Does Aetna cover therapy in Arizona? What you will actually pay

If you have an Aetna card and you are thinking about therapy or a psychiatric evaluation, you have two questions: is it covered, and what will it cost per visit. The first has a short answer. The second depends on your plan, and this article is about finding it.

We accept Aetna, Cigna, Carelon Behavioral Health and Curative at PATH, for individual therapy, couples therapy, psychiatric evaluations and medication management. That covers everything on this page except the Intensive Outpatient Program and the Partial Hospitalization Program, which those four plans do not cover.

The short answer

Most employer and marketplace health plans cover outpatient mental health care, and federal parity rules require that coverage to be comparable to the coverage for medical care. An Aetna plan that covers a visit to a specialist will, in almost every case, cover a visit to a therapist or to a board-certified psychiatric nurse practitioner. What varies is your share: a copay on some plans, a percentage on others, and on some plans the full agreed amount until a deductible is met.

So the honest answer is: almost certainly yes, and the number on your bill is written in your plan documents, not ours. We do not quote a dollar copay for Aetna plans, because there is no single figure; two Aetna members can pay very different amounts for the same hour.

What in-network means

In network means the plan and the provider have agreed, in advance, on what each kind of visit costs. The plan pays the provider most of that amount, and you pay your share. Because the price is settled before you walk in, there is no surprise bill and nothing for you to file.

Out of network means there is no such agreement: you pay the provider, and your plan may pay you back for part of it later, after you send in a receipt called a superbill. PATH works both ways, and the second is explained below.

Copay, coinsurance and deductible, in plain words

• A copay is a fixed amount per visit, often printed on the card. If your plan uses one for office visits, that is usually what a therapy session costs you.
• Coinsurance is a percentage of the agreed price rather than a fixed amount. At 20 percent you pay a fifth and the plan pays the rest.
• A deductible is the amount you pay in full each plan year before the plan starts paying. Some plans apply it to therapy visits; others let the copay apply from the first visit. This is the biggest reason two Aetna members pay different amounts.
• An out-of-pocket maximum is the cap. Once you reach it in a plan year, covered visits cost you nothing for the rest of that year.

How to check your own Aetna plan

1. Your card. Many Aetna cards print the office visit and specialist copays on the front. The specialist figure is usually the one that applies to therapy. If the card shows only a plan name and a member ID, go to the next step.
2. The member portal or app. Open your benefits summary and look for outpatient mental health or behavioral health: a copay or coinsurance percentage, whether the deductible applies, and how much of it you have met.
3. The number on the back of the card. A representative can read you the figures and tell you whether video visits are covered on the same terms as office visits.

If you call, ask: Is outpatient mental health covered? Is there a copay or coinsurance for a visit with a licensed therapist, and with a psychiatric nurse practitioner? Does my deductible apply first, and how much of it have I met? Are video visits covered the same as office visits? Is prior authorization needed? Write the answers down, with the date.

What PATH does on the free consultation

You do not have to do this alone. Every patient starts with a free 15-minute video consultation with our front desk. Bring your card. We ask which plan you have, we check your coverage, and you hear the dollar amount for your situation before anything is final. The consultation is a conversation about cost and next steps, not the evaluation or the first session, and it commits you to nothing. If you would rather be seen in the Tempe office than by video, say so on the call; most plans cover both on the same terms, and we confirm it for yours.

Billing runs through Headway

Billing for Aetna, Cigna, Carelon Behavioral Health and Curative at PATH is handled by our billing partner, Headway. After you book with one of those plans, you get an email from Headway asking you to confirm your coverage and add a card for your copay or coinsurance. The email is expected, and it shows your estimated cost before your first session. The claim goes to Aetna from Headway, and your card is charged your share. If anything in the email looks wrong, call us before your first visit.

If you are not covered, or not covered yet

• Your deductible has not been met. The visit is still covered, but you pay the agreed in-network price until the deductible is met, and every dollar counts toward it.
• Your plan is not one of the four we accept. You can still see us. You pay our self-pay rate, we give you a superbill after each session, and your plan may pay you back for part of it if it has out-of-network benefits. Our out-of-network page walks through the four steps.
• You would rather not use insurance. Our self-pay prices are public: therapy is $75 to $150 a session, a psychiatric evaluation is $300, and a medication management follow-up is $150, the same by video as in person. A sliding scale is available for financial hardship. Everything is on the insurance and pricing page.

Paying yourself or using out-of-network benefits, you also receive a written Good Faith Estimate of what your care will cost before your first appointment. That is your right under federal law.