Tips for Aetna families

Last reviewed: July 2026
Insurance requirements may change. The member’s current benefit plan and the payer’s current requirements govern coverage and authorization.

Aetna

Aetna ABA coverage varies by the member’s specific plan. Employer-sponsored and self-funded plans may have different networks, benefits, referral rules, and cost-sharing requirements even when the insurance card says Aetna. Aetna generally requires prior authorization, also called precertification, for ABA services. The member’s benefit plan ultimately determines what is covered. Aetna’s current provider manual

What Families Should Ask Aetna

Before beginning services, call the Member Services or Behavioral Health number on the back of the insurance card and ask:

  • Does this plan cover ABA for autism?
  • Are the behavioral health benefits managed directly by Aetna or by another company?
  • Is Behave Yourself LLC in network for this specific plan?
  • Is Rebecca Babek, BCBA, LBA, recognized as an in-network rendering or treating provider?
  • Is a physician referral or order required?
  • Is prior authorization required for the ABA assessment and ongoing treatment?
  • What deductible, copayment, or coinsurance applies?
  • Has the deductible been met?
  • Are there plan-specific limits or exclusions for home- or community-based ABA?
  • Does the plan require use of a particular assessment, diagnostic document, or provider form?

Please record the date of the call, the representative’s name, and any reference number provided. Insurance representatives occasionally give incomplete or conflicting information, and a call reference can help if clarification is needed later.

What Behave Yourself May Need

For an Aetna benefit and authorization review, I may request:

  • A copy of the front and back of the insurance card
  • The subscriber’s name and date of birth
  • The client’s autism diagnostic evaluation
  • A referral or physician order when required by the plan
  • Relevant clinical or developmental records
  • Information about current or previous ABA services
  • Details about any existing ABA authorization

I will provide a secure method for sending these documents. Please do not send insurance identification numbers or diagnostic records through the public website contact form.

Assessment and Prior Authorization

After confirming preliminary eligibility and fit, Behave Yourself submits the appropriate request for an ABA assessment. Once the assessment and treatment plan are complete, the clinical information is submitted to Aetna for review when required.

Aetna reviews the requested type, intensity, frequency, and duration of treatment for medical necessity. Its current clinical guidance also expects caregiver participation, repeated measurement, standardized assessments, measurable progress, and ongoing treatment review. Aetna’s 2026 ABA Medical Necessity Guide

An authorization identifies the approved services, date range, and units or hours. Authorization does not remove deductibles, copayments, coinsurance, or other responsibilities established by the member’s plan.

Continuing Services

Aetna may require updated treatment information before the authorization period ends. This can include:

  • Progress on current goals
  • Updated treatment recommendations
  • Current behavior and skill data
  • Caregiver participation
  • Standardized assessment results
  • Barriers affecting progress
  • Plans for generalization, fading support, and eventual discharge

I monitor authorization dates and prepare the clinical documentation needed for continued services. Families should tell me promptly about changes in employment, insurance plan, subscriber information, or other coverage because these changes can affect an existing authorization.