Aetna Behavioral Health Benefits
The goal of the following services and tools is to assist you in managing the diagnosis and treatment of your patients. Aetna Behavioral Health's approach looks at the entire spectrum of health care needs, both physical and mental. We also integrate services to maximize your opportunity to help patients achieve better overall health.
Determination of Medical Necessity
As a behavioral health professional working with Aetna, you will have access to our proprietary Level of Care Assessment Tool (LOCAT) to help you assess an Aetna member's level of functioning and the appropriate level of care. For members with possible chemical dependency, we refer to, as a guide, the American Society for Addiction Medicine Patient Placement Criteria (ASAM), a nationally recognized guideline for treatment of chemical dependency. For members in Texas, we refer to the Texas Commission on Alcohol and Drug Abuse (TCADA) regulations. Ultimately, however, each health care professional must exercise his or her own independent medical judgment when providing services to Aetna members. For more information, please see our regularly updated bulletins on Aetna's secure website for physicians, hospitals, and health care professionals.
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Case Management
Case management is usually performed by registered nurses. Case managers can help patients get the care they need, learn more about their conditions and help them better manage their conditions. Acting as a health advocate, it is a case manager's role to assess patient needs, arrange treatment services, and develop and carry out a medical/psychiatric management plan for members who meet the program's admission criteria. Case management includes the integration of behavioral health services, as well as the coordination of medical care.
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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 maximize a patient's response to antidepressant medications. The program integrates care from various sources, including primary care physicians, behavioral health professionals and pharmacy. In addition, the Alcohol Disease Management Program can help you to identify certain warning signs of alcohol abuse in your patients. It also suggests ways you can help your patients to access the kind of care they need to address a possible dependency on alcohol. In 2005, we will offer screening tools to help better identify patients who may have an alcohol dependency, along with referral and case management information.
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Psychiatric Evaluation/Assessment
Depending on the severity of a patient's behavioral health problem, a full psychiatric evaluation and mental health assessment may be needed to get the proper assistance to restore the person to optimum health and productivity.
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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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