Inpatient addiction treatment is often the most effective option for severe substance use disorders (SUDs) due to the 24/7 clinical supervision and treatment in a trigger-free environment.
Many policyholders easily get confused regarding what Cigna PPO covers due to the different plan types under PPO. They each have varying coverage, benefits, and costs. Terms like deductibles, copays, and coinsurance can also be difficult to grasp.
This article will explain exactly how Cigna PPO coverage works for inpatient addiction treatment, including eligibility, limits, and steps to verify benefits. If you’re considering Cigna PPO, talk to our team at Nirvana Recovery for expert guidance. We’re a trusted guide for inpatient addiction treatment and insurance navigation.
Understand Cigna PPO Plans
A PPO plan is a health plan with an extensive network of facilities and healthcare providers.
Compared to HMOs and EPOs, PPO plans are more flexible. You don’t need a referral to see in-network providers. You also don’t need a primary care physician (PCP) to coordinate or approve specialist visits.
How Out-of-Network Coverage Works
You can see out-of-network providers, though at higher costs and reduced reimbursements. Out-of-network providers don’t file claims on your behalf; you will need to submit them yourself.
You may also be subject to a separate out-of-network deductible. Once you meet the deductible, Cigna can begin cost-sharing. However, besides out-of-network coverage limitations, you still get emergency care.
Cigna’s PPO Network Nationwide
Cigna’s PPO network is broad. It gives you access to over 1 million healthcare providers and more than 6,000 facilities. Cigna offers its PPO plans through employer-based insurance designed for national coverage.
While the coverage is broad, the offerings of your PPO plan depend on the employer’s choice. Not all states may have access to every PPO type.
Cigna’s PPO plans give you access to both in-network and out-of-network providers. In-network providers have contracts with Cigna that set negotiated rates. You’ll thus pay lower deductibles, copays, and coinsurance. In-network providers also file claims on your behalf. However, some services may require pre-authorization.
While PPO plans allow you to see out-of-network providers, they may subject you to higher out-of-pocket costs, deductibles, and coinsurance.
How PPO Benefits Apply to Addiction Treatment
Behavioral health is included in your employer’s medical plan and isn’t provided as a separate benefit. It includes therapy, psychiatry, inpatient treatment, outpatient care, and case management.
Here’s what you need to know about in-network inpatient care:
In-network facilities and healthcare providers have contracted with Cigna to provide discounted rates
Healthcare providers cannot charge you more than the agreed-upon cost
Most services are handled through cashless billing, since providers file claims for you
Here’s what you need to know about out-of-network inpatient care:
Out-of-network facilities and healthcare providers haven’t contracted with Cigna, and will thus not provide discounted rates
Healthcare providers can charge you more than the amount Cigna deems “allowed”
You’re responsible for filing claims, including detailed documentation
Inpatient Addiction Treatment Explained
What Qualifies as Inpatient Treatment
Inpatient treatment for substance use involves receiving overnight care at a hospital-based program or a residential facility. Here’s the difference between residential rehab and hospitalization:
Hospital inpatient care is provided in a hospital setting, while residential rehab care is provided in a licensed facility, such as a residential treatment center
Hospitalization is designed for people who need medical supervision, while residential rehab is designed for individuals who need a structured, supportive environment
The following standards guide Cigna’s criteria for medical necessity of inpatient treatment for behavioral health:
MCG Behavioral Health Guidelines for mental health care
American Society of Addiction Medicine (ASAM) Criteria for substance use disorder treatment and patient placement
Level of Care Utilization System (LOCUS) for mental health levels of care in states like California
Common Services Included in Inpatient Care
Detox Services
Cigna defines inpatient detox as medically supervised withdrawal services provided 24/7. They’re required for patients with substance dependence, like opiates, alcohol, or sedatives.
Cigna requires one-on-one assessment by facility staff before the level of care is provided. Your clinical information is then submitted for authorization based on medical necessity.
24/7 Medical Monitoring
Inpatient acute care involves around-the-clock supervision by medical staff. This level of care may follow detox and is offered to patients with ongoing medical or psychiatric needs until they stabilize.
