Insurance Coverage

Is Therapy for Substance Use Covered by Insurance in Illinois?

If you’ve made the decision to start therapy for substance use, whether it’s for alcohol, drugs, or another behavioral addiction—you’ve already taken an incredibly important step. One of the next questions that usually comes up is: How much is this going to cost me? And more specifically, Is therapy for substance use covered by my insurance?

The good news? In Illinois, most major insurance plans do cover therapy for substance use. But like anything involving insurance, the details can get confusing fast.

Here’s a breakdown of what to expect with different insurance carriers, what’s typically covered, and how to navigate the process—without getting overwhelmed. We also included a deep dive of the insurance carriers that we accept at Health in Tandem.  Please note that although you may have one of these insurance carriers, your specific plan may not cover treatment. If you have additional questions regarding if we accept your specific plan, contact intake@healthintandem.com for additional assistance. 

Does Insurance Cover Substance Use Therapy at All?

Yes! Under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act, all major insurance companies are required to provide comparable coverage for mental health and substance use treatment as they do for medical care. That includes therapy, outpatient services, inpatient detox or rehab, and medications used to support recovery.

But how it’s covered, which providers are included, and what your out-of-pocket costs are—those things can vary quite a bit depending on your specific plan.

Aetna (Illinois Plans)

Aetna generally covers therapy for substance use, especially if you're seeing a licensed clinician in-network. Most Aetna plans in Illinois include:

• Outpatient therapy for substance use disorders

• Intensive outpatient programs (IOPs)

• Medication-assisted treatment (MAT)

• In-network providers usually cost less per session, but some plans offer partial out-of-network benefits

You’ll want to check if preauthorization is needed. Some plans require it for higher levels of care (like IOPs or residential treatment), but not for weekly outpatient therapy.

Allied Benefit Systems

Allied Benefit is a third-party administrator that often partners with major carriers (like Cigna or Aetna), so your benefits will depend on your employer’s setup. That said, behavioral health services, including therapy for substance use, are typically covered—especially if you’re working with a licensed provider in-network.

You may need to contact Allied directly or use their member portal to check what behavioral health network your plan uses. It's not uncommon for therapy to require pre-certification through a partner like Evernorth or Optum.

Blue Cross Blue Shield of Illinois (BCBSIL)

BCBSIL is one of the most widely used plans in the state, and it covers substance use treatment comprehensively, including:

• Individual and group therapy

• Intensive outpatient and partial hospitalization programs

• Residential treatment

• Telehealth and virtual therapy sessions

If you have PPO coverage, you may have some out-of-network coverage, although your costs will be higher than in-network. If you’re on an HMO plan, you'll likely need a referral from your primary care doctor.

BCBS also offers a tool on their website where you can search for substance use providers by zip code and plan type.

Cigna / Evernorth

Cigna’s behavioral health services are administered through Evernorth, their mental health and substance use division. Cigna generally provides:

• Weekly outpatient therapy

• Virtual therapy options

• Access to substance use specialists

• Medication support (e.g., naltrexone or Suboxone when appropriate)

In Illinois, many therapists are credentialed with Evernorth, and the company often covers both in-person and telehealth sessions. Check your specific plan to understand session limits, co-pays, and if a referral is needed.

Optum / UnitedHealthcare

Optum is the behavioral health arm of UnitedHealthcare, so if you're covered through UHC in Illinois, your substance use treatment will likely fall under Optum’s network.

Here’s what’s commonly included:

• Individual therapy sessions with licensed providers

• Online/virtual therapy options

• Addiction treatment programs (including inpatient and outpatient)

• Access to digital tools like guided CBT for substance use

Optum has a strong network in Illinois, and most of their plans do not require a referral for outpatient therapy—but higher levels of care (like residential treatment) may need preauthorization.

What If I’m Out of Network or Paying Out of Pocket?

If your preferred therapist or treatment center is out of network, you may still be able to get partial reimbursement—especially if you have a PPO plan.

Here’s how to check:

1. Look at your insurance card or portal to see if you have out-of-network benefits.

2. Ask the therapist for a "superbill"—a detailed receipt you can submit to your insurance.

3. File a claim through your member portal or by mail.

4. Reimbursement usually takes a few weeks and may range from 30% to 80% of the session cost, depending on your plan.

Out-of-network therapy gives you more freedom to choose a provider you connect with, but it usually means more upfront costs.

Tips for Navigating Insurance Coverage

• Call the customer service number on the back of your insurance card and ask directly: “Do I have coverage for outpatient therapy for substance use?”

• Get the details: Ask about co-pays, deductibles, session limits, and whether telehealth is covered.

• Check for in-network providers: Most insurance websites have a provider search tool.

• Ask your therapist for help: Many providers are used to helping clients understand and use their insurance.

Takeaways

Therapy for substance use is covered by most insurance plans in Illinois—including Aetna, Allied Benefit, BCBSIL, Cigna/Evernorth, and Optum. The key is knowing the specifics of your plan, understanding what services you’re entitled to, and not being afraid to ask questions.

Remember, seeking help isn’t just a medical decision—it’s a deeply personal and powerful step. And your insurance coverage should support that.

If you’re looking for support in Illinois and want help navigating your insurance options, many therapy practices (including ours) are happy to walk you through the process, verify benefits, and help you make informed choices.