Aetna Coverage for Mental Health & Addiction Treatment
Aetna insurance may also include coverage for drug and alcohol rehab centers, mental health counseling, and other resources to help treat addictions. Again, it is important to know what your specific Aetna insurance policy covers.
What Aetna members should know
- Verify Coverage Quickly
- No Obligation
- Confidential
Does Aetna Cover Drug & Alcohol Addiction Therapy?
Aetna insurance programs may have coverage for behavioral health services as well as treatment of substance use disorders as part of their overall coverage for health insurance. According to the Affordable Care Act, treatment for addiction as well as mental health services are part of the essential healthcare services but vary for different insurance programs.
Aetna rehab benefits may hinge upon whether the facility is in-network or out-of-network with Aetna, the specific Aetna plan you have, and whether or not a requested treatment is deemed medically necessary. Prior approval is usually necessary for inpatient rehab, residential care, and some outpatient treatment.
Because Aetna offers multiple health plans including employer-sponsored plans, Medicaid- and Medicare-related plans, and local network options coverage should always be verified directly.
What Addiction Treatment Services May Be Covered by Aetna?
Insurance services for addiction treatment, including those provided by Aetna, may be available when clinical criteria are met.
Medical Detox
Medical detox could be covered under Aetna insurance if performed under the care of medical professionals and considered medically necessary. Detoxing could be necessary for someone who physically depends on or abuses alcohol or drugs. Detox requires prior authorization.
Inpatient / Residential Rehab
Inpatient rehab offers 24/7 care for individuals struggling with substance use disorders that are considered to be mild, moderate, and severe. However, this may vary depending on the type of plan and the need for treatment.
Partial Hospitalization Programs (PHP)
Partial hospitalization programs offer daytime intense care, with the option of returning home in the evening. Most Aetna plans have coverage for PHP as a step-down from inpatient treatment.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs provide structured therapy several days a week and are commonly covered under Aetna when inpatient care is not necessary.
Standard Outpatient Treatment
This includes scheduled therapy sessions and ongoing recovery support in the form of outpatient treatment. Aetna does cover outpatient rehab under the treatment benefits of substance abuse on many occasions.
Aftercare / Continuing Care
Other aftercare services that may be covered, depending on one's insurance plan, include relapse prevention and recovery support.
Note: Length of stay and level of care are typically determined by medical necessity and clinical evaluations.
Does Aetna Cover Mental Health Treatment and Therapy?
Aetna mental health services, which could be provided in terms of therapy sessions or counseling, are usually a component of addiction treatment.
Coverage may include:
- Individual therapy and counseling
- Group and family therapy
- Co-occurring disorder treatment
- Ongoing mental health support
In addition, many Aetna plans cover psychiatry services, including medication management, evaluation, and prescription medication when medically appropriate.
Inpatient Mental Health Coverage
Certain Aetna insurance plans may include coverage of inpatient mental health treatment or residential treatment for serious mental health issues or dual diagnosis treatment. Prior authorization and medical necessity documentation are required.
How Much Does Mental Health and Addiction Therapy Cost With Aetna?
The cost of treatment with Aetna differs depending on your specific insurance policy. Aetna does provide some payment options through their insurance. The out-of-pocket expenses depend on the plan the policyholder takes out.
Factors That Affect Your Out-of-Pocket Cost
- In-network vs. out-of-network providers
- Deductibles, coinsurance, and copays
- Prior authorization and medical necessity review
- Level of care (medical detox, inpatient treatment, outpatient treatment)
- Location, state regulations, and plan type (PPO, HMO, EPO, Gold or Silver plans)
What You Can Do Right Now
Banyan Treatment Center can assist with verifying your insurance coverage with Aetna to determine treatment options prior to admission. Where possible, we can estimate the costs of treatment in advance based on your coverage.
If You Call Aetna Directly, Ask:
- Is medical detox covered?
- Are inpatient or residential programs covered under my plan?
- Is PHP or intensive outpatient programs covered?
- Do I need prior authorization?
- Is this facility in-network?
- What are my deductibles, coinsurance, and copays?
- Are there any restrictions on days, sessions, or visits?
Or, We Can Verify for You (Recommended)
- We contact your insurance provider directly
- We review coverage details and medical necessity requirements
- We explain the benefits clearly and confidentially
How to Find Treatment That Accepts Aetna
“Accepting” Aetna doesn't necessarily mean the treatment facility is an in-network provider or has out-of-network benefits, as they can vary by state or Aetna’s policy.
Getting Matched to the Right Level of Care
A clinical assessment also enables clinicians to identify treatment options based on drug use, mental health requirements, and insurance coverage.
Next Steps: Verify your Aetna coverage or call admissions to speak with a specialist.
Frequently Asked Questions
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Coverage varies by Aetna plan and state. Insurance verification is required to confirm eligibility and benefits.
Coverage varies by Aetna plan and state. Insurance verification is required to confirm eligibility and benefits.
Verify Your Aetna Coverage for Treatment
Coverage varies by Aetna insurance plan, location, and medical necessity. Our admissions team can help you review your benefits and determine appropriate treatment options confidentially and with no obligation.
Banyan Facilities for Drug, Alcohol, & Mental Health Treatment
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Located in Castle Rock, CO
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Located in Gilman, IL
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Located in Cathedral City, CA
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