Therapy
Cigna covers therapy during SUD treatment. Options include individual, group, and family therapy. Counseling options may consist of the following to foster sobriety and relational health:
Cognitive behavioral therapy (CBT)
Motivational interviewing
Motivational enhancement therapy
Relapse Prevention Planning
Cigna encourages healthcare providers to educate patients on relapse prevention strategies, including the following:
Stress management
Lifestyle changes
Self-help resources
Inpatient treatment care plans should include long-term strategies for aftercare support to foster ongoing recovery.
Duration of Stay
Cigna covers standard inpatient treatment programs with program lengths of 30, 60, or 90 days. However, your authorization depends on what Cigna deems medically necessary based on your clinical assessment and progress.
Many residential inpatient programs run for 1-6 weeks. More intensive programs for people with complex needs extend to 30, 60, and even 90 days.
Before inpatient rehab begins, your provider should submit clinical documentation, which may include the following:
Medical evaluations
Diagnosis
Medical history
Cigna uses this documentation to determine medical necessity. It then grants an initial authorization for a specific number of days. The approved duration of stay depends on your individual needs and clinical documentation.
Cigna PPO Coverage for Inpatient Addiction Treatment
ACA and Parity Law Protections
The Affordable Care Act (ACA) requires health plans to cover ten categories of Essential Health Benefits. One of the categories is mental health and substance use disorder services, including behavioral health treatment.
Inpatient addiction treatment includes mental health and SUD services. Thus, it’s classified as an essential health benefit, in line with the ACA mandate.
Cigna includes mental health and SUD benefits in a standard medical plan, often with no separate deductible.
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurers to ensure equal coverage for mental health or SUD and medical conditions. Health insurers should not be more restrictive in the coverage of mental health or SUD services than in medical or surgical services. This ensures the following:
Equal financial requirements
Equal treatment limits
What Cigna PPO Typically Covers
Here’s how Cigna PPO covers key benefits of inpatient treatment:
Room and Board: Included under medically necessary inpatient care
Medical Care: Cigna covers detoxification and other medical services throughout your inpatient stay
Therapy: Cigna covers individual, group, and family therapy under medically necessary inpatient programs
Your healthcare provider submits pre-authorization requests for in-network care. Out-of-network care requires you to make pre-authorization requests yourself.
In-Network vs. Out-of-Network Coverage
In-network coverage provides care at a lower cost compared to out-of-network. Cigna negotiates these discounted rates with in-network providers and facilities. You enjoy lower deductibles, copays, and coinsurance. You will also not be billed beyond your plan share.
Since out-of-network providers and facilities don’t have a contract with Cigna, you face higher deductibles and coinsurance percentages. Providers and facilities may also charge more than what Cigna deems “allowed.”
Click “Doctor by Type” or “Doctor by Name” to search for a doctor
Click “Search” once you select the type of doctor or enter the doctor’s name
If prompted, enter your location details and click “Continue”
Select your plan type if asked to
Follow these steps to find an in-network facility:
Click “Health Facilities and Group Practices”
Select the type of facility under “Common Facilities” or “All Facilities” and click “Search”
Limitations and Exclusions
The following are key services that are excluded by Cigna PPO plans if not medically necessary:
Routine, non-medical exams and reports, like those required for employment, licensing, insurance, or court
Non-medical services like behavioral training, vocational rehabilitation, sleep therapy, and hypnosis (unless specifically defined as medically necessary)
Non-medical assistance with activities of daily living, like eating, bathing, or dressing
Private hospital rooms or private-duty nursing, unless determined to be medically necessary
The following are luxury amenities that Cigna PPO plans may not cover:
Private rooms or luxury accommodations, including upgraded lodging beyond basic medically necessary room and board
Spa treatments, massage, and holistic therapies like acupuncture, yoga, and art or music therapy
Luxury meals, private chefs, and upgraded dining
Resort amenities like gyms, swimming pools, saunas, personal trainers, or outdoor activities like excursion programs
The “Customer Forms” section under “Member Guide” contains your SBC and OOC. You can review them for inpatient behavioral health details, including the following:
Deductibles
Coinsurance
Stay duration
Pre-authorization requirements
In your SBC or OOC, look through the following areas:
Benefit Summary: Locate categories like “Mental Health/Substance Use Disorder–Inpatient,” and note cost-sharing details like copays, coinsurance, or deductibles
Utilization Review or Case Management: Such terms indicate how Cigna manages admission and length of stay
Contacting Cigna Member Services
Ask questions about the following:
Coverage
Does your plan cover inpatient/residential treatment for behavioral health or SUDs? Specify whether the coverage includes detox, residential rehab, or inpatient psychiatry.
