When a teen is struggling with mental health or substance abuse issues, it can be overwhelming for parents to find the right treatment. The financial aspect of treatment, including insurance coverage, adds another layer of stress. At Key Healthcare, we often receive questions from parents about Aetna insurance. One of the most common concerns parents have is whether their Aetna insurance covers teen substance abuse and mental health treatment in California. We’re here to reassure you that California Aetna does offer comprehensive coverage for teen mental health and substance abuse treatment, and we can help guide you through the process.
With our simple and confidential insurance verification form, Key Healthcare can quickly verify your Aetna coverage and give you peace of mind. Below, we answer some frequently asked questions to help you better understand Aetna’s coverage and how it can support your teen’s treatment journey.
Does Aetna Insurance Cover Residential Treatment for Teens in California?
Yes, Aetna covers residential treatment for teens with mental health and substance abuse issues in California. Most Aetna plans include behavioral health services, a key part of their offerings. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires Aetna to provide the same level of coverage for mental health and substance abuse treatments as it does for physical health conditions. This means inpatient or residential treatment for behavioral health issues is covered when necessary.
How Can I Verify My California Aetna Insurance Coverage?
It’s simple! At Key Healthcare, we provide an easy-to-use insurance verification form. Once you submit the form, our Admissions Department will verify your coverage with California Aetna and contact you to explain the details. This step ensures you know exactly what’s covered and what to expect. You can get started here [Verify Insurance Form].
What Types of Teen Mental Health Treatment Does California Aetna Cover?
California Aetna’s plan includes comprehensive coverage for mental health and substance abuse treatment, which applies to child dependents. This includes the following services:
Inpatient Services
- Room and board in a hospital, psychiatric hospital, or residential treatment facility.
- Semi-private room rates are covered, and private rooms are covered when medically necessary.
- Mental health services also extend to autism spectrum disorder treatments, which cover psychiatric and psychological care, as well as applied behavior analysis (ABA) and therapeutic care.
Outpatient Services
- Coverage for office visits with mental health professionals, such as psychiatrists, psychologists, social workers, or licensed professional counselors. This also includes telemedicine consultations.
- Other mental health outpatient treatments include:
- Teen Partial hospitalization programs.
- Adolescent Intensive outpatient programs.
- Skilled behavioral health services provided at home under specific conditions, such as being homebound or unable to receive care outside the home.
- Electro-convulsive therapy (ECT).
- Transcranial magnetic stimulation (TMS).
- Psychological and neuropsychological testing.
- Aftercare programs support teens once they complete residential treatment and maintain long-term recovery.
- Dual diagnosis treatment covers teens who need care for both mental health and substance abuse disorders.
Substance Abuse Treatment
- Coverage for teen substance use disorder treatments is also provided, with a focus on prevention and early intervention through screening and counseling services.
- Outpatient programs and inpatient care in a hospital or residential treatment facility for substance use disorders are covered when deemed medically necessary.
Aetna’s broad coverage for behavioral health results from federal mandates and its commitment to holistically addressing physical and mental health.
Is Precertification Required For Teen Residential Treatment?
Precertification is required for stays in a residential treatment facility for teen mental disorders but not required for services related to substance use disorders. This means that while some mental health services may require pre-approval, substance abuse treatment can typically be accessed without precertification.
Are There Any Limitations to California Aetna’s Coverage for Teen Substance Abuse and Mental Health Treatment?
Yes, like all insurance plans, California Aetna insurance has some limitations. These are designed to ensure appropriate care is delivered based on the teen’s needs:
- Pre-authorization requirements: Aetna often requires that residential treatment be pre-approved based on medical necessity. This ensures that the treatment is appropriate and necessary for the teen.
- In-network vs. out-of-network providers: Choosing an in-network provider, such as Key Healthcare, helps minimize costs. Out-of-network providers may be covered, but at a higher out-of-pocket cost.
- Duration of stay: Based on ongoing evaluations of the teen’s progress, Aetna may limit the length of residential treatment to what is medically necessary.
These limitations are common in insurance plans, but working with an in-network provider like Key Healthcare can maximize coverage and reduce costs.
What Are My Out-Of-Pocket Costs For Teen Residential Treatment in California?
Out-of-pocket costs will depend on your specific Aetna plan, including your deductible, copayment, and coinsurance responsibilities. At Key Healthcare, we work hard to minimize these costs for families by being an in-network provider. Typically, families can expect to pay between $1,000 to $10,000, depending on their plan and the length of treatment. Once we verify your coverage, we’ll provide you with a clear estimate of your financial responsibility.
