Does Cigna Cover PHP for Mental Health and Addiction?Ā
Does Cigna cover PHP for mental health and addiction?
Yes, Cigna may cover partial hospitalization programs for mental health disorders and addiction (dual diagnosis) when treatment is medically necessary. Other factors, such as prior authorization, your specific plan type, network status, and state guidelines, may also affect your treatment coverage. ChoicePoint evaluates each patient carefully and documents medical necessity before requesting insurance approval. We verify your Cigna benefits and guide you step by step through the authorization process.
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When Is Dual Diagnosis PHP Clinically Necessary?
A dual diagnosis partial hospitalization program, also called PHP, is an ASAM 2.5 level of care. It provides structured daytime therapy (around 20 hours per week) for mental health and addiction. It is necessary when substance use and mental health symptoms are severe enough to interfere with daily functioning, but do not require an overnight stay.
Our team of licensed professionals may recommend PHP for dual diagnosis if you:
- Feel unable to manage alcohol or drug addiction, depression, or anxiety on your own
- Experience mood swings that affect work or family life
- Need close monitoring during mental health and addiction medication changes
- Recently discharged from inpatient addiction and mental health treatment
- Struggle with daily functioning due to emotional distress
- Require structured therapy for several hours per day
Does Cigna Cover Partial Hospitalization Programs for Mental Health and Addiction?
Yes, Cigna covers partial hospitalization programs for mental health & addiction (co-occurring disorders) when treatment is medically necessary. A co-occurring disorder means a person has both a mental health condition and a substance use disorder at the same time. When they are treated together in dual diagnosis treatment, outcomes are often better and more stable.
Mental health disorders covered in dual diagnosis treatment include,
What Substance Use Disorders Does Cigna Typically Cover Under Dual Diagnosis PHP?
Cigna may approve dual diagnosis PHP coverage for several substance use disorders when a medical evaluation shows that this level of care is required for the patient’s better life outcomes. The substances covered in dual diagnosis include:
What Services Are Included in Mental Health and Addiction PHP?
At ChoicePoint, our Partial Hospitalization Program is led by licensed medical professionals. Each of our PHP services caters to patientsā mental health and substance use symptoms, diagnosis, and goals.
Here are the key services included in our PHP.
| Service | Description |
|---|---|
| Psychiatric and Addiction Evaluation | Comprehensive substance use and mental health assessment to establish an accurate diagnosis and treatment plan. |
| Individual Therapy | One-on-one sessions focused on managing addiction, addressing mental health symptoms, and developing coping strategies. |
| Group Therapy | Structured group sessions designed to enhance communication skills, peer support, and emotional stability. |
| Family Sessions | Family-inclusive sessions to improve communication, strengthen relationships, and build a supportive recovery environment. |
| Cognitive Behavioral Therapy (CBT) | Evidence-based therapy focused on identifying and modifying negative thought patterns and behaviors. |
| Dialectical Behavior Therapy (DBT) | Skills-based therapy emphasizing emotional regulation, distress tolerance, and interpersonal effectiveness. |
| Solution-Focused Brief Therapy | Goal-oriented therapy centered on practical solutions and measurable short-term progress. |
| Trauma Therapy | Specialized therapy to address trauma-related symptoms and promote emotional healing. |
| Motivational Enhancement Therapy | Structured approach designed to strengthen motivation and support positive behavioral change. |
| Medication Management | Clinical oversight of psychiatric and addiction medications, including evaluation, prescribing, and adjustments as needed. |
| Crisis and Relapse Planning | Personalized safety and relapse prevention planning to reduce hospitalization risk and support long-term recovery. |
Will I Have Out-of-Pocket Costs With Cigna Dual Diagnosis PHP Coverage?
Yes, you may have some out-of-pocket costs even if Cigna approves dual diagnosis treatment. The out-of-pocket cost you may have to pay with Cigna includes,
- Deductible payments
- Copayments
- Coinsurance
- Out-of-network cost differences
The exact cost depends on your Cigna insurance type, provider network status, your state and location, and approved length of treatment. Our team of licensed specialists explains these details clearly before you begin PHP.
How to Verify Your Cigna Insurance for PHP at ChoicePoint?
At ChoicePoint, you can verify your insurance for Dual Diagnosis PHP in three simple steps.
Step 1: Click to Verify
Step 2: Fill and Submit the Form
Enter your personal and Cigna insurance plan details and submit.
Step 3. Coverage Explanation
We will call you to explain the PHP services covered, what costs to expect, and how soon you can begin treatment.
FAQs About Does Cigna Cover PHP for Mental Health and Addiction
People who get PHP for mental health and addiction treatment at ChoicePoint often ask,
How Many Hours Per Day Is a dual diagnosis PHP?
A dual diagnosis PHP usually runs 4-8 hours per day, five days per week. The exact schedule depends on your addiction and mental health treatment needs and clinical recommendations. Our team adjusts the schedule based on your symptom severity and progress.
How can I determine if PHP is medically necessary?
ChoicePoint does a full clinical mental health and addiction assessment before approving PHP. Our team looks at symptom severity, risk level, daily functioning, past treatment history, and whether lower levels of care have been effective.
Can I use my Cigna out-of-network benefits for PHP?
Some Cigna PPO plans offer out-of-network benefits. It means you can access du]al diagnosis treatment even if the provider is not in network. However, you may have to pay the deductible and coinsurance in this case. Call us 844.445.2565 to confirm your specific out-of-network coverage costs.
Does Cigna cover virtual or telehealth PHP programs?
Yes, certain Cigna plans may cover virtual PHP services if they meet clinical standards and state regulations. However, the coverage depends on your location, Cigna plan details, and whether telehealth services are included in your behavioral health benefits.
Other Insurance Plans We Accept
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24/7 ADMISSION HELPLINE 844.445.2565Medical Disclaimer:
ChoicePoint aims to improve the quality of life for people struggling with substance use disorder and mental health issues. Our team of licensed medical professionals research, edit and review the content before publishing. However, this information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice please consult your physicians or ChoicePoint's qualified staff.
Medical Disclaimer:
ChoicePoint aims to improve the quality of life for people struggling with substance use disorder and mental health issues. Our team of licensed medical professionals research, edit and review the content before publishing. However, this information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice please consult your physicians or ChoicePoint's qualified staff.