What levels of treatment are covered? Ask whether the intensive outpatient program (IOP) or partial hospitalization program (PHP) is included.
Length of Stay
How many days of inpatient treatment does your plan cover? Besides the maximum duration, ask whether the coverage requires medical necessity.
How do you extend coverage beyond the initial approved length of stay? Confirm if you’ll need ongoing progress reports or clinical reviews.
Costs
Ask about your copays, coinsurance, and deductibles, specifically for inpatient rehab services. Remember to ask for in-network and out-of-network services.
Using a Rehab Facility’s Insurance Verification Service
Our admissions team at Nirvana Recovery offers a helpful insurance verification service. We can check the benefits on your behalf. We’re happy to help and recommend checking ahead of time. By the end of the verification process, you’ll know which services are covered and to what extent (inpatient care, detox, therapy, and MAT).
We will require the following information to do the verification for you:
Your insurance provider (e.g., Cigna)
Your member ID and policyholder details
Your name, date of birth, and contact information
Understanding Pre-Authorization
After filing for pre-authorization, Cigna evaluates whether the requested/proposed medical services or medications are medically necessary and covered under your benefits. Inpatient care, diagnostic tests, and specialty medications often require prior approval. Cigna may deny coverage if it doesn’t approve your pre-authorization.
Providers initiate a pre-authorization request on your behalf for in-network care. They’ll provide a clinical diagnosis and relevant medical records and complete the standard pre-authorization form. You will need to file it yourself when seeking out-of-network care.
Ensure the following to increase the chances of approval:
Be thorough and submit early
Use electronic submissions for fast delivery
The requested service aligns with established standards (Cigna will evaluate medical necessity based on these guidelines)
Common Coverage Challenges and How to Overcome Them
Denial of Claims
Cigna may deny claims for the following common reasons:
They believe the care requested isn’t medically necessary or doesn’t align with established standards
Your documentation is incomplete or incorrect, with missing codes, wrong diagnoses, or insufficient records
Care is provided without prior approval
Out-of-network doctors or facilities offer the service without proper authorization
The following are strategies for a successful appeal:
Find out and understand the exact reason for the denial
Note the appeal deadline and prepare adequately before you run out of time
Support your appeal with clear documentation, such as medical records, test results, provider notes, or a formal letter of medical necessity
Start with an informal call to customer service; submit a formal, written appeal if unresolved
Shorter-Than-Needed Coverage Periods
Here’s how to request extensions based on your treatment progress if you receive a coverage period that’s shorter than clinically needed:
Ensure your care aligns with expectations defined by Cigna. Upon starting inpatient treatment, Cigna assigns you a care manager to conduct weekly reviews and assess treatment continuation.
Provide sufficient documentation. Include dates of last substance use or change in mental health status, evidence of positive progress or lingering symptoms that still require care, challenges with transitioning, and a concrete aftercare plan.
Request a peer-to-peer review. Your provider can speak directly with a Cigna provider to clarify the medical necessity of continued inpatient treatment.
Out-of-Network Exceptions
The following are circumstances when Cigna may approve out-of-network inpatient facilities:
Emergencies. The No Surprises Act mandates Cigna to cover services from out-of-network providers at in-network rates when you require emergency care.
No in-network provider is reasonably accessible. Thus, you can request a network gap exception. Cigna will evaluate whether an in-network provider is available within a reasonable distance or timeframe. If not, Cigna may grant the exception at its discretion and with no guarantees.
A particular out-of-network facility is essential. You can thus negotiate a single-case agreement. In cases where a specific facility is the only one qualified to deliver your needed care, a single-case agreement can get you covered.
