Does Aetna cover eating disorder treatment?

Aetna is one of the largest health insurers in the United States and part of CVS Health¹, covering people through employer-sponsored plans, individual marketplace plans, and Medicare. If you have Aetna and are looking into eating disorder treatment, the questions are what your specific plan covers, at which level of care, and how to confirm it. This page explains how Aetna coverage generally works for eating disorder treatment and how to verify your benefits.

Does Aetna cover eating disorder treatment?

Generally, yes. Aetna plans cover eating disorder treatment that is medically necessary, and federal mental health parity law requires plans to cover behavioral health, including eating disorders, no more restrictively than comparable medical care.²³ The 21st Century Cures Act of 2016 expressly clarified that eating disorder benefits, including residential treatment, are protected under federal parity rules.⁴ What that means in practice, though, varies by your specific plan: your network, deductible, copays, and the authorization rules differ from one Aetna policy to another.

What to know about Aetna for eating disorder treatment

A few things are useful to understand:

• Behavioral health benefits. Aetna administers behavioral health benefits within its plans, and eating disorder treatment falls under that umbrella. For ACA-compliant plans, mental health and substance use services are required essential health benefits.⁵ Your plan documents or member services can confirm your specific behavioral health coverage.
• In or out of network. Out-of-network does not automatically mean paying much more. Many Aetna plans reimburse a share of out-of-network care, so the cost can be comparable. It is usually worth choosing the program that fits clinically, then having it check what your plan would actually cost.
• Medical necessity drives approval. Aetna, like other insurers, authorizes treatment based on clinical criteria, and higher levels of care require documentation that the level is medically necessary.

Levels of care

When it is medically necessary, an Aetna plan can cover the full range of eating disorder care, from weekly outpatient therapy and intensive outpatient up to partial hospitalization, residential, and hospital-based inpatient or medical stabilization. Aetna authorizes the higher levels against its own published clinical-policy criteria and re-reviews longer stays to decide whether to keep approving that level. Standard outpatient therapy usually needs no prior approval.

Verifying your Aetna benefits

Call the number on this page and a licensed eating disorder program will check your Aetna benefits, see what your plan would cover in or out of network, and tell you what level of care it is likely to authorize. Because Aetna manages behavioral health in-house rather than through a separate carve-out, that review runs against Aetna's own criteria. For how prior authorization, cost-sharing, and appeals work across any plan, see verifying your insurance.

Finding a program that accepts Aetna

Many eating disorder programs work with Aetna, and a program confirms participation for your plan when it verifies your benefits. Search the directory and call to speak with a licensed eating disorder facility. EDrehab is not an Aetna network provider; the licensed eating disorder programs on the other end of the line do.