Aetna Mental Health Coverage Guide

Does Aetna Cover Therapy?

Yes, Aetna covers therapy. As a subsidiary of CVS Health, Aetna provides comprehensive mental health coverage to approximately 35 million members nationwide. Under the Mental Health Parity and Addiction Equity Act, Aetna is required to cover mental health services at the same level as medical and surgical benefits. This means your therapy sessions should have comparable copays, deductibles, and visit limits to other medical care.

Aetna plans typically cover a broad range of outpatient mental health services, including individual therapy, group therapy, family therapy, psychiatric evaluations, and medication management. Coverage specifics depend on your particular plan, but most Aetna members have access to meaningful behavioral health benefits.

If you are new to therapy, our therapy for beginners guide can help you understand what to expect and how to get started.

Types of Therapy Covered by Aetna

Aetna covers most evidence-based therapy approaches when provided by a licensed mental health professional. Commonly covered types include:

• Individual therapy — one-on-one sessions with a therapist, typically billed under CPT codes 90834 (45 minutes) or 90837 (60 minutes)
• Group therapy — sessions led by a licensed professional with multiple participants (CPT 90853)
• Family therapy — sessions that include family members, usually requiring a diagnosed individual to be present (CPT 90847)
• Psychiatric evaluation — initial diagnostic assessment by a psychiatrist or psychologist (CPT 90791)
• Medication management — ongoing sessions to monitor and adjust psychiatric medications

Specific therapeutic approaches covered include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), EMDR, exposure and response prevention (ERP), and other evidence-based modalities. Coverage generally applies as long as the treatment is deemed medically necessary for a diagnosed mental health condition.

Aetna also covers treatment for a wide range of conditions including anxiety, depression, PTSD, OCD, bipolar disorder, eating disorders, and substance use disorders.

In-Network vs. Out-of-Network Coverage

Understanding the difference between in-network and out-of-network coverage is one of the most important factors in managing your therapy costs.

In-Network Therapists

When you see a therapist who is part of Aetna's provider network, you benefit from:

• Lower copays or coinsurance — typically $20 to $50 per session, depending on your plan
• Negotiated rates — Aetna has pre-negotiated fees with in-network providers, so you pay less overall
• No surprise billing — in-network providers agree to accept Aetna's approved amount as full payment
• Simpler claims process — your therapist files claims directly with Aetna

Out-of-Network Therapists

If you choose a therapist who is not in Aetna's network, you can still receive coverage, but at a higher cost:

• Higher deductible — many Aetna plans have a separate, higher deductible for out-of-network services
• Higher coinsurance — you may pay 40% to 50% of the allowed amount instead of a flat copay
• Balance billing — out-of-network providers can charge above Aetna's allowed amount, and you are responsible for the difference
• Superbill required — you typically pay the full session fee upfront, then submit a superbill to Aetna for reimbursement

For a complete guide to understanding your payment options, see our guide to paying for therapy.

How to Find In-Network Therapists

Aetna offers several ways to find therapists who accept your plan:

1. Online provider directory — Visit Aetna's Find a Doctor tool and filter by "Behavioral Health" to search for therapists in your area. Make sure to enter your specific plan information for accurate results.

2. Call member services — Dial the number on the back of your insurance card (or 1-800-872-3862 for general inquiries) and request a list of in-network behavioral health providers near you.

3. Aetna Health app — The mobile app allows you to search for providers, verify benefits, and manage your care on the go.

4. Ask your therapist directly — If you already have a therapist in mind, call their office and ask whether they accept Aetna. Be sure to specify your exact plan name, as some therapists may be in-network for certain Aetna plans but not others.

When evaluating potential therapists, our guide on how to interview a therapist can help you ask the right questions to find a good fit.

Common Copays and Deductibles

Aetna therapy costs vary widely based on your specific plan. Here are typical ranges:

These figures are estimates. Your actual costs depend on your employer's plan selection, whether you have an HMO, PPO, EPO, or HDHP plan, and whether you have met your deductible. Always call Aetna's member services to verify your specific benefits before starting therapy.

Many Aetna employer-sponsored plans also include an Employee Assistance Program (EAP) that provides 3 to 6 free therapy sessions. Ask your HR department whether your plan includes EAP benefits — these sessions are typically available at no cost and without requiring you to meet a deductible.

Mental Health Parity Information

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires Aetna to provide mental health benefits that are no more restrictive than medical and surgical benefits. This means:

• No discriminatory visit limits — Aetna cannot impose annual or lifetime session limits on mental health treatment that are stricter than limits on medical care
• Comparable cost-sharing — copays, deductibles, and coinsurance for therapy must be in line with those for medical visits
• Equal network access — Aetna must maintain adequate behavioral health provider networks comparable to their medical networks
• Equivalent prior authorization standards — any preauthorization requirements for mental health must be consistent with those for medical services

If you believe your mental health benefits are being applied unfairly compared to your medical benefits, you have the right to request a written explanation from Aetna and to file an appeal.

