit, but every inpatient and residential admission needs prior authorisation from Evernorth first, and the request is reviewed against The ASAM Criteria. Ask the facility for the authorisation number before you admit rather than after.
Do I need a referral from my doctor to go to rehab with Cigna?
No. Every Cigna plan type listed in Evernorth’s 2026 administrative guidelines carries the same line: referrals are not required for behavioural health services. That holds even on the plans where you have to select a primary care physician.
Will Cigna pay for an out-of-network rehab?
It depends entirely on which network is printed on your card. Out-of-network care is covered at a reduced benefit on OAP, POS and PPO plans. On SureFit, Connect, HMO, HMO Open Access, Network Open Access, OAPIN, EPO and LocalPlusIN it is not covered beyond emergencies, and on LocalPlusIN that means the full cost falls to you.
How many days of rehab will Cigna cover?
There is no fixed number. Evernorth authorises an initial period and then reviews the case at intervals while you are in treatment. The two numbers worth asking for on admission are the length of the initial authorisation and the date of the first concurrent review.
The facility never got prior authorisation and I have been billed. Do I have to pay?
If the facility was in network, no. Its provider agreement with Evernorth states that it cannot bill patients for covered services denied because it failed to obtain prior authorisation. Put that in writing to the billing office and copy the number on the back of your card.
How long do I have to appeal a Cigna rehab denial?
A first-level appeal has to be filed within 180 calendar days of the claim denial. A second-level appeal, where available, has to be filed within 60 days of receiving the first-level decision letter. State law timelines take precedence where they give you longer.
Who reviews my appeal?
Not the person who issued the denial. After a peer-to-peer review the case goes to a physician not previously involved in it, an Evernorth-contracted board-certified psychiatrist or doctoral-level psychologist, and the review can be expedited if you are still in that level of care.
Does Cigna use ASAM criteria?
Yes, for substance use disorder levels of care. Mental health reviews use the MCG Behavioral Health Guidelines instead, or LOCUS and CALOCUS-CASII in California and New York, where Evernorth adopted them to comply with California SB 855 and New York Part 514.
Does Cigna cover Suboxone?
Evernorth describes office-based buprenorphine treatment as routine, and says both induction and ongoing medication management do not typically require prior authorisation. Whether the prescription itself is paid under your pharmacy benefit or your medical benefit is a separate question, and it changes your share of the cost.
Is a Cigna EAP self-referral confidential from my employer?
On a self-referral, Evernorth’s guidance states the employer is given no information about the individual’s contact. A management referral is different by definition, since a manager or HR made it, and in that case the employer knows a referral was made.
Questions that do not depend on your insurer — what an employer sees, what you pay before the deductible, what to do when a lower level of care is approved instead — are answered on the insurance overview.
Compare levels of care
Practical guides
Where this sits in the system of care
Addiction treatment is organised into levels of care, and clinicians choose between them using the ASAM criteria (six dimensions covering withdrawal risk, medical and psychiatric conditions, readiness, relapse risk and, decisively, the environment you return to. Facilities are licensed by the state and many hold additional accreditation from bodies such as the Joint Commission or CARF; that status is worth confirming for any specific programme. Percentages below are our count of how many facilities in the federal directory report offering each level of care.
- Detox19.5% of facilitiesmedical withdrawal management, 3–7 daysDetox vs rehab
- Residential21.4% of facilitieslive on site, 24-hour staffingInpatient vs outpatient
- PHP20–30 structured hours a week, sleep at homePHP vs IOP
- IOP9–19 hours a week, usually compatible with workPHP vs IOP
- Standard outpatient85.4% of facilities1–8 hours a week, the maintenance levelMutual aid options
“Remaining in treatment for an adequate period of time is critical.”
Programmes for specific groups
Facilities also report dedicated programming, and the coverage is wider than most people expect, worth asking about before assuming a programme will not fit. From our count: 42.7% run programmes for adolescents, 39.2% for veterans, 38% for pregnant and postpartum women, and 25% provide services in Spanish. Medication for opioid use disorder is available at 59.2% (buprenorphine) and 13.7% (methadone).
Cost and coverage vary by level: residential care is the tier insurers scrutinise most and almost always requires prior authorisation before admission. See what your plan covers and how to pay without insurance. Family involvement is a standard part of most programmes, and aftercare planning ( step-down to a lower level, sober living, relapse prevention) should be discussed before admission, not at discharge. If a mental health condition is also present, ask specifically whether the programme is staffed for co-occurring disorders: 69.5% of facilities in the directory report treating them, but that is a self-reported field worth confirming.
Sources
- Evernorth Behavioral Health Administrative Guidelines, September 2026 edition (PDF, 290 pages)
- Evernorth Prior Authorization and Billing Resource Guide (PDF)
- Cigna Standards and Guidelines, Medical Necessity Criteria 2020 edition. Archived: applies only to cases submitted before 27 November 2020 (PDF)
- American Society of Addiction Medicine: The ASAM Criteria
- US Department of Labor: statement on enforcement of the 2024 MHPAEA final rule (15 May 2025)
- CMS: Mental Health Parity and Addiction Equity Act
- HealthCare.gov: mental health and substance abuse coverage
- Medicare.gov: outpatient mental health care coverage
- SAMHSA: FindTreatment.gov, the federal treatment locator
- NIDA: Medications for Opioid Use Disorder
How this page was made
- Who wrote it:
- the Westbrook Recovery editorial team : researchers and writers, not clinicians. No doctor has reviewed this page, and we do not claim otherwise. What that means in practice: we report what public clinical sources say and show you where to read them, rather than offering a clinical opinion of our own.
- Checked against:
- 10 primary sources listed above: federal agency material and published clinical criteria. Where a figure varies by state, plan or facility, we say so instead of publishing a number that looks authoritative and is not.
- Original analysis:
- the facility proportions on this page are our own count of SAMHSA’s public directory. The full method is documented , including what we count, what we deliberately do not publish, and an error the approach caught. You can repeat the pull and check the numbers.
- Last reviewed:
- . This date changes when the content is actually re-checked, not automatically on every visit.
- What this page is not:
- a medical recommendation, a diagnosis, or a referral. Decisions about levels of care and medication belong with a clinician who knows your history. We do not operate facilities, take placement fees, or receive payment for sending anyone anywhere.
Other insurers
Deciding on a level of care? Compare PHP and IOP or inpatient and outpatient rehab.
Coverage details change and vary between plans from the same insurer. This page explains how to verify your own benefit: it is not a statement of what your plan covers, and it is not medical or legal advice. If you are in crisis, call or text 988 in the US, or reach the SAMHSA National Helpline at 1-800-662-4357 — free, confidential, 24/7.