How Do I Know My California Aetna Plan Will Cover My Teen’s Substance Abuse and Mental Health Treatment?
Aetna offers a variety of health plans across the U.S., and the specific coverage for mental health and substance abuse treatment will depend on your plan type. Common Aetna plans include:
Check Your Aetna Plan Type
- Aetna HMO (Health Maintenance Organization): Requires you to use in-network providers and obtain referrals for specialists. Residential treatment may be covered, but pre-authorization is required.
- Aetna PPO (Preferred Provider Organization): This plan provides more flexibility to see out-of-network providers, but in-network providers like Key Healthcare will result in lower costs.
- Aetna EPO (Exclusive Provider Organization): Coverage for services must be obtained from in-network providers only.
- Aetna QPOS (Quality Point-of-Service): You can choose between in-network and out-of-network care, but coverage is better with in-network providers.
- Aetna Medicare Advantage: If your teen qualifies, this plan provides extensive behavioral health services for mental health and substance abuse.
1. Use Aetna’s Online Tools
Aetna Member Portal: Log in to the Aetna member portal at www.aetna.com. Here, you can access your specific plan details, including coverage for mental health and substance abuse treatment for your child. The portal also allows you to review your benefits, check in-network providers, and see any pre-authorization requirements.
Aetna Mobile App: Download the Aetna app for your smartphone. On the go, you can view your coverage details, check claims, and find in-network providers for mental health and substance abuse treatment.
2. Call Aetna Customer Service
Customer Service Line: You can contact Aetna directly by calling the customer service number on your insurance card. They can verify your coverage for teen mental health and substance abuse treatment, provide details on pre-authorization, and confirm out-of-pocket costs. This approach allows you to clarify coverage without involving the treatment provider.
3. Check Your Plan Documents
Review your Summary of Benefits and Coverage (SBC), which Aetna provides. It will include detailed information about what services are covered under your plan, including inpatient and outpatient treatment for teen mental health and substance abuse.
4. Fill Out an Insurance Verification Form
If you prefer, you can fill out an insurance verification form Key Healthcare offers. This form allows us to verify your insurance benefits without directly conversing with you, and we will contact you afterward to explain the coverage.
Using these methods, you can easily verify whether your Aetna plan covers the necessary treatment for your teen without having to speak directly with the treatment provider upfront.
When Can Aetna Deny Coverage for Teen Treatment?
Aetna can deny coverage for several reasons, including:
- No pre-authorization: Coverage may be denied if the treatment is not pre-authorized or deemed medically unnecessary.
- Out-of-network provider: If the treatment provider is out of network and your plan doesn’t cover such providers, coverage may be limited.
- Exceeded treatment duration: Aetna may stop coverage if the length of stay in residential treatment exceeds what they deem medically necessary.
However, at Key Healthcare, we work closely with Aetna to ensure all necessary steps are taken to approve and continue coverage for your teen’s treatment.
What US Laws Protect My Teen’s Access to Mental Health and Substance Abuse Treatment?
Several government acts help ensure that teens have access to the care they need:
- The Mental Health Parity and Addiction Equity Act (MHPAEA): This law requires insurance companies, including Aetna, to provide the same level of coverage for mental health and substance abuse treatment as they do for other medical conditions.
- The Affordable Care Act (ACA): This law ensures that insurers, like Aetna, cannot deny coverage for pre-existing conditions such as mental health or substance abuse disorders, and that children can remain on their parent’s insurance plan until age 26.
- Medicaid and SCHIP: Public insurance programs like Medicaid and the State Children’s Health Insurance Program (SCHIP) offer mental health and substance abuse coverage for low-income families.
How Can I Get Started with Key Healthcare?
We make it easy to get your teen the help they need. Here’s how you can get started:
- Fill out our insurance verification form to check your Aetna benefits. It’s quick and confidential, and our team will handle the rest.
- Receive a call from our team: Once we’ve verified your coverage, we’ll contact you to explain the benefits and next steps.
- Begin treatment: We’ll guide you through admissions to ensure your teen receives the best care possible.
At Key Healthcare, we’re dedicated to helping families navigate the process of verifying insurance and getting their teens the care they need. Verify your Aetna coverage today and take the first step toward healing.