Myths About Cigna PPO and Inpatient Rehab
“PPO Plans Always Cover 100%”
While PPO plans offer flexibility and good coverage, cost-sharing is still required. You’re subject to deductibles, copays, and coinsurance, even for in-network services. You will pay your share, but not more than your plan’s out-of-pocket maximum. When you reach this limit, Cigna covers 100% of covered services.
Expect higher deductibles and coinsurance when you use out-of-network providers or facilities.
“You Can Stay as Long as You Want”
Authorization for inpatient treatment is time-limited and based on medical necessity. You don’t get open-ended stays. Cigna may initially cover 20 days. To get extensions, you’ll need to provide proof of clinical need and progress.
Additional days are not provided based on your preference; they must be justified. In some cases, clinical justification alone is not enough. You may need to provide proper documentation to support medical necessity.
“All Rehab Facilities Accept PPO Plans”
Not all facilities accept your Cigna PPO plan, even if they’re in-network. While some treatment centers may appear in in-network search directories, they may not currently accept your specific plan or have an active provider status.
Out-of-network facilities that may accept your plan may provide upfront care but expect you to file claims. They may be available at higher costs than in-network facilities.
Always verify directly with both the facility and Cigna to confirm that your PPO plan is accepted for the type of care you need.
Start Your Recovery with Confidence in Nirvana Recovery
Inpatient addiction treatment can be affordable and accessible with the proper insurance navigation. Insurances can appear complex, but at Nirvana Recovery, we aim to make them easier. There’s no reason why you shouldn’t be covered today. You’re one step closer to your recovery or that of your loved one.
Our team at Nirvana is experienced in verifying insurance coverage. We can confirm your Cigna PPO coverage for you and coordinate admissions quickly. Since we understand what Cigna PPO offers you, we aim to bring this information to you in a way that’s easy to comprehend.
Nirvana Recovery is your trusted source for Cigna PPO coverage information. We know why this insurance matters to you. We understand how much your recovery means to you. Nirvana is the meeting point of your recovery needs and insurance information. Talk to our team at Nirvana Recovery today for help with confidential benefit verification.
Frequently Asked Questions (FAQs)
Does Cigna PPO Cover All Types of Inpatient Addiction Treatment?
While Cigna PPO plans have broad coverage, they don’t cover all types of inpatient addiction treatment. Coverage depends on various factors, including medical necessity, the kind of treatment facility, and the specifics of your plan.
Does Cigna PPO Cover Inpatient Addiction Treatment?
Published On September 18, 2025
Table of Contents
Inpatient addiction treatment is often the most effective option for severe substance use disorders (SUDs) due to the 24/7 clinical supervision and treatment in a trigger-free environment.
Many policyholders easily get confused regarding what Cigna PPO covers due to the different plan types under PPO. They each have varying coverage, benefits, and costs. Terms like deductibles, copays, and coinsurance can also be difficult to grasp.
This article will explain exactly how Cigna PPO coverage works for inpatient addiction treatment, including eligibility, limits, and steps to verify benefits. If you’re considering Cigna PPO, talk to our team at Nirvana Recovery for expert guidance. We’re a trusted guide for inpatient addiction treatment and insurance navigation.
Understand Cigna PPO Plans
A PPO plan is a health plan with an extensive network of facilities and healthcare providers.
Compared to HMOs and EPOs, PPO plans are more flexible. You don’t need a referral to see in-network providers. You also don’t need a primary care physician (PCP) to coordinate or approve specialist visits.
How Out-of-Network Coverage Works
You can see out-of-network providers, though at higher costs and reduced reimbursements. Out-of-network providers don’t file claims on your behalf; you will need to submit them yourself.
You may also be subject to a separate out-of-network deductible. Once you meet the deductible, Cigna can begin cost-sharing. However, besides out-of-network coverage limitations, you still get emergency care.
Cigna’s PPO Network Nationwide
Cigna’s PPO network is broad. It gives you access to over 1 million healthcare providers and more than 6,000 facilities. Cigna offers its PPO plans through employer-based insurance designed for national coverage.
While the coverage is broad, the offerings of your PPO plan depend on the employer’s choice. Not all states may have access to every PPO type.