Pre-Authorization Requirements

For most outpatient therapy, Aetna does not require prior authorization. You can typically schedule an appointment with an in-network therapist and begin treatment without needing approval first.

However, prior authorization is generally required for:

• Applied behavioral analysis (ABA) for autism spectrum disorder
• Psychological and neuropsychological testing
• Intensive outpatient programs (IOP)
• Partial hospitalization programs (PHP)
• Residential treatment
• Inpatient psychiatric hospitalization

If your therapist recommends a higher level of care, they will typically initiate the prior authorization process on your behalf. You can also call Aetna Behavioral Health directly to request authorization.

Telehealth and Online Therapy Coverage

Aetna covers telehealth therapy sessions, allowing you to meet with a licensed therapist from home via video or phone. This is especially valuable if you live in an area with limited mental health providers or prefer the convenience of virtual sessions.

Key points about Aetna's telehealth coverage:

• Same cost-sharing as in-person visits — most Aetna plans apply the same copay or coinsurance to telehealth sessions as in-person visits
• Wide provider access — many in-network therapists offer both in-person and virtual options
• CVS Health integration — through the CVS Health ecosystem, Aetna members may have access to additional virtual behavioral health resources
• No geographic restrictions — you can see any therapist licensed in the state where you are located during the session

Telehealth has become an increasingly popular option for therapy. If you are considering it, check whether your preferred therapist offers virtual sessions and confirm with Aetna that your specific plan covers them.

Tips for Maximizing Your Aetna Benefits

Getting the most from your Aetna mental health coverage requires a proactive approach:

1. Verify benefits before your first session — Call the number on your member ID card and ask specifically about behavioral health benefits, including your copay, deductible status, and any session limits.

2. Choose in-network providers when possible — The cost difference between in-network and out-of-network can be substantial. Use Aetna's provider search to find covered therapists.

3. Use your EAP first — If your employer offers an EAP through Aetna, start there. You can get several free sessions and then transition to your regular insurance benefits.

4. Track your deductible — Log into the Aetna member portal to check how much of your deductible you have met. Early in the plan year, you may need to pay more out of pocket until you reach your deductible.

5. Request superbills for out-of-network care — If you see an out-of-network therapist, ask for a superbill after each session. Submit it to Aetna for reimbursement through the member portal, by fax to 1-860-754-5596, or by mail.

6. Use your HSA or FSA — Therapy is an eligible expense for Health Savings Accounts and Flexible Spending Accounts. Use pre-tax dollars to pay for copays, coinsurance, or out-of-network costs.

7. Appeal denied claims — If Aetna denies a claim, you have the right to appeal. Request the denial in writing and ask your therapist to provide a letter of medical necessity.

8. Understand your plan type — HMO plans may require a referral from your primary care provider, while PPO and EPO plans generally allow direct access to mental health providers.

For more strategies on affording therapy, read our comprehensive guide on how to pay for therapy.

FAQ

Does Aetna cover therapy without a referral?

Most Aetna PPO and EPO plans allow you to see a therapist without a referral from your primary care physician. However, if you have an Aetna HMO plan, you may need a referral to see a specialist, including mental health providers. Check your specific plan documents or call member services to confirm.

How many therapy sessions does Aetna cover per year?

Under the Mental Health Parity Act, Aetna cannot impose visit limits on outpatient mental health treatment that are stricter than limits on comparable medical care. Most Aetna plans do not have annual session limits for outpatient therapy, though some plans may have specific provisions. Verify with your plan.

Does Aetna cover couples therapy?

Aetna covers family therapy (CPT code 90847) when it is medically necessary and billed under a member who has a diagnosed mental health condition. Pure relationship counseling without a clinical diagnosis is generally not covered. If one partner has a diagnosable condition such as depression or anxiety, therapy that addresses that condition within the couple context may be billable.

Does Aetna cover therapy for children and teens?

Yes, Aetna covers mental health treatment for children and adolescents. This includes individual therapy, family therapy, and specialized treatments like play therapy or applied behavioral analysis (ABA) for autism. Pediatric mental health coverage is also required under the Affordable Care Act as an essential health benefit.

How long does Aetna take to reimburse out-of-network claims?

Aetna typically processes out-of-network claims within 4 to 6 weeks of receiving a complete superbill. You can check claim status through the Aetna member portal or the Aetna Health app. If your claim is taking longer, call member services for an update.

Does Aetna cover online therapy platforms like BetterHelp or Talkspace?

Some Aetna plans have partnerships with specific online therapy platforms. Coverage varies by plan, so check with Aetna directly. Even if a platform is not directly covered, you may be able to submit superbills from licensed therapists on those platforms for out-of-network reimbursement, depending on your plan's out-of-network benefits.