Aetna therapy coverage: Finding the right mental health support

Getting professional mental health support shouldn’t be something that requires a degree in health insurance navigation. The complexity that comes with trying to find therapy and therapy that’s covered by insurance is often difficult for many to decipher. That’s why it’s imperative to know your stuff so that you can get access to the right types of therapy required.

Aetna is considered one of the largest health insurers in the US, and under federal law, it must provide a robust behavioural health coverage.

The difficulty lies in understanding how your specific Aetna plan works, making sure to find a therapist who accepts it, and avoiding unexpected medical bills.

If you’re looking to find the right mental health support this year, then following this guide will ensure you pick the one that’s right for you.

The legal baseline: Does Aetna cover therapy?

A starting point in the process is understanding your legal rights to mental health care. There’s something called The Mental Health Parity Act, which requires insurers to treat mental health benefits equally to medical/surgical benefits. Copays and session limits cannot be more restrictive for therapy than for a primary care doctor visit.

Aetna, in particular, typically covers the following:

• Individual outpatient psychotherapy.
• Group and family therapy.
• Psychiatric evaluations and medication management.
• Intensive Outpatient Programs (IOP) and Partial Hospitalisation Programs (PHP).

Let’s briefly break down each of these therapy types so that you’re aware of what type of therapy service you’ll need.

Individual outpatient psychotherapy

One-on-one sessions with licensed therapists help with discussing personal challenges, processing your emotions, and developing coping strategies.

Group and family therapy

Group therapy involves peers working together through similar issues. Family therapy is focused on improving communication and repairing relationships within the household.

Psychiatric evaluations and medication management

Medical assessments conducted by psychiatrists help with diagnosing conditions, prescribing medications, and monitoring their effectiveness and side effects over time.

Intensive Outpatient Program (IOP) and Partial Hospitalisation Program (PHP)

A structured treatment schedule provides robust therapeutic and psychiatric support, whilst allowing you to continue working, school, or personal responsibilities.

Partial hospitalisation is the most intensive type of outpatient program. It acts as a step down from inpatient hospitalisation and requires a significant time commitment. It’s a highly structured clinical setting without an overnight stay needed.

These sessions must be deemed medically necessary, meaning the therapist should provide a formal mental health diagnosis code to justify billing.

Decoding your specific Aetna plan

Next, you’ll want to understand the plan variations available, as well as the financial terms that are good to know in order to ensure you have the right plan for your needs.

HMO

HMO stands for Health Maintenance Organisation and requires you to see strictly in-network providers. Out-of-network care is generally not covered at all. It might require a primary care physician referral.

PPO

PPO offers flexibility, covering both in-network and out-of-network therapists, though you may find that out-of-network costs a lot more.

HDHP

A high deductible health plan will result in you needing to pay the full contracted rate for therapy out of pocket until you hit the annual deductible.

The deductible is the amount you pay before the insurance firm Aetna begins chipping in. The copay describe is a flat fee paid for each session, and coinsurance is a percentage fee paid after meeting the deductible.

Step-by-step: How to find an Aetna-approved therapist

When looking for an Aetna-approved therapist, there are some methods you can explore.

The Aetna member portal 

To use this method, you’ll need to log into the DocFind or Aetna Navigator tool to filter strictly by Behavioural Health. You’ll also want to add your specific plan network name. Great therapists that accept Aetna can be found at Manhattan Mental Health Counselling.

Third party directories

Using platforms like Psychology Today or Zodoc is good, as you can use their built-in insurance filters to select Aetna.

However, directories can be outdated, so it’s always a good idea to double-check by asking the therapist directly during your first call or over email, if they’re currently an in-network provider for the specific Aenta plan you’re on.

Virtual care platforms

It’s good to highlight Aetna’s partnerships with large telehealth networks like Headway, Talkspace, or CVS MinuteClinic/Behavioural Health services. These all offer streamlined in-network scheduling.

Navigating out-of-network care and superbills 

So what can you do if your perfect therapist doesn’t accept Aetna? Many high-quality therapists will not accept insurance directly due to the low reimbursement rates and the inevitable paperwork faced, too.

If you have an Aetna PPO, you can still see an out-of-network therapist. This superbill process works as follows:

1. You pay the therapist their full cash rate upfront.
2. The therapist provides a monthly statement called a Superbill.
3. You submit this document to Aetna via their portal or by mail.
4. Aetna then reimburses you a percentage of the allowed amount, once the out-of-network deductible has been met.

Pre-authorisation and avoiding billing surprises

For standard outpatient talk therapy, Aetna won’t usually require prior authorisation. However, when it comes to intensive programs or psychological testing, it almost always does.

There are three questions to ask Aetna before making a booking with a therapist.

1. What is my copay or coinsurance for an outpatient mental health office visit?
2. Have I met my deductible for the year?
3. Do I need a referral from my primary care doctor to see a counsellor?

These are questions you should be asking ahead of time to ensure all possible coverage has been offered.

Prioritising your wellbeing

While navigating the system that is Aetna takes a bit of upfront homework, there’s a lot to be gained in financial savings when utilising insurance benefits. It makes high-quality mental healthcare accessible. It’s also important to prioritise your wellbeing in general, where you can.

If you’re signed up and a member of Aetna already, it’s good to check what insurance coverage you have when it comes to mental health counselling. Everyone deserves access to mental healthcare, and now it is readily available and affordable for many to use.