Cigna’s PPO plans give you access to both in-network and out-of-network providers. In-network providers have contracts with Cigna that set negotiated rates. You’ll thus pay lower deductibles, copays, and coinsurance. In-network providers also file claims on your behalf. However, some services may require pre-authorization.
While PPO plans allow you to see out-of-network providers, they may subject you to higher out-of-pocket costs, deductibles, and coinsurance.
How PPO Benefits Apply to Addiction Treatment
Behavioral health is included in your employer’s medical plan and isn’t provided as a separate benefit. It includes therapy, psychiatry, inpatient treatment, outpatient care, and case management.
Here’s what you need to know about in-network inpatient care:
Here’s what you need to know about out-of-network inpatient care:
Inpatient Addiction Treatment Explained
What Qualifies as Inpatient Treatment
Inpatient treatment for substance use involves receiving overnight care at a hospital-based program or a residential facility. Here’s the difference between residential rehab and hospitalization:
The following standards guide Cigna’s criteria for medical necessity of inpatient treatment for behavioral health:
Common Services Included in Inpatient Care
Detox Services
Cigna defines inpatient detox as medically supervised withdrawal services provided 24/7. They’re required for patients with substance dependence, like opiates, alcohol, or sedatives.
Cigna requires one-on-one assessment by facility staff before the level of care is provided. Your clinical information is then submitted for authorization based on medical necessity.
24/7 Medical Monitoring
Inpatient acute care involves around-the-clock supervision by medical staff. This level of care may follow detox and is offered to patients with ongoing medical or psychiatric needs until they stabilize.
Therapy
Cigna covers therapy during SUD treatment. Options include individual, group, and family therapy. Counseling options may consist of the following to foster sobriety and relational health:
Relapse Prevention Planning
Cigna encourages healthcare providers to educate patients on relapse prevention strategies, including the following:
Inpatient treatment care plans should include long-term strategies for aftercare support to foster ongoing recovery.
Duration of Stay
Cigna covers standard inpatient treatment programs with program lengths of 30, 60, or 90 days. However, your authorization depends on what Cigna deems medically necessary based on your clinical assessment and progress.
Many residential inpatient programs run for 1-6 weeks. More intensive programs for people with complex needs extend to 30, 60, and even 90 days.
Before inpatient rehab begins, your provider should submit clinical documentation, which may include the following:
Cigna uses this documentation to determine medical necessity. It then grants an initial authorization for a specific number of days. The approved duration of stay depends on your individual needs and clinical documentation.
Cigna PPO Coverage for Inpatient Addiction Treatment
ACA and Parity Law Protections
The Affordable Care Act (ACA) requires health plans to cover ten categories of Essential Health Benefits. One of the categories is mental health and substance use disorder services, including behavioral health treatment.
Inpatient addiction treatment includes mental health and SUD services. Thus, it’s classified as an essential health benefit, in line with the ACA mandate.
Cigna includes mental health and SUD benefits in a standard medical plan, often with no separate deductible.
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurers to ensure equal coverage for mental health or SUD and medical conditions. Health insurers should not be more restrictive in the coverage of mental health or SUD services than in medical or surgical services. This ensures the following:
What Cigna PPO Typically Covers
Here’s how Cigna PPO covers key benefits of inpatient treatment:
The following behavioral health services require pre-authorization:
Your healthcare provider submits pre-authorization requests for in-network care. Out-of-network care requires you to make pre-authorization requests yourself.
In-Network vs. Out-of-Network Coverage
In-network coverage provides care at a lower cost compared to out-of-network. Cigna negotiates these discounted rates with in-network providers and facilities. You enjoy lower deductibles, copays, and coinsurance. You will also not be billed beyond your plan share.
Since out-of-network providers and facilities don’t have a contract with Cigna, you face higher deductibles and coinsurance percentages. Providers and facilities may also charge more than what Cigna deems “allowed.”
