Aetna Behavioral Health Benefits
Aetna Behavioral Health's integrated approach may be able to help you to enhance employee performance, lower absenteeism, improve retention rates and control your health care costs. How? Aetna's large network of participating health care professionals aligns members with health care professionals to provide the appropriate level of care, while also helping members to better balance their work and home lives.
The Importance of the Mind-Body Connection
The mind-body connection means that problems with the body can affect the mind, and problems with the mind can affect the body. Aetna's integrated approach combines an Employee Assistance Program and mental health and substance abuse services with medical and disability information. This enables us to identify certain potential problems and direct your employees to a health care professional for treatment.
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Which Plans Are Available?
An employer can purchase behavioral health services in addition to Aetna's medical benefits programs. These programs are offered by Aetna’s 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?
Individual and Family Counseling
Aetna Behavioral Health offers both individual and family counseling. Your employees will meet with health care professionals who can help the employee and his or her family work through tough times. These professionals also share valuable techniques for handling future problems.
Individual Psychotherapy
Psychotherapy is more involved and vigorous than counseling. Think of counseling as "support" and psychotherapy as "treatment." Psychotherapy involves a psychologist or psychiatrist. Psychologists and psychiatrists can diagnose and treat serious mental illnesses, such as depression, bipolar disorder and schizophrenia. As you know, depression and other mental health conditions can lead to tremendous workplace costs. Getting early and effective treatment may help to alleviate some of this lost time and productivity.
Psychiatric Evaluation/Assessment
Depending on the severity of the employee's behavioral health problem, a full psychiatric evaluation and mental health assessment may be necessary for a health care professional to render effective services, as determined by the health care professional, to the member.
Case Management
Case managers help employees get the care they need from health care professionals, teach employees about their conditions and help them to better manage their conditions. Acting as a health advocate, case managers help to assess employee needs, arrange treatment services by a health care professional, and develop and carry out a medical/psychiatric management plan, if the employee meets the program's admission criteria. Case management includes the integration of behavioral health services with the coordination of medical care.
Case management focuses on identifying members who need support, getting them access to services by a health care professional and helping them to remain engaged in treatment at the appropriate level of care. Support may include discharge planning and facilitating access to the next level of care. Members may include those with psychiatric and chemical dependency disorders and chronic medical illnesses, or those with severe psychosocial stressors that result in the frequent use of higher levels of care.
Disease Management
Disease management programs typically focus on long-term health problems, such as depression and diabetes. The Depression Disease Management Program, for example, uses treatment intervention to help maximize a person's response to antidepressant medications. The program integrates care from various sources, including pharmacy, primary care physicians and behavioral health professionals. It also offers self-assessments and online educational information to employees.
Determination of Medical Necessity
Behavioral health professionals who work with Aetna use our proprietary Level of Care Assessment Tool (LOCAT) to assess our members' level of functioning and the appropriate level of care. For members with possible chemical dependency, we instruct our health professionals to use the American Society for Addiction Medicine Patient Placement Criteria (ASAM), a nationally recognized guideline for treatment of chemical dependency. For members in Texas, we use the Texas Commission on Alcohol and Drug Abuse (TCADA) regulations. Ultimately, however, each health care professional is directed to exercise his or her own independent medical judgment when providing services to Aetna members.
Management Consultation
As a manager, supervisor or human resources professional, you may be able to access workplace-trained professionals through the Aetna Employee Assistance Program. These professionals can provide consulting services related to employee work performance, substance abuse concerns or other workplace issues.
Critical Incident Support
Through the Aetna Employee Assistance Program, should a catastrophic event occur (whether external or internal to your organization), trained professionals from the Aetna Employee Assistance Program will consult with your staff to provide guidance and arrange for on-site services if they are needed.
Worksite Education and Training
Through the Aetna Employee Assistance Program, you can offer your employees on-site seminars on such diverse topics as stress, managing change, and other workplace or home life issues.
Account Management
Your Aetna account executive acts as your single point of contact, allowing one-stop shopping for all your Aetna products, services and programs.
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Advantages of the Aetna Plan
Continuum of Care
Aetna Behavioral Health guides your employees as they move through different levels of care. One of your employees may start, for example, by reading useful materials from our Employee Assistance Program about stress. If the employee's stress leads to depression, the employee can find additional help through counseling or psychotherapy from an Aetna health care professional.
Integration of Health and Productivity Management Solutions
Aetna's focus on integrated health, where all the benefits are part of a continuum of care, helps you to improve your employees' productivity, increase their satisfaction and better manage your health care costs. This "one-stop shop" concept enables members to receive high-quality specialty services from Aetna health care professionals, such as behavioral health and employee assistance within Aetna’s overall suite of medical products.
24-Hour Phone Access
With Aetna Behavioral Health, your employees enjoy the benefits of 24-hour, toll-free phone access to a customer service center that allows them to find participating health care professionals, confirm approved services and obtain precertification, if required by the terms of their health benefits plans.
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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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