Your mental health/substance abuse benefits will be administered by Magellan Healthcare. The Aetna network is not used for mental health or substance abuse care. Magellan Healthcare provides precertification of inpatient (which may be required) treatment, provider referral, ongoing consultation and review, and case management for mental health and substance abuse treatment. You do not need a referral from your PCP to obtain care from participating mental health and substance abuse providers. Instead, when you need mental health or substance abuse treatment, call the Magellan Healthcare telephone number shown on your ID card. A clinical care manager will assess your situation and refer you to participating providers, as needed.
Behavioral health treatment
The Plan covers the following services for behavioral health treatment:
- Inpatient medical, nursing, counseling and therapeutic services in a hospital or non-hospital residential facility, appropriately licensed by the Department of Health or its equivalent.
- Intensive outpatient programs providing planned, structured mental health services for at least 2 hours per day and 3 days per week, consistent with Magellan’s published Medical Necessity criteria. Requires precertification by Magellan.
- Applied Behavior Analysis (ABA) for the treatment of autism spectrum disorder. Requires precertification by Magellan.
- Short-term evaluation and crisis intervention mental health services provided on an outpatient basis.
Treatment of substance abuse
The Plan covers the following services for treatment of substance abuse:
- Inpatient care for detoxification, including medical treatment and referral services for substance abuse or addiction.
- Inpatient medical, nursing, counseling and therapeutic rehabilitation services for substance abuse or dependency in an appropriately licensed facility.
- Outpatient visits for substance abuse detoxification. Benefits include diagnosis, medical treatment and medical referral services by your PCP.
- Outpatient visits to a participating behavioral health provider for diagnostic, medical or therapeutic rehabilitation services for substance abuse.
- Outpatient treatment for substance abuse or dependency must be provided in accordance with an individualized treatment plan.
The Aetna Select option includes a number of provisions specific to mental health and substance abuse treatment. When determining whether a service or supply is medically necessary, Magellan utilizes written medical necessity criteria. Those criteria are available upon request, consistent with applicable law. You and your providers may contact Magellan at 800-442-4123 to request the medical necessity criteria applicable to a treatment or visit their website at Magellan Ascend.