Visit the Cigna Health Care Provider Directory to find in-network facilities and providers. Follow these steps to find an in-network provider:
Follow these steps to find an in-network facility:
Limitations and Exclusions
The following are key services that are excluded by Cigna PPO plans if not medically necessary:
The following are luxury amenities that Cigna PPO plans may not cover:
How to Verify Your Cigna PPO Inpatient Coverage
Review Your Policy Documents
The myCigna member portal provides access to the following essential documents:
The “Customer Forms” section under “Member Guide” contains your SBC and OOC. You can review them for inpatient behavioral health details, including the following:
In your SBC or OOC, look through the following areas:
Contacting Cigna Member Services
Ask questions about the following:
Coverage
Length of Stay
Costs
Ask about your copays, coinsurance, and deductibles, specifically for inpatient rehab services. Remember to ask for in-network and out-of-network services.
Using a Rehab Facility’s Insurance Verification Service
Our admissions team at Nirvana Recovery offers a helpful insurance verification service. We can check the benefits on your behalf. We’re happy to help and recommend checking ahead of time. By the end of the verification process, you’ll know which services are covered and to what extent (inpatient care, detox, therapy, and MAT).
We will require the following information to do the verification for you:
Understanding Pre-Authorization
After filing for pre-authorization, Cigna evaluates whether the requested/proposed medical services or medications are medically necessary and covered under your benefits. Inpatient care, diagnostic tests, and specialty medications often require prior approval. Cigna may deny coverage if it doesn’t approve your pre-authorization.
Providers initiate a pre-authorization request on your behalf for in-network care. They’ll provide a clinical diagnosis and relevant medical records and complete the standard pre-authorization form. You will need to file it yourself when seeking out-of-network care.
Ensure the following to increase the chances of approval:
Common Coverage Challenges and How to Overcome Them
Denial of Claims
Cigna may deny claims for the following common reasons:
The following are strategies for a successful appeal:
Shorter-Than-Needed Coverage Periods
Here’s how to request extensions based on your treatment progress if you receive a coverage period that’s shorter than clinically needed:
Out-of-Network Exceptions
The following are circumstances when Cigna may approve out-of-network inpatient facilities:
Myths About Cigna PPO and Inpatient Rehab
“PPO Plans Always Cover 100%”
While PPO plans offer flexibility and good coverage, cost-sharing is still required. You’re subject to deductibles, copays, and coinsurance, even for in-network services. You will pay your share, but not more than your plan’s out-of-pocket maximum. When you reach this limit, Cigna covers 100% of covered services.
Expect higher deductibles and coinsurance when you use out-of-network providers or facilities.
“You Can Stay as Long as You Want”
Authorization for inpatient treatment is time-limited and based on medical necessity. You don’t get open-ended stays. Cigna may initially cover 20 days. To get extensions, you’ll need to provide proof of clinical need and progress.
Additional days are not provided based on your preference; they must be justified. In some cases, clinical justification alone is not enough. You may need to provide proper documentation to support medical necessity.
“All Rehab Facilities Accept PPO Plans”
Not all facilities accept your Cigna PPO plan, even if they’re in-network. While some treatment centers may appear in in-network search directories, they may not currently accept your specific plan or have an active provider status.
Out-of-network facilities that may accept your plan may provide upfront care but expect you to file claims. They may be available at higher costs than in-network facilities.
Always verify directly with both the facility and Cigna to confirm that your PPO plan is accepted for the type of care you need.
Start Your Recovery with Confidence in Nirvana Recovery
Inpatient addiction treatment can be affordable and accessible with the proper insurance navigation. Insurances can appear complex, but at Nirvana Recovery, we aim to make them easier. There’s no reason why you shouldn’t be covered today. You’re one step closer to your recovery or that of your loved one.
Our team at Nirvana is experienced in verifying insurance coverage. We can confirm your Cigna PPO coverage for you and coordinate admissions quickly. Since we understand what Cigna PPO offers you, we aim to bring this information to you in a way that’s easy to comprehend.
Nirvana Recovery is your trusted source for Cigna PPO coverage information. We know why this insurance matters to you. We understand how much your recovery means to you. Nirvana is the meeting point of your recovery needs and insurance information. Talk to our team at Nirvana Recovery today for help with confidential benefit verification.
Frequently Asked Questions (FAQs)
While Cigna PPO plans have broad coverage, they don’t cover all types of inpatient addiction treatment. Coverage depends on various factors, including medical necessity, the kind of treatment facility, and the specifics of your plan.