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Aetna Insurance for Mental Health Coverage

The Mental Health Parity Act of 1996 was a watershed moment in our country’s understanding of mental health and the acceptance of mental health disorders as diseases like any other physical disease. As part of this legislation, large group health plans, like Aetna, could no longer offer annual and lifetime coverage limits on mental health benefits that were lower than medical or surgical counterparts on the same policy. This legislation was updated in 2008 to include substance abuse disorders.

To start, it is essential to distinguish between the parity of services within the plan and coverage. These government protections did not mandate that all insurance companies cover mental health and substance abuse disorders. Instead, these protections required that substance abuse and mental health issues be treated equally to medical or surgical conditions.

Eventually, the Affordable Care Act further increased coverage to individual plans, insured small group plans, and Medicaid expansion plans by requiring them to cover ten essential health benefits. Specific goals could no longer impose annual and lifetime limits, and preexisting conditions could not factor in cost or the denial of services.

Will Aetna Cover Me for Mental Health?

Most Aetna policies cover mental health and substance use disorder treatment, but coverages vary. It is important to remember that if you are in crisis, the first call you or your loved one should make is 9-1-1. If you or they have suicidal thoughts, call 9-8-8, and connect to the suicide prevention hotline.

Understanding your Aetna policy benefits is important, and we suggest making two calls about your coverage. We encourage you to call us and confirm your benefits; our admission specialists will perform a complete benefits analysis that will guide us, in part, when developing your treatment protocols. Then, feel free to contact the number on your policy documentation. This will connect you with Aetna subscriber services, where you can further verify your benefits and ask any questions that you may have about mental health coverage, as well as financial obligations. If you have further questions about coverage or financial obligations, we strongly encourage you to contact our billing department or speak directly with Aetna. We want to provide you with the support you need to address all your questions and concerns.

Most Aetna plans cover preventative care and screening, and you can speak to our admission specialists to understand precisely what that entails. During this time, you can also discuss your coverages for Partial Hospitalization (PHP) and outpatient mental health and substance use disorder treatment. Once again, costs and coverage may vary between plans.

What about out-of-state Aetna plans? Coverages may vary between programs in different states, but we can accept many insurance plans from most states. When you call us, please have your insurance card ready. Providing us with this information allows for simple insurance verification, at which point we can discuss coverages with you and the steps to enter treatment.

Is Aetna Mental Health Coverage Free?

Aetna plans cover your healthcare, including mental health, to different degrees. To the extent that you, a family member, or your employer pay a monthly premium for your Aetna policy, no, mental health coverage is not free. The Affordable Care Act and other incentives and benefits may cover part or most of the cost of your plan. Your obligations beyond the monthly premium will also vary depending on your plan. Some policies include a deductible, the amount you must pay before your benefits cover care. This is not a free pass for providers to charge as much as they want. Aetna has negotiated both in-network and out-of-network rates which are then passed on to you. Once you meet the deductible, you may have coinsurance, a portion of the subsequent treatment costs you share with Aetna as your insurance company. Depending on the policy, these coinsurance requirements may be as little as 0% and up to 50% or more. It is also important to remember that you will likely have a copay, which is a fixed cost or percentage of the cost of care for each visit or service provided. When you reach your out-of-pocket maximum for the year, you should only incur expenses associated with your insurance-covered mental health care once you reach your plan maximum, if any.

Does Coverage Roll Over at the End of the Year?

Typically, insurance plans are administered over the course of a calendar year. When we reach the new year, subscribers’ plan limits will reset. There may be different financial implications depending on when you receive your mental healthcare.

Does Aetna Cover Depression, Anxiety, and PTSD?

If your policy provides mental health coverage, you should be covered for depression, anxiety, and PTSD, which would fall under the banner of mental health treatment. If you are experiencing any of these conditions and have an Aetna plan, we encourage you to contact us to verify your benefits and understand the treatment options available.

Does Aetna Cover Transcranial Magnetic Stimulation?

One of The Sylvia Brafman Mental Health Center’s unique offerings is Transcranial Magnetic Stimulation, or TMS, which Aetna covers with specific criteria, including the type of device used, the age of the patient, the diagnosis, proper documentation, and evidence that the patient has not received a sufficient response from the treatment of an episode occurring no more than five years in the past. Some contraindications to TMS may disqualify the patient’s coverage for TMS. We will discuss these criteria with you during the admission process. Repetitive TMS may also be useful for treating certain mental health and substance use disorders, but Aetna does not cover this. These circumstances would always be discussed as they arise in the course of making treatment recommendations.

Does Aetna Cover EMDR?

Eye Movement Desensitization and Reprocessing, or EMDR therapy, is another therapeutic modality used here at Sylvia Brafman Mental Health Center. Aetna considers EMDR an appropriate medical therapy for patients with Post-Traumatic Stress Disorder or PTSD, and Aetna has designated EMDR for other mental health concerns as well. The use of EMDR as a method for preventing PTSD is experimental and investigational, and therefore, Aetna does not currently cover the procedure for that purpose.

Can Aetna Deny My Claim?

All claims sent to your insurance company are reviewed; unfortunately, some can be denied. These denials are rare when working with a treatment center with a robust and accurate billing program like ours. A claim can be rejected due to a clerical error, like using the wrong diagnosis code, or Aetna can decide that the treatment used was not medically necessary. Insurance companies like Aetna must disclose their medical necessity standards and reasons for denial if requested.

At SBMHC, we understand that our patients are concerned about their ultimate costs. As part of the admissions and intake process, we verify your insurance benefits to ensure our services are covered. You will fully understand any financial obligations you may have during treatment. We also utilize utilization review specialists who work with their insurance company counterparts to evaluate and justify the treatment we provide on an ongoing basis while you are with us receiving care.

Should a claim be denied, our billing team will work with you to appeal the denial by providing appropriate documentation to justify the treatment. Most importantly, we want you to know that we are your partner in clinical and billing matters and focus on transparency and honesty in everything we do.

My Aetna Deductible Is High. Is It Better to Pay Out of Pocket?

Today’s insurance policies have higher deductibles and out-of-pocket expenses than ever before. For some, paying out of pocket for their mental health treatment could be advantageous. This determination must be made on a case-by-case basis and should include the advice of a trusted financial advisor.

If I use my mental health coverage, will my mental health issues be documented forever?

This is an important consideration as many patients are concerned as to whether their medical record of mental health care will be available as part of a background check or somehow made public. It is important to remember that a diagnosed mental illness is a medical concern and, therefore, part of a patient’s confidential medical record, protected by several privacy laws. Your mental health care practitioner, Aetna, as the insurance company, and any other organization affiliated with your mental health care is legally obligated to keep your information private unless you consent to release it. Similarly, from an employment standpoint, it is illegal and punishable for an employer to discriminate against you due to a mental health condition. Further, an employer cannot request your health information before offering you a job.

The Bottom Line on Aetna Coverage

Insurance policies, including those from Aetna and its affiliate insurance companies, must be clarified. We aim to help you fully understand your benefits so you can receive the best and most comprehensive care. Seeking out mental health and substance abuse treatment is a step that requires courage, so being confident in your coverage serves to remove one more variable from your care and recovery. While coverages can vary between insurance companies, and even between plans – no two Aetna plans are the same, you should be relieved to know that mental health and substance use disorder coverages have never been as robust as they are today, and we look forward to assisting you with accessing the effective care you need. Call or e-mail us for more information and verification of your Aetna insurance benefits.


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