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Did you know that Aetna is the third largest insurance company in the U.S. with coverage for over 22.1 million members in 2021? If you or a family member are struggling with mental health or substance abuse issues and have Aetna rehab coverage, it can be overwhelming to figure out how and when to seek treatment.

When battling mental health disorders such as depression or trauma, life can feel heavy. Maybe you’ve been using alcohol or drugs to self-medicate your symptoms. Maybe you’ve realized you have a substance abuse problem for a while but feel too ashamed or embarrassed to get help. Before you start beating yourself up in an endless cycle, use this moment to take a breath, and know you are not alone and help is available.

In 2008, a law was passed called Mental Health Parity that requires insurance companies with over 50 members on their plans to cover mental health and substance abuse disorders in the same way that physical medical conditions are covered. This means if you have Aetna coverage as your insurance, you cannot be discriminated against. 

Here are some helpful pointers to assist you or your loved one get the treatment you need with Aetna rehab coverage. 

Young girl putting up a drawing of a smile concept image for mental health.

Call the Customer Care Number on the Back of Your Aetna Insurance Card

Taking this first step can be scary. You don’t want to feel judged, and the thought of telling a stranger that you need help may be the last thing you want to do. Rest assured that the customer care team at Aetna is trained to handle even the toughest problems. All insurance companies must abide by the federal law known as The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Your call will be confidential, and personal health information can not be released without your consent.

When you call, you will want a list of questions to ask Aetna’s customer care team. Keep a pen and paper nearby to take notes. These are some of the questions you may want to ask:

  1. What are the behavioral health benefits of my Aetna plan? You will want to know what levels of care are covered, if there are limits on inpatient stays or visits, and if any treatments require pre-certification.
  2. Who are Aetna network providers, and does the plan pay for out-of-network providers? In-network providers are ones with Aetna contracts and are known as Aetna network providers. This doesn’t necessarily mean you can’t see an out-of-network provider, but you may end up paying for what your plan does not cover.
  3. What are the bottom line costs for treatment? Here you will get further information about your plan’s deductible amount if the deductible has been met, copays, and any out-of-pocket maximums. Insurance companies are bound by law to give members transparent and accurate pricing information.
  4. Does my plan offer case management benefits for behavioral health? If so, you may want to request a case manager to assist you. Case managers are healthcare professionals who work for the insurance company to assist members with referrals, authorizations, claims, and much more. You may want this service if it is available.

Start Contacting Providers in Your Area

Using the list Aetna provided, you can start calling or researching providers on the Internet. Some of the questions to ask a potential provider are:

  1. What levels of care are available at your facility? Mental health and substance abuse treatment have standard levels of care that all providers will know about and be able to tell you about.
  2. What kind of licensure or accreditation do you hold? The best providers will have licensed professionals on staff and be licensed by the state in which they are located. For inpatient facilities, also ask about national accreditation from The Joint Commission (JCC).
  3. Are you in-network with my Aetna insurance plan? You will already know if out-of-network providers are covered by your plan. If they are and the provider is out-of-network, ask about the costs that your plan won’t pay for and will be your responsibility. 
  4. What kind of treatments do you provide? Here, be sure to ask about Medication Assisted Therapy (MAT) for substance abuse disorders, as well as therapeutic services like Eye Movement Desensitization and Reprocessing (EMDR) for trauma, and traditional Cognitive Behavioral Therapy (CBT) which is used for a myriad of mental health and substance abuse issues. 

Health insurance concept image.

Decide On a Plan of Action with Your Aetna Rehab Coverage

Sometimes making that first call is the hardest part of recovery. Once you have all the knowledge you need, decide on a provider and start your treatment journey. You’ve got this! Life is short and we are all in this together. 

For additional information on Aetna rehab coverage for mental health or substance abuse issues, contact Mending Fences.