AETNA
At Kor Counseling, we have a team of experienced mental health counselors, covered by Aetna, as we are dedicated to delivering therapy that is accessible. Our Aetna therapists are committed to delivering high-quality care to our clients. They recognize that embarking on therapy can be scary, and aim to establish a secure and inviting atmosphere for their clients.
It is important to find the right therapist to help with managing stress, improving relationships, and promoting well-being. Whether online or in-person, our Aetna therapists can provide the support you need. We are trained in topics including anxiety, depression, trauma, ADHD, family and relationship issues, substance abuse, and life transitions, among others.
Aetna Benefits
Aetna’s regular health plans include coverage for mental health care. Every Aetna member is entitled to receive behavioral health treatment, including psychotherapy and counseling services as a component of their basic health benefits. Both primary Aetna members and dependents covered by their health plans can address their mental health concerns with a licensed professional who accepts Aetna.
Typically, most Aetna insurance plans require a copay and/or deductible. However, Aetna’s mental health benefits often include a waiver of the deductible for therapy sessions. In such cases, individuals are only responsible for the Aetna therapy copay. The process of initiating therapy covered by Aetna is simple. There’s no need for pre-authorization or a prescription from a primary care physician before seeing an Aetna in-network therapist.
Coverage limitations:
In most cases, there is no restriction on the number of therapy sessions Aetna covers. If your Aetna coverage is active, you can attend weekly sessions with an Aetna therapist in New York. However, the licensed therapist must be in-network with Aetna for this arrangement to be applicable. Additionally, there should be a medical necessity, such as anxiety, depression, Post Traumatic Stress Disorder (PTSD), Attention Deficit/Hyperactivity Disorder (ADHD), or similar conditions, to justify the need for these sessions.
Although uncommon, your Aetna plan might not include coverage for therapy services in the following situations:
- If you have an Aetna international insurance plan that explicitly excludes Aetna mental health benefits.
- If you voluntarily signed a waiver excluding Aetna therapy coverage when enrolling in your health insurance.
While these waivers are occasionally still in use, particularly for international individuals residing in the United States, they are generally not allowed otherwise. In the past, pre-existing conditions could be excluded from an Aetna plan through such waivers, but this practice is no longer permitted since the implementation of the Affordable Care Act.
Additionally, it’s important to note that your Aetna plan may not cover certain therapy services. Some of the newer or more experimental therapies, such as biofeedback, neurofeedback, or bioenergetic therapy, may not be covered.
Understanding your Aetna therapy coverage:
To know more about the specifics of your plan, call the number on the back of your Aetna insurance card. New York Aetna members can call this number as well: 1-855-456-9126.
Be sure to ask Aetna member services about your copay for mental health outpatient services, specifically for codes 90834 and 90837 (those CPT codes are used by Aetna therapists). Additionally, it is important to find out if there is a session cap per year.
To determine if your Aetna plan includes coverage for therapy, locate the “Outpatient Mental Health” section in your Summary of Benefits. Psychotherapy falls under the category of outpatient mental health services.
You can access your Summary of Benefits by logging into your Aetna Member Services portal. From there, you can contact member services directly or check your employer’s benefits portal
If your employer provides your health insurance, you can reach out to the human resources department of your company for further guidance.
Types of Therapy Coverage:
Aetna’s mental health benefits cover a wide range of treatment modalities, which may include various therapeutic approaches. Consult the benefit plan and Aetna Clinical Policy Bulletins to check the coverage and limitations. You can also call our office at (646) 535-8611 and we will gladly check your insurance information. Online therapists often referred to as telehealth, can accept Aetna and are known as Aetna in-network therapists.
Psychodynamic Therapy, Family therapy, Dialectical Behavior Therapy (DBT), and Cognitive Behavior Therapy (CBT) are all evidence-based techniques to diagnose and/or treat mental and emotional health conditions that are covered within Aetna’s standard mental health benefits plans.
Most Aetna Behavioral Health mental health coverage doesn’t require a referral or pre-authorization from a primary health care provider. Aetna offers various treatment options, but it’s crucial to review the benefit plan and policy bulletins to check for coverage and limitations. Certain exclusions and limits may apply, and coverage may be contingent on specific criteria and conditions. Aetna’s Clinical Policy Bulletins (CPBs) provide information on the medical necessity, experimental nature, or cosmetic nature of certain services or supplies. These CPBs are regularly updated and subject to change. Ultimately, members should discuss any coverage or CPB related to their condition with their treating provider.
To understand Aetna’s mental health benefits, check their Summary of Benefits for the “Outpatient Mental Health” line item or call 212-960-8626. Depending on what you are grappling with, you might benefit from a high level of care. In this case, check the Summary of Benefits for “Inpatient Mental Health” benefit schedule that accepts Aetna in your area.
How much does therapy cost with Aetna?
The cost of therapy sessions varies widely from one Aetna plan to another. Most often, there is some co-pay, but you might also have a deductible to pay upfront before the sessions are partly or fully covered. With an Aetna therapist, your therapy sessions will likely cost between $10 – $60 per session after you meet your deductible. The co-pay is the fixed amount that you owe at each therapy visit. The deductible is the total amount you need to spend on medical costs in a year before your insurance begins to cover the cost of mental health services. Deductibles may apply but are generally waived for Aetna therapy.