Aetna Behavioral Health's approach looks at the entire spectrum of health care needs, both physical and mental. We integrate multiple services to maximize your opportunity to achieve better overall health.

• Which Plans Are Available?
• What Is Included?
• Advantages of the Aetna Plan
• Precertification/Authorization Requirements
• Aetna's Level of Care Assessment Tool (LOCAT)

Which Plans Are Available?

All of Aetna's medical benefits programs include provisions for behavioral health and substance abuse treatment. This includes HMO, point-of-service (POS), preferred provider organization (PPO), Health Network Options (HNO), indemnity, health spending account (HSA), health reimbursement arrangement, flexible savings account (FSA) and open-access plans. Individual coverage descriptions vary by plan, but allow for a broad spectrum of treatment options.

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What Is Included?

Behavioral Health Evaluation/Assessment
A behavioral health evaluation can be provided by a network of professionals, including nurses, social workers, psychologists and psychiatrists. Depending on the severity of the problem, a full psychiatric evaluation by a psychiatrist is also available. (Psychiatrists are doctors with advanced training in mental health. They can prescribe medications if needed.)

Behavioral Health Treatment
Psychotherapy and medications are the main sources of behavioral health treatment. With psychotherapy, also called talk therapy, you can receive care as an individual, in a group or with your family. A qualified nurse, social worker, psychologist or psychiatrist will direct your sessions. Therapy can help you deal with depression, anxiety, alcohol and substance use, and other issues. Many behavioral health disorders also respond to medications, such as antidepressants, antianxiety agents and mood stabilizers. A referral to a psychiatrist can be made for an assessment and possible medication treatment.

Case Management
Case managers help you to get the care you need, help you to learn more about your condition and help you to better manage it. Acting as your health advocate, case managers assess your needs, arrange treatment services by a health care professional, and develop a medical/psychiatric management plan, if you meet the program's admission criteria. Case management may include the integration of behavioral health services with the coordination of medical care.

Disease Management
Disease management programs typically focus on long-term health problems, such as depression or diabetes. The program integrates care from various sources, including pharmacy, primary care physicians and behavioral health professionals. It offers self-assessments and online educational information.

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Advantages of the Aetna Plan

The Aetna Network/Aetna Health Care Professionals
Aetna provides members with access to a host of participating health care professionals (more than 50,000), programs and facilities.

Health care professionals include:

• Psychiatrists
• Psychologists
• Clinical social workers
• Clinical counselors
• Nurse practitioners
• Certified chemical dependency counselors

Facilities include:

• Inpatient care
• Day treatment programs (also called partial hospital programs)
• Intensive outpatient care
• Residential care
• Other alternative settings

You can find which health care professionals participate in the Aetna network by visiting DocFind®, our online directory.

Out-of-Network Health Care Professionals
If you have an existing relationship with a health care professional who is not in the Aetna network, you may be able to continue seeing the out-of-network health care professional, depending on the terms of your plan.

24-Hour Phone Access
With Aetna benefits, you enjoy 24-hour, toll-free phone access to a customer service center that allows you to find a participating health care professional, confirm approved services and get a precertification, if necessary.

Precertification/Referrals
Aetna Behavioral Health's precertification/referral process can help you to obtain certification for medically necessary covered benefits by a network health care professional (or an out-of-network health care professional, depending on the terms of your plan).

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Precertification/Authorization Requirements

As of January 1, 2006, Aetna no longer requires precertification or authorization for individual outpatient therapy visits. At the beginning of 2005, we stopped requiring precertification or authorization for the initial eight (8) sessions of individual outpatient therapy. Now, members will be able to continue past the original eight (8) visits without seeking precertification or authorization. Aetna Behavioral Health (ABH) will review available patient information to determine if any course of outpatient treatment raises concerns or would benefit from a discussion between the treating clinician and an ABH Care Manager.

Learn more about precertification/authorization requirements.

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Aetna's Level of Care Assessment Tool (LOCAT)

The Aetna Level of Care Assessment Tool, or "LOCAT" helps participating behavioral health providers determine the appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions and diagnoses, and for patients in need of placement in specialized behavioral health care facilities or units.

Learn more about LOCAT.

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