First Health Network Mental Health Coverage

In 2021, an estimated 61.5 million adults were living with a mental illness in the United States.^[1] Unfortunately, although there is a huge demand for mental health treatment, access to care is often financially overwhelming without insurance support.

Insurance providers that partner with in-network healthcare professionals make treatment more accessible.

First Health Network is a subsidiary of Aetna that operates across the country and connects members to a broad range of medical and mental health providers. If you would like assistance with understanding how to navigate First Health Network, the team at Mission Connection is on hand to help.

This page can also help you better understand First Health Network mental health coverage, as it explores:

• What the First Health Network is.
• What First Health Network offers.
• The mental health services First Health covers.
• How to check if your plan covers therapy.
• The First Health insurance verification process.
• How to find First Health behavioral health providers.
• Costs and limitations of coverage.
• Answers to FAQs about the First Health Network.

What Is the First Health Network?

The First Health Network is a nationwide healthcare provider network. It was originally founded in 1985 as First Health Group Corp. The goal was to build a Preferred Provider Organization (PPO) network that could connect people to quality care with manageable costs.^[2]

Today, First Health operates as a well-established PPO network and is currently owned by Aetna, a CVS Health company. It functions as a provider network that many insurance plans use. If your insurance card lists First Health, it means your plan gives you access to a wide range of in-network doctors, hospitals, therapists, and mental health professionals across the country.

The network is widely used by employers, third-party administrators, and government-related plans. It currently includes more than 6,400 hospitals, 151,000 medical facilities, and approximately 1.22 million licensed healthcare professionals nationwide.

First Health Network Products

First Health therapy coverage falls into four main categories, which we explain in the following paragraphs.^[2]

1. Medical Network Options

Medical network options are the foundation of First Health’s services and are used to support employer-sponsored and third-party health plans. Here are the details:

• The First Health Primary Network serves as a main PPO option with nationwide access.
• The First Health Complementary Network is layered with other networks to expand provider choice.
• The First Health International Network bridges gaps in coverage outside the United States for people who travel or live abroad.
• There are also specialized options such as the Limited Benefit Plan Network and the Health Share Plan Network.
• The Confinity Network extends access to an even wider group of healthcare providers

2. Dental

Aetna Dental Administrators (ADA) is at the back of First Health Network’s dental coverage. The Aetna Dental Access Network includes more than 285,000 dental providers across the United States. The broad coverage allows members to access routine and specialized dental care without traveling long distances.

Dental benefits cover preventive and diagnostic services such as routine exams, cleanings, and X-rays. The coverage also extends to restorative services, including fillings, root canals, crowns, and orthodontic procedures (for example, braces).

3. Non-Network Claim Options

First Health Network provides additional protection for patients and health plans when care is received outside of a contracted network. You pair non-network claims with medical network plans to maintain continuity of care. These services include:

• Large claim reviews that ensure all your bills are accurate and free of errors.
• Provider negotiations for unreasonably high charges.
• Medicare-based repricing to align your treatment costs within accepted Medicare benchmarks.
• Access to supplemental networks when in-network care is limited or unavailable.

4. Medical Management

First Health Network provides medical management services in partnership with American Health Holding. It delivers evidence-based and patient-centered care to all clients.

There are two core components of medical management. These are:

1. Case management that supports patients with complex medical or behavioral health needs. Case managers coordinate your care across multiple providers and ensure that treatment plans are in line with your health goals.
2. Disease management programs for people living with chronic conditions, such as diabetes, hypertension, or long-term mental health disorders. The programs provide education and monitoring along with your treatment.

What Mental Health Services Does First Health Cover?

First Health covers both outpatient and inpatient mental health services. Most plans also cover addiction treatment. In the following sections, we explore the ins and outs of these services.

Outpatient Mental Health Services

Outpatient mental health care refers to treatment you receive while living at home and attending appointments at regular intervals. These services include individual therapy, group therapy, and family counseling with licensed mental health professionals who are in-network with First Health.

These clinicians are credentialed and contracted to provide evidence-based care. First Health outpatient mental health services also include psychiatric medication management. A psychiatrist or other qualified prescriber can evaluate your response to medications and adjust dosages based on side effects over time.

First Health plans allow these outpatient services to be delivered both in person and through telehealth. Since it operates as a PPO network, you don’t need a referral from your primary care physician to see an in-network mental health provider for outpatient services.

Inpatient Mental Health Treatment

Inpatient care is delivered in a hospital or specialized facility where you stay because your condition requires constant supervision. Therefore, First Health inpatient mental treatment is reserved for severe symptoms, such as danger to self or others.

Inpatient psychiatric hospitalization is included as part of behavioral health benefits under First Health Network plans when deemed medically necessary by your provider. It includes acute psychiatric hospitalization, or in other words, 24-hour care for stabilization, medication adjustment, crisis intervention, and the initial stages of recovery.

Plans may also cover residential behavioral health programs that provide intensive therapeutic care in a non-hospital but still supervised living environment.

The actual coverage for inpatient care varies by the insurance plan. Yet most ACA-compliant plans that utilize the network must provide mental health and substance use disorder treatment at parity with medical and surgical benefits under U.S. law.^[3]

So, coverage for inpatient mental health treatment cannot be more restrictive than coverage for other medical inpatient care in terms of limits on days, deductibles, or co-insurance.

Common Conditions Treated Under First Health Mental Health Coverage

The following mental health conditions are covered under First Health mental health treatment:

• Major depressive disorder and persistent depressive disorder
• Bipolar disorder
• Anxiety disorders like generalized anxiