Does Aetna Cover Psychiatry: A Look into Specific Insurance Coverages

Seeking mental health care can feel overwhelming – you don’t know what your insurance will cover or what providers even accept it. Delaying treatment only worsens these feelings of anxiety and depression, furthering mental anguish.

Californians are no strangers to poor mental health, with 31.7% reporting symptoms of an anxiety and/or depressive disorder in February of 2023. This shows the need for better connections between mental health treatment and care options.

BNI Clinics is committed to delivering high-quality care to adults and children throughout Southern California. In this article, we will discuss insurance and answer the question: Does Aetna cover psychiatric services?

Understanding Aetna’s Mental Health Coverage

Aetna is one of the nation’s leading insurance providers, covering over 36 million people here in the United States. As mental health parity laws have expanded, insurance plans are now required to provide coverage for behavioral health services comparable to that of physical health conditions. Aetna has responded by developing plans that support access to both outpatient and inpatient psychiatric care.

Each individual Aetna insurance plan varies in coverage and out-of-pocket costs. Some may have copays at each visit, while others meet a deductible and then pay little to no cost. To determine what your plan covers, it is highly recommended to contact the number on your insurance card or your human resources representative if the plan is through your workplace.

Are Psychiatric Services Included in Aetna’s Insurance Plans?

As mentioned above, psychiatric services are required to be covered by commercial health insurance. Depending on your specific plan, the number of visits, level of care, and medication coverage will vary. However, Aetna in general covers the following services:

• Medically managed residential care
• Medically monitored residential services
• Medically monitored non-residential services
• High-intensity community-based care
• Low-intensity community-based care
• Recovery maintenance
• Preventative maintenance

These services include inpatient treatment, partial hospitalization, intensive outpatient, outpatient, and continued care. Mental health is an ongoing occurrence, and Aetna has coverage for each stage of care. There are specific criteria for each level, which Aetna will use to evaluate each claim and determine the appropriate amount of coverage for treatment.

What Types of Psychiatric Care Are Covered by Aetna?

The level of care you are in will determine what services are covered and by what percentage. In general, common psychiatric care modalities that Aetna covers include:

• Individual therapy
• Group therapy
• Nursing and medical needs
• Hygiene products and basic living needs (for inpatient stays)
• Medications as needed
• If available, remote services

These services are based on Aetna’s level of care assessment, and your insurance agent will work with the treatment facility to discuss your results and care plan for moving forward.

Can You Access Out-of-Network Psychiatric Services with Aetna?

Accessing out-of-network psychiatric services is determined by your specific Aetna plan type. Preferred Provider Organization (PPO) plans typically allow for out-of-network care, although reimbursement rates may be significantly lower compared to those of in-network providers. Also, you may be required to meet a higher deductible or submit claims for reimbursement manually. Three considerations you will want to take into account when using an out-of-network provider:

1. Reduced reimbursement or increased out-of-pocket costs
2. Potential limitations on session frequency or service types
3. Need for itemized billing and documentation of medical necessity

In contrast, Health Maintenance Organization (HMO) plans generally require all services to be obtained from in-network providers unless it is an emergency or a specific exception is granted.

To determine your out-of-network benefits, review your plan’s coverage through human resources or contact Aetna’s member services directly. If you have a specific provider in mind that you wish to use, please contact them before starting services. They will be able to navigate your insurance plan, including what you can expect to be covered and any upfront costs.

Psychiatric Services at BNI Clinics

Navigating psychiatric services doesn’t have to be overwhelming, especially with insurance providers like Aetna helping to make quality mental health services more accessible. At BNI Clinics, we provide comprehensive outpatient psychiatric care for adults and children, and we are proud to accept Aetna insurance for a wide range of services.

Our team is led by board-certified psychiatrists who provide expert evaluations, medication management, and personalized treatment plans tailored to your unique needs. In addition to traditional care, we offer advanced, evidence-based interventions including transcranial magnetic stimulation (TMS) and ketamine therapy for treatment-resistant conditions.

If you have Aetna insurance and are seeking psychiatric care, our staff is here to assist you. Our dedicated team will explain your benefits and guide you through the intake process, ensuring a smooth transition into treatment. Contact us today at (310) 691-5005 to take the next step toward effective, quality mental health care.

BNI Treatment Centers: Science-based, evidence-backed, compassion-led.

Dr. Aram Keshishyan, PsyD.

Aram Keshishyan, PsyD. is a bilingual, Armenian-speaking, licensed clinical-forensic psychologist who has been practicing since 2013. Dr. Keshishyan emigrated to the United States at the age of 1 and grew up in the highly diverse Los Angeles County area. He obtained a Bachelor of Arts degree in Psychology from the University of California, Los Angeles, and Master of Arts and Doctorate of Psychology degrees in Clinical-Forensic Psychology from Alliant International University, Alhambra.

Arastou Aminzadeh, MD

Dr. Aminzadeh co-founded BNI to provide patients with exceptional and complete care that goes beyond the regular standards. Each individual is unique and based on each person's genetic makeup, some have a more painful response to challenges that arise on their journey and need assistance to get back on track.