Does Aetna cover therapy?

If you have Aetna insurance and are considering therapy, you may be wondering about the details of your coverage. Aetna therapy coverage includes mental health counseling, behavioral health treatments, and physical therapy. However, coverage may vary depending on your specific plan and location. 

In this guide, we will explore:

• The types of therapy Aetna therapy coverage includes
• What may not be covered
• How to check your coverage
• Steps to get therapy covered online

If you’re ready to take the next step in your mental health journey, consider booking an appointment with Klarity Health. Klarity Health connects you with licensed therapists and psychiatrists, offering convenient online sessions that could be covered under your Aetna mental health coverage.

Not sure if your insurance covers therapy?

Licensed providers on Klarity Health can assess your condition and guide you toward care that fits your needs—coverage varies by plan.

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What states is Aetna insurance available in?

Aetna operates in most, but not all, states within the United States , including:

• California
• New York
• Texas
• Florida
• Illinois
• Pennsylvania
• Ohio
• Virginia
• Georgia
• North Carolina

Aetna’s State-Specific Information page provides a comprehensive list of states where they offer therapy coverage.

Does Aetna cover therapy?

Aetna therapy coverage can vary depending on your specific plan, but coverage generally includes a wide range of mental health, behavioral health, and physical therapy options. Understanding your coverage details is essential to ensuring you receive the care you need.

What types of therapy does Aetna cover?

Aetna’s coverage for therapy services includes:

1. Mental Health Counseling

Aetna offers coverage for outpatient mental health services, such as:

• Individual Therapy: Sessions with licensed therapists to address conditions like anxiety, depression, and stress.
• Group Therapy: Sessions involving multiple participants, often focusing on shared issues or conditions.
• Family Therapy: Therapy sessions aimed at improving communication and resolving conflicts within families.
• Telehealth Services: Telehealth services are an integral part of Aetna’s mental health offerings, providing members with access to care via phone or video conferencing.

These services are typically provided by licensed professionals, such as Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), and Licensed Marriage and Family Therapists (LMFTs).

2. Behavioral Health Services

Aetna covers a range of behavioral health services, including:

• Substance Use Disorder Treatment: Programs designed to help individuals overcome addiction.
• Psychiatric Services: Care provided by psychiatrists, which may include medication management and therapy.
• Telehealth Services: Virtual behavioral health services, allowing members to access care remotely .

3. Physical Therapy

Aetna provides coverage for physical therapy services when deemed medically necessary. This may include treatment for injuries, surgeries, or chronic conditions that affect mobility and function.

What types of therapy are not covered by Aetna?

While Aetna offers comprehensive therapy coverage, certain services may not be included, such as:

• Alternative Therapies: Services like acupuncture or chiropractic care may not be covered unless specifically included in your plan.
  
• Cosmetic Procedures: Therapies deemed cosmetic, such as certain facial surgeries, may not be covered.
  
• Educational Services: Therapies provided primarily for educational purposes may not be covered.
  
• Services Deemed “Never Effective”: Any therapy considered not effective according to professional standards is excluded from coverage.

Does Aetna cover online therapy?

Yes, Aetna offers coverage for online therapy services, commonly referred to as telehealth or virtual care. These services allow members to receive therapy sessions through phone or video conferencing, which can be more convenient and accessible for many. Telehealth coverage details may vary by plan.

How to check if your Aetna covers therapy

To determine if your Aetna insurance plan covers therapy services, try the following:

1. Log In to Your Aetna Member Portal

The most direct way to check your therapy coverage is to log in to your Aetna member account. Once logged in, you can access personalized information about your benefits, including:

• Summary of Benefits and Coverage (SBC): This document outlines the details of your plan’s coverage, including mental health services.
• Behavioral Health Benefits: Specific information about therapy services covered under your plan.
• Provider Search Tools: Access to find in-network therapists and mental health professionals.

If you don’t have an account, you’ll need to register on their website to create one. 

