Using Insurance for Therapy

AETNA OUT-OF-NETWORK

We help clients use their out-of-network insurance benefits to cover the cost of therapy.

If you have AETNA insurance, you most likely have out-of-network benefits. You also mostly likely do not need pre-approval for a 45 or 60 minute psychotherapy session, and there is no limit to the amount of sessions you can have in a year.

Open Access Commercial PPO

Aetna will typically cover 70% of their customary rate or allowed amount for out-of-network coinsurance reimbursements. While some plans set the allowed amount at an artificially low rate ($83 for a 45 minute meeting), other plans use the usual and customary rate ($275 for a 45 minute meeting, and $310 for a 60 minute meeting). To find out what the allowed amount for your specific plan is, please speak to your insurance company.

Here’s an example of what this looks like using the Fair Health Consumer website to calculate expenses for a 45-minute session. This is a useful tool to provide you with an estimate of your healthcare expenses.

70% of the usual and customary fee means that they will pay $210 of a $300 fee, making the out of pocket cost $90 after reimbursement. 

 

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Choice POS II

The last time we spoke with AETNA insurance regarding the out-of-network coinsurance reimbursement rate for Choice POS II, we were told that they will cover 60% of the usual and customary rate or allowed amount ($300 for a 45 minute meeting, and $375 for a 60 minute meeting).

Here’s an example of what this looks like using the Fair Health Consumer website to calculate expenses for a 45-minute session.

60% of the usual and customary fee means that they will pay $180 of a $300 fee, making the out of pocket cost $120 after reimbursement. We have also seen out-of-network deductibles range from $2,250 – $3,000 depending on the plan.

 

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To receive an approximate estimate of what you can expect to pay for therapy, enter your information into our Insurance Benefits Calculator. You can download and email us this information and we will cross-verify your benefits on your behalf. 

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