Aetna administers behavioral health benefits and substance use benefits for colleagues in the Basic, HSA, PPO, and National HMO medical plans. (If you enroll in a local HMO plan not administered by Aetna, contact your HMO provider for behavioral health coverage information.)
Behavioral health services may or may not be covered based on diagnosis, type of service, source of referral, treatment setting, and type of provider. Some services may be covered at certain settings (such as at a counselor’s office) and not covered in a more intensive setting.
Deductibles and out-of-pocket maximums for behavioral health are combined with the medical deductibles and out-of-pocket maximums.
You and your provider should consult with Aetna to determine if a service you are seeking is covered and, if so, at what level.
Pre-certification is required for inpatient services and non-standard services. If these services are not pre-certified, they will be subject to a penalty. To pre-certify, call Aetna at 1-833-361-0223.
When you need behavioral health treatment, you can access network providers over the phone or online. The best way is to call Aetna at 1-833-361-0223 or search for providers on the Aetna provider website.