How to verify your Aetna (Commercial) mental health benefits.
Aetna commercial plans cover outpatient mental health at the in-network rate without a referral on most products. The verification call is short — usually under ten minutes — but it's worth doing before your first visit so you know the copay, the deductible status, and whether your employer's plan includes an Employee Assistance Program (EAP) that can stack on top of your regular benefit. Aetna Better Health of New Jersey is a separate Medicaid product; if your card says Aetna Better Health, follow the NJ FamilyCare verification guide instead. This page is for commercial Aetna: employer-sponsored plans, Aetna marketplace plans through Get Covered NJ, and Aetna individual plans.
The call, in order.
Total time: about 10 minutes for most plans, 24 hours if the rep has to call back.
Call the number on the back of your Aetna card
Commercial Aetna's member services number is on the back of your card, not the one for Aetna Better Health (Medicaid). You can also start the verification online at aetna.com once logged in, but the phone path is faster for the first call because the rep can answer follow-up questions in real time.
Tell the rep the clinic name and address
Say Positive Reset Eatontown, 615 Hope Rd Suite 3B, Eatontown, NJ. Ask the rep to confirm we are in-network for outpatient mental health under your specific plan name (Aetna Open Choice PPO, Aetna Choice POS II, Aetna CVS Health marketplace, etc.). The rep looks up the provider directory live.
Confirm copay or coinsurance
Aetna commercial copays for outpatient mental health typically range from $0 to $40 per visit, depending on the plan. If your plan uses coinsurance instead, ask for the percentage after the deductible (commonly 10–30%). Confirm whether the deductible has been met for this calendar year — if not, you'll owe the deductible amount before coinsurance kicks in.
Ask about the referral and prior-auth rules
Most Aetna commercial plans don't require a PCP referral for behavioral health visits, but a small number of HMO products still do. Ask the rep specifically. TMS for treatment-resistant depression does require prior authorization documenting two or more failed antidepressant trials — we handle that paperwork.
Check for an Employee Assistance Program
If your plan is employer-sponsored, Aetna may bundle Resources for Living (the Aetna EAP) at no cost. That typically gives you three to six no-cost sessions before your regular behavioral-health benefit starts billing. We apply EAP visits first when available, so your benefit isn't drawn down.
Confirm telehealth coverage
Aetna covers telehealth for behavioral health at parity with in-person on essentially all commercial plans. Ask the rep to confirm for yours specifically, especially if you're enrolled in a narrow-network or marketplace plan where the policy can vary.
Exactly what to ask the rep.
Copy this list before the call. Each item is the kind of answer that should be on the line with you, not in a follow-up email a week later.
- Is Positive Reset Eatontown in-network for outpatient mental health under my Aetna plan?
- What is the copay or coinsurance per visit?
- Has my deductible been met for this calendar year?
- Do I need a PCP referral?
- Does my plan include Resources for Living (EAP)?
- Is telehealth covered at parity with in-person?
- What's the prior-authorization process if I need TMS later?
Plan-specific notes.
Aetna's most common NJ commercial products are Aetna Open Choice PPO and Aetna Choice POS II (both typically employer-sponsored), plus Aetna CVS Health marketplace plans sold through Get Covered NJ. All three cover outpatient mental health at the in-network rate when you see Positive Reset Eatontown. The marketplace plans tend to have higher deductibles than employer plans — verify the deductible status before your first visit so the copay number isn't a surprise.
If you carry both a commercial Aetna card and an Aetna Better Health of New Jersey card (rare, but it happens during transitions), the Medicaid product takes precedence for billing — you should not be charged a copay. Tell us about both cards on the verification call and we'll route the claim correctly.
For employer-sponsored plans only: the Aetna Resources for Living EAP is bundled at no cost and runs in parallel with the regular behavioral-health benefit. EAP visits don't count toward any annual session limit. Ask HR or check your employer's benefits portal if you're not sure whether your plan includes it.
We can run the verification for you.
Call us with your member ID and we’ll do the verification call ourselves — usually 5–10 minutes for most plans, 24 hours for plans that require a callback. You’ll get the copay and coverage answer before you book your first visit.
See the full Aetna coverage page for what we treat and what’s covered.
Other things people ask.
Do you accept Aetna?
Yes, we accept commercial Aetna plans (HMO, PPO, EPO) for mental health care. Note that Aetna Better Health of New Jersey is a separate Medicaid product — also accepted, but billed differently. If you have Aetna through your employer, that's the commercial plan; if you have Aetna Better Health of New Jersey through NJ FamilyCare, that's the Medicaid product.Do I need a referral from my primary care doctor?
For most plans, no. Commercial plans like Aetna, Cigna, Horizon BCBS, Oxford, and UnitedHealthcare typically don't require a referral for outpatient mental health. Some Medicare Advantage plans do. NJ FamilyCare doesn't require a referral for outpatient therapy or psychiatry. We tell you up front if your specific plan needs one.What if my insurance changes between visits?
Tell us as soon as possible. We re-verify benefits when an insurance plan changes — call (732) 724-1234 with the new card. Coverage of mental health care often continues without interruption, but the copay or coverage level may shift, and we want you to know what to expect for the next visit.How much will therapy cost me?
If you're insured and we're in-network, you typically pay only your plan's copay or coinsurance — usually $0 to $40 per visit. NJ FamilyCare members pay $0. Self-pay rates start at $125 for medication management and $150 for individual therapy. We tell you the exact cost before your first visit, per the No Surprises Act.
Last updated: 2026-05-23