Aetna Eating Disorder Coverage

If you or someone you care about is struggling with an eating disorder, navigating the insurance process when seeking treatment options can be difficult.

There are many different kinds of treatments offered for eating disorders, including inpatient treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and group therapy, and it can feel challenging to determine the necessary level of care for you or your loved one. Additionally, eating disorder treatment is often expensive, and many people can’t afford to pay for it out-of-pocket.

Thankfully, many health care insurance providers offer options for coverage, so it is possible to receive financial assistance with treatment, whether it be paid in part or full.

If your health insurance policy is through Aetna, you should be eligible to have a number of eating disorder treatments covered. As a major insurance provider that covers over 30 million people, Aetna spans a wide range of care networks, and a wide variety of treatment centers will accept this insurance. [1]

Does Aetna Cover Eating Disorder Treatment?

In a word, yes. Aetna does provide coverage for eating disorder treatment, but coverage can vary greatly depending on whether you are on an individual, corporate, or Medicaid/Medicare plan.

Aetna may provide full or partial coverage for inpatient care, such as short-term stays at a hospital or residential facility. Outpatient services like therapeutic evaluations and interventions may also be covered, but these benefits may be limited.

It’s important to review your plan to learn more about the specific coverage you’re entitled to, and any potential limits. It’s also helpful to seek out in-network treatment, in order to receive the best possible coverage.

For more specific details about what your plan covers, you can call the behavioral health number on the back of your insurance card. You may have a deductible to meet before your coverage kicks in, or you may have co-pays. An insurance agent can help you determine how much those will be, so you can get a better picture of your coverage.

What is covered?

Aetna covers treatment considered medically necessary for the management of anorexia nervosa (AN) or bulimia nervosa (BN), but for long-term care, coverage may not extend the full course of treatment.

Aetna also covers some virtual care options, including some types of telehealth appointments.

Some general categories of treatment frequently covered by Aetna include: [2]

• Medical evaluations, including an intake of medical history and physical evaluation
• Psychiatric and psychological consultation
• Bone density measurements
• Electrocardiography
• Liver Function Tests

Additionally, Aetna may cover more specific treatments to help manage anorexia nervosa and bulimia nervosa, such as: [2]

• Nutritional counseling
• Pharmacology, or medication-based treatment
• Psychotherapy
• Enteral nutrition, such as tube feeding, in extreme cases

It’s important to remember that this list may not be complete, and individuals should verify coverage with Aetna before undergoing treatment, to ensure they understand what will be covered.

What is not covered?

Aetna doesn’t typically cover treatment the company considers to be experimental or lacking sufficient peer-reviewed evidence. This can apply to many different types of treatment, but some of the more common forms of care that generally aren’t covered include: [2]

• Blood-based serotoninergic biomarkers to diagnose bulimia nervosa or help tailor treatment
• Estrogen receptor 1 gene testing to diagnose eating disorders
• Brain imaging
• Acupuncture
• Deep brain stimulation
• Neural therapy

For the most recently updated and complete list of treatments Aetna will not cover, you can search the company’s policy website.

Treatment Programs Under Aetna Eating Disorder Coverage

If you’re covered by Aetna and ready to begin treatment, you may have options for residential, outpatient, PHP, and virtual care.

Below are just a few of the rehab centers and treatment facilities that are in-network with, or accept, Aetna insurance. Before beginning care at any facility, however, it’s important to call the behavioral health number on the back of your insurance card and verify specific coverage.

Eating Recovery Center

The Eating Recovery Center is one of the most widespread eating disorder programs in the country, treating patients in Colorado, California, Illinois, Florida, Maryland, New York, Pennsylvania, Ohio, Texas, and Washington. They also have a virtual program, which can extend to patients living anywhere.

At an ERC treatment center, you can receive care for bulimia nervosa, anorexia nervosa, binge eating disorder (BED), compulsive overeating, and more, through residential, inpatient, partial hospitalization, and intensive outpatient treatment.

Alsana

Alsana is another country-wide service, with seven locations across Alabama, Missouri, and California. The service also includes virtual options for patients living beyond these locations.

Alsana’s program is designed to help treat BN, AN, and BED, as well as co-occurring conditions, such as depression or anxiety disorders. Their variety of programs include two-week intensives, virtual programming, residential treatment, and LGBTQ+-affirming treatment. Alsana also offers vegan-friendly options for people who have dietary restrictions.

Virtual Care

Aside from the in-person centers partnering with Aetna, the company also works alongside Equip, a virtual treatment company, to extend virtual eating disorder coverage to many of its members.

If you have Aetna’s commercial coverage in California, New Jersey, New York, Oregon, Texas, or Washington, you will have in-network coverage with Equip. And the program may expand to other locations in future years.

The virtual treatment options provided by Equip include family-based treatment, where parents and guardians work alongside a five-person clinical team to help mitigate disordered eating behaviors.

Aetna is also accepted by Nourish, another virtual platform for eating disorder treatment. This platform helps provide nutritional planning, and offers virtual health appointments, as well as coordination with a care team.

Starting on the Path to Recovery

Navigating insurance may be difficult, but Aetna offers many options for finding the proper care to recover from your eating disorder. From residential to outpatient and even virtual care, nearly every level of care for an eating disorder can be covered through your Aetna policy.

In fact, the number of choices you have may even seem overwhelming. But once you do a little research, you should hopefully be able to find a program that fits your needs.

Before enrolling, it’s important to call the behavioral health phone number on the back of your insurance card, to verify your coverage and find freedom from your eating disorder.

But by following these simple steps, you’ll be that much closer to the road to recovery.

Resources

1. Aetna Facts. (n.d.). Aetna. Accessed March 2023.
2. Eating Disorders. (n.d.). Aetna. Accessed March 2023.
3. Vaidya, A. (2022, March 8). Aetna Expands Access to Virtual Eating Disorder Treatment. mHealth Intelligence. Accessed March 2023.

Published on May 21, 2023 Published on EatingDisorderHope.com