Everything You Need to Know About Using Aetna for Mental Health Care

Aetna for Mental Health Care

If you are struggling with mental health challenges, do not let financial worries stop you from getting the help you deserve. Your insurance company may actually pay for more treatments than you think. This guide to Aetna insurance will help you figure out how much financial assistance you can expect.

Does Aetna Health Insurance Cover Mental Health Care?

Aetna is a health insurance company with a wide range of plans, including individual plans, business plans, Medicare, and Medicaid. Regardless of what plan you have with Aetna, they will cover some or all of your costs associated with mental health care. Thanks to the Affordable Care Act, Aetna and other health insurance companies are legally required to cover care for mental health conditions like depression, obsessive compulsive disorder, and generalized anxiety disorder.

Legally speaking, mental health conditions are treated just like any other condition. Your insurance company cannot deny you coverage because you have a mental health condition, and they cannot refuse to cover care for any diagnosed condition. As long as your treatment is in-network, Aetna will cover it. Under most Aetna plans, mental and behavioral health treatment is defined as a type of specialist treatment. This means insurance for mental health treatment can cost slightly more than a general checkup visit, but you still get some assistance with the costs.

Understanding How Much Your Aetna Plan Will Pay For

The precise amount of coverage you get will depend on your Aetna plan. Some people have a plan with copays or coinsurance. A copay is a set amount of money you pay for each doctor’s visit or prescription medication. Coinsurance is similar, but instead of being a specific dollar amount, it is a specific percentage. Typically, you have to pay at least some of the cost for mental health care until you reach the deductible for your plan. Once all of your healthcare costs for the year reach the deductible amount, Aetna will cover the rest of your care.

Keep in mind that some Aetna plans may not have a copay or coinsurance for mental health care. In these cases, the costs still go towards meeting your deductible, and Aetna will cover costs after your deductible is reached. Furthermore, Aetna has special deals with many healthcare providers, so your out-of-pocket costs per visit is still less than an uninsured person would pay. Since costs vary so much depending on what plan you have, it is important to go over your plan carefully. To find out the exact cost of treatment, you should login to your Aetna account. They have an online cost estimator tool that lets you know how much coverage your plan gives for various treatments.

How to Get Aetna to Approve Your Treatments

Keep in mind that Aetna usually does not allow its members to just get whatever medical care they want and then request reimbursement afterward. If you want Aetna to assist you with coverage, you may need to get their approval first. There are a few different treatment approval methods used by Aetna. For most mental health coverage, the first type of approval you need is a referral. This will be where you meet with your primary care physician and get them to refer you to a mental health specialist.

You may also need pre-approval or pre-authorization for certain medications and procedures, and the healthcare clinic typically handles pre-approvals. They will take your insurance information and then contact Aetna to get approval for any care you need. Pre-approval, pre-authorization, and referrals are not required if you are in a mental health crisis though. If you need to seek emergency care because you feel you are a danger to yourself or others, you do not need to stop and get Aetna’s permission beforehand. They will still cover emergency treatment even if you do not get it authorized in advance.

What Sorts of Treatment Will Aetna Cover?

Most of Aetna’s covered treatments are divided into three categories. For most mental health disorders like depression, talk therapy is the starting point. Aetna will cover your treatment with a therapist who can learn more about your challenges and recommend further treatments. Your doctor may also recommend various medications that your insurance for mental health treatment will also usually cover.

In addition to standard therapy and medication, Aetna will also cover some alternative treatments and other helpful procedures. To be covered by Aetna, a depression or other mental health treatment usually needs to be prescribed by your physician. Furthermore, it also needs to be clinically proven to be effective. This means that alternative treatments that have not been properly studied may not be covered. However, certain holistic and experimental treatments that are backed up by scientific study may potentially be covered by Aetna.

Using TMS Treatment for OCD and Depression

One type of procedure that is becoming increasingly popular among Aetna members is transcranial magnetic stimulation. Called TMS for short, this is an entirely pain-free and non-invasive treatment. During TMS sessions, magnetic pulses are sent through the brain. This can help to activate underperforming brain regions. It is used to treat many conditions, including:

  • Depression
  • Anxiety
  • Epilepsy
  • Substance abuse disorders
  • Obsessive compulsive disorder

Research has shown that TMS can be especially useful for cases of depression and OCD that are not responding well to medication. Regular TMS sessions are shown to diminish symptoms without resulting in any severe side effects.

If you think transcranial magnetic stimulation could help with your mental health challenges, Aetna may cover the cost of your treatments. PulseTMS is happy to help you get approval from Aetna. We can assess your situation, recommend a TMS therapy schedule for you, and talk to Aetna about covering your costs. Schedule an appointment with us to see if Aetna will help pay for your TMS treatments.