How Aetna Pays Out-of-Network Benefits: percentage of allowed amounts (Behavioral Health)

Behavioral Health out-of-network rates

We negotiate rates with psychiatrists, psychologists, counselors and other appropriately licensed and credentialed behavioral health care providers to help you save money. We refer to these providers as being “in our network.”

Some of our plans pay for services from providers who are not in our network. For dates of service effective January 1, 2015, we have changed the percentage of allowed amounts paid to some out-of-network behavioral health providers. Our out-of-network rates are aligned with Medical and Medicare and are as follows:

Providers Percentage of Allowed Amount
Psychiatrists and Psychologists 100% of the allowed amount
Psychiatric Nurses, Nurse Practitioner (Behavioral Health focused) and Physician Assistant (Behavioral Health focused) 85%
Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, Drug and Alcohol Counselors, Psychological Examiner, Pastoral Counselor, Certified Addictions Counselors, Applied Behavior Analyst, Behavior Analysts Assistant 75%

For more information

Please see your plan documents to learn more. Or call member services. The phone number is on the back of your Aetna ID card.

* This policy does not apply in all states.


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