Aetna Benefit Phone Script

Verifying Aetna benefits used to be fairly easy with Navinet (can still access if you pay for it!), but since they switched to Availity, I don't know about you, but I find it kind of tricky (even though I think I figured it out!).

I've had a lot more luck with calling Aetna and talking to the robot (whom I have dubbed my Aetna Robot Boyfriend). He even tells you when the plan is self-funded or fully-funded (hint, most are self-funded) which is REALLY useful information during all this cost-sharing with telehealth stuff.

I've called him so much, that I have the whole thing down! This phone prompt script will be verifying psychotherapy office visit benefits. I know, I know but telehealth....you'll have to speak to someone to verify that coverage for now. Unless they've added it since I last called Aetna, which in that case, awesome!

Here are the deets:

How to Verify Aetna Benefits Over the Phone

I keep my phone on 'mute' for most of the call as the Robot-Man picks up basically any noise....unlike other robots....annoying lol.

Call 800-624-0756

• Put your phone on mute and speakerphone
• Input your EIN and press #, Press 2 for benefits
• Put the client's member ID without the 'W' (just the numbers) and #
• Put the client's birthday MMDDYYYY and #
• Listen to confirm the client, press 1
• If you'd like to have it faxed, press 2.
• Write the reference number down
• Robo-man will tell you about the plan effective date, whether it's self or commercially funded (IMPORTANT FOR COST-SHARING), active, their group number (if you need it, write it down) and if referrals are needed. Press 1 for benefit details
• Unmute and say 'psychotherapy' which is Anccilary code A6, put back on mute (if he says no benefits under this plan--that's a MH carve-out!). Confirm these are the benefits you want.
• Choose the level of benefits (INN or ONN)
• Listen for 'outpatient professional visit for mental health'
• You will hear about copay/co-insurance if a deductible applies.
• If you need to speak to a representative, after the robot is done with the benefit quote, say 'representative' or sometimes hitting 00000 also gets you a live person as well.

I use Availity to double-check and make sure I have the correct address, subscriber etc.

Hope this helps you out!