2. Review Your Plan Documents

Your plan’s official documents provide detailed information about your coverage:

• Summary of Benefits and Coverage (SBC): This document provides an overview of your plan’s coverage, including mental health services.
• Evidence of Coverage (EOC): A more detailed document that explains what is and isn’t covered, including any limitations or exclusions.
• Annual Notice of Change (ANOC): If you’re enrolled in a Medicare Advantage plan, this document outlines any changes to your coverage for the upcoming year.

These documents can typically be found in your member portal online, but a papercopy may also be mailed to you annually. 

3. Use Aetna’s Provider Search Tools

Once you understand what’s covered and what’s not, you can find a provider that suits your plan benefits and needs. To find therapists covered by your plan you can use:

• DocFind: Aetna’s online directory allows you to search for in-network behavioral health providers by location, specialty, and plan type.
  
• Find a Doctor: This tool helps you locate in-network providers, including therapists and mental health professionals, based on your plan.

4. Contact Aetna Member Services

If you’re unable to find the information you need online, you can contact Aetna’s Member Services:

• Phone: Call the number on the back of your Aetna ID card.
• Online Chat: Use the secure messaging feature in your member portal to chat with a representative.

Aetna’s Member Services can provide detailed information about your therapy coverage, including copayments, deductibles, and any prior authorization requirements.

5. Check for Telehealth Coverage

Many Aetna plans offer coverage for virtual therapy sessions:

• Telemedicine Services: Aetna partners with providers on different platforms to offer virtual mental health services.

Check your plan documents or contact Member Services to confirm whether virtual therapy is covered under your plan.

How much does Aetna cover for therapy?

The extent of Aetna’s coverage for therapy services varies based on your specific plan and the type of therapy. Coverage may come with :

• Deductibles: The amount you pay before your insurance starts to pay.
• Copayments: A fixed amount you pay for a covered health care service.
• Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage.

For detailed cost information, refer to your plan’s Summary of Benefits or contact Aetna Member Services for assistance.

Why Aetna might deny therapy coverage

Aetna may deny therapy coverage for various reasons, such as:

• Lack of Medical Necessity: If the therapy is not considered medically necessary.
• Out-of-Network Providers: If the therapist is not in-network and your plan does not cover out-of-network services.
• Insufficient Documentation: If the required documentation or prior authorization is not provided.
• Plan Exclusions: If therapy is excluded from your specific plan.

If a claim is denied, you can appeal through Aetna’s complaints and appeals process.

Tips for improving your chances of therapy approval

To enhance the likelihood of therapy coverage approval:

• Obtain Prior Authorization: Ensure that any required pre-approvals are obtained before starting therapy.
• Provide Comprehensive Documentation: Submit all necessary medical records and supporting documents.
• Choose In-Network Providers: Opt for therapists within Aetna’s network to maximize coverage.
• Consult with Your Healthcare Provider: Work closely with your doctor to ensure that the therapy is medically necessary and properly documented.

How to get prior authorization from Aetna for therapy

Prior authorization, also known as preauthorization or precertification, is a process used by health insurance companies to ensure the service is medically necessary and covered by the patient’s plan before it’s delivered. To request prior authorization:

• Contact Aetna: Call the number on your Aetna ID card to inquire about the prior authorization process.
• Submit Required Documentation: Provide all necessary medical records and information to support the request.
• Follow Up: Regularly check the status of your request to ensure timely processing.

For more information, visit Aetna’s Prior Authorization page.

Find out if your insurance covers therapy

Providers on Klarity can recommend the right care and help you understand if your plan might cover it.

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Get your online therapy covered by Aetna 

Ready to begin therapy with Aetna coverage? Scheduling an appointment with Klarity Health is a straightforward process:

• Visit Klarity Health‘s website to explore their network of licensed mental health professionals.
• Select a therapist or psychiatrist who aligns with your needs and preferences.
• Check your insurance compatibility by indicating that you have Aetna insurance during the booking process. Klarity Health will verify your coverage to ensure your session is covered.
  
• Schedule an online appointment at a convenient time for you 
• Prepare for your session by ensuring you have a stable internet connection and a private space for your appointment.