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Mental health is just as important as physical health, yet many people hesitate to seek care—often due to concerns about insurance coverage. If you’re asking, “Does Aetna cover mental health?”, you’re in the right place. In this guide, we’ll explain what mental health services Aetna covers, what might not be included, and how you can access care online or in person. By the end, you’ll have a clear understanding of what’s covered under your Aetna plan.
If you’re ready to take the next step in your mental health journey, book a consultation through Klarity Health today.
Does Aetna cover mental health?
Yes, Aetna covers mental health services—usually at the same level as physical health services.
Aetna, a CVS Health company, offers behavioral health benefits through most individual, family, employer-sponsored, and Medicare Advantage plans. Coverage typically includes therapy, psychiatric evaluations, crisis support, inpatient and outpatient care, and mental health medications, in accordance with federal parity laws.
Get affordable, personalized telehealth care today
Klarity connects you with licensed providers, and some visits may be covered by insurance—cost varies by plan.
What types of mental health do Aetna cover?
Aetna’s mental health benefits typically include:
- Individual and group therapy (such as CBT, DBT, and family therapy)
- Psychiatric evaluations and medication management
- Outpatient care, including partial hospitalization programs (PHP)
- Inpatient psychiatric services for acute conditions
- Substance use treatment, including inpatient and outpatient options
- Crisis support, including 24/7 hotlines and emergency care
- Virtual mental health services through CVS Virtual Care, Teladoc, MinuteClinic, and more
- Annual depression screenings, psychotherapy, and medication coverage through Medicare Advantage plans
These services are designed to support a wide range of mental health needs.
What types of mental health do Aetna not cover?
While Aetna covers a broad range of evidence-based treatments, some services are typically excluded from coverage. These may include:
- Experimental or cosmetic treatments, such as non-FDA-approved neurofeedback
- Alternative therapies like hypnotherapy that lack sufficient clinical evidence
- Out-of-network care, except in emergency situations
Always check your plan’s Summary of Benefits and Coverage (SBC) for a full list of exclusions.
Eligibility criteria for Aetna coverage for mental health
To receive mental health coverage through Aetna, the following criteria generally apply:
- Enrollment in an eligible plan
Most individual, family, employer-sponsored, Medicaid, and Medicare Advantage plans offer mental health benefits. Limited-benefit or short-term plans may exclude mental health services, so it’s important to review your SBC or contact Aetna Member Services.
- Medical necessity
Covered services must be considered medically necessary and supported by a clinical diagnosis. Aetna uses established clinical guidelines to determine necessity.
- Use of in-network providers
To receive the highest level of coverage and avoid higher out-of-pocket costs, choose in-network mental health providers. Out-of-network services may result in higher copays or balance billing.
- Authorization for certain levels of care
Some services require prior authorization, including inpatient hospitalization, PHP, intensive outpatient programs (IOP), residential treatment centers (RTC), and transcranial magnetic stimulation (TMS).
- Documented mental health diagnosis
A provider must submit a diagnosis using DSM-5 criteria to initiate mental health services under your plan.
- Compliance with parity laws
Aetna’s mental health coverage is aligned with federal parity laws, such as the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires mental health benefits to be offered on par with medical services.
Does Aetna cover mental health online?
Yes, Aetna covers online mental health services through several telehealth platforms—often with the same copays and coinsurance as in-person visits. These virtual options make it easier and more convenient to access therapy, psychiatric care, and medication management from home.
Aetna-covered telehealth platforms include:
- Klarity Health – Connects you with licensed therapists and psychiatric providers who accept Aetna insurance. Easily book virtual mental health appointments online.
- CVS Virtual Care – Offers online therapy and psychiatric evaluations
- Teladoc – Provides access to licensed therapists seven days a week
- MinuteClinic Virtual Care – Delivers virtual counseling sessions through CVS MinuteClinic
- Specialty telehealth partners – Aetna partners with digital mental health platforms like Meru Health, Telemynd, and Brightside
- Medicare Advantage plans – Often include coverage for virtual behavioral health services
Why Aetna might deny mental health coverage
There are several reasons Aetna may deny a mental health claim:
- The service is not deemed medically necessary
- Prior authorization was not obtained for a service that requires it
- The provider is out-of-network and not covered by your plan
- Your plan’s visit or day limits have been reached
- Incorrect billing or coding
- The service is excluded under your specific plan
If your claim is denied, Aetna will provide a reason and information about how to appeal.
Tips for improving your chances of approval for Aetna coverage for mental health
- Review your plan’s mental health benefits in your SBC or member portal
- Choose in-network providers to avoid coverage issues
- Confirm whether your service requires prior authorization
- Provide complete documentation, including your diagnosis and treatment plan
- Monitor coverage limits for visits or treatment days
- Appeal any denied claims with full supporting records
Klarity Health can help you navigate these steps and improve your chances of approval.
How to get prior authorization from Aetna for mental health
Follow these steps to request prior authorization for mental health services:
Check if prior authorization is required
Review Aetna’s Behavioral Health Precertification List or search by CPT code to see if your service requires approval. Common services that require precertification include inpatient care, PHP, RTC, TMS, and ABA therapy.
Submit the authorization request
Providers can submit requests through:
- Availity portal
- AetnaElectronicPrecert.com
- Vendor-specific platforms listed at aetna.com/provider/vendor
- Phone (use the number on the back of the member ID card)
Include necessary documentation
Your provider will need to submit:
- DSM-5 diagnosis
- Treatment plan with goals and care setting justification
- Clinical history and progress notes
- ASAM criteria or LOCUS/CALOCUS scores, if applicable
Undergo utilization review
Aetna will review your request. Inpatient and high-acuity care typically undergo concurrent or retrospective reviews. Outpatient services may be reviewed based on documentation alone.
Wait for the decision
- Routine requests are typically processed within 3–10 business days
- Urgent requests may be reviewed faster, especially under Medicare Advantage plans
Manage your results
Approved services will receive an authorization number. Denied requests include an explanation and steps for appeal. Some requests may be marked as pending if more information is needed.
Understand your appeal rights
If your request is denied, you can request an internal review or an external review—especially if the service was deemed not medically necessary or investigational.
Ready to take the next step with Klarity Health?
Aetna’s mental health coverage is broad, but navigating insurance requirements can still feel overwhelming. Klarity Health is here to help.
- Get clear guidance on your Aetna mental health benefits
- Connect with in-network therapists and psychiatric providers
- Get support with authorizations and appeals
- Access online or local mental health care with ease
If you’re ready to take charge of your mental health treatment, book a consultation through Klarity Health today.
Find telehealth providers who may accept your insurance
Klarity lets you filter by specialty, cost, and whether providers may accept your insurance—availability varies by plan and provider.
FAQs about Aetna and mental health
*Appointments are generally available within 24 hours. Free initial consultations are available only with select providers. Prescriptions, particularly for controlled substances, may require an in-person evaluation depending on the state of residence and current federal regulations.
The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage. Not all providers on Klarity Health prescribe all medications, particularly medications that are controlled substances.
If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.
