Summary Plan Description
Behavioral Health Services
90% Network and 80% Non-Network
Services and Supplies Must Be Precertified Unless the Patient Is A Medicare-Eligible Retiree
Behavioral health services refers to the category of services including mental health, substance use disorder and other behavioral health services. The plan provides coverage for inpatient, residential, partial hospitalization, intensive outpatient programs, and individual counseling, including an initial assessment, history and physical evaluation. Medical records must substantiate the medical necessity for specific drug testing or repeat testing. Coverage is not provided for quantitative drug testing. Individual or group guidance counseling, and addiction education are considered inclusive in the allowance made by the plan for the facilities room and board charge and are not reimbursed separately. Benefits for Medicare-eligible retirees are limited to those services covered by Medicare.
Precertification is required when a patient is inpatient, in a residential treatment center, in a partial hospitalization program, in an intensive program or any similar program, or requires applied behavioral analysis therapy or electroconvulsive therapy. Your physician or other provider must call Aetna's Behavioral Health Program at (800) 424-4047 to obtain precertification. The program's telephone number is also listed on your Aetna/Carpenters Trusts ID card. If the patient does not require this level of care, precertification is not required. All benefits are subject to the terms and conditions as set forth in Aetna's Behavioral Health Program. A behavioral health facility must be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) or the Commission on Accreditation of Rehabilitation Facilities (CARF).
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