Networks change. We verify your specific Aetna plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Aetna Commercial Health, Aetna HMO/EPO/POS/PPO, Aetna Medical Rental Networks.
Aetna, now part of CVS Health, covers outpatient mental health under the same cost-sharing rules as medical care, as federal parity law requires. For most Aetna PPO and POS plans, a psychiatry visit with an in-network provider costs a specialist copay, often between $30 and $60, or the plan's coinsurance after the deductible on high-deductible plans. Aetna HMO plans may ask you to stay within the network but generally do not require a primary care referral for behavioral health. Telehealth psychiatry is covered at parity with office visits for Florida and South Carolina members, and Aetna has kept video visits as a standard benefit since 2020.
For Deep TMS, Aetna has a clinical policy bulletin that treats TMS as medically necessary for major depressive disorder when you have failed at least two antidepressant trials at adequate dose and duration, or could not tolerate them, and have a documented symptom score. Prior authorization is required and usually approves an initial course of around 30 to 36 sessions. Spravato requires prior authorization through Aetna's pharmacy benefit, often managed by CVS Caremark, plus documentation of treatment-resistant depression and concurrent oral antidepressant use. Our staff submit both requests on your behalf.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Aetna cover psychiatry visits at Stedfast Psychiatry?
Most Aetna commercial plans cover in-network psychiatric evaluations and medication management. Your cost is usually a specialist copay or coinsurance after the deductible, depending on your plan design. Call the member services number on your card, or ask our front desk to run an eligibility check before your first appointment, so there are no surprises.
Do I need a referral from my primary care doctor with Aetna?
Aetna PPO and POS plans do not require referrals for behavioral health. Some Aetna HMO plans do, and a few employer plans route mental health through a separate behavioral health vendor. Check your plan documents or call Aetna to confirm whether a referral or a specific network applies to psychiatry.
Does Aetna cover telehealth psychiatry in Florida and South Carolina?
Yes. Aetna covers video visits for mental health at the same benefit level as in-person care in both states. You must be physically located in Florida or South Carolina during the visit so that our provider is licensed where you are. Phone-only visits may be covered differently, so video is preferred.
Will Aetna pay for Deep TMS?
Aetna's policy covers TMS for major depressive disorder when medical necessity criteria are met, including documented failure or intolerance of antidepressants and a current severity score. Prior authorization is required. Our Palm Beach Gardens TMS team gathers your medication history and submits the request, and we can appeal a denial with a peer-to-peer review.
Is Spravato covered by Aetna?
Spravato typically requires prior authorization under Aetna's pharmacy benefit, with documentation that you have treatment-resistant depression and are taking an oral antidepressant. The drug may be supplied through a specialty pharmacy and administered at one of our certified offices. Session monitoring is billed under the medical benefit. We coordinate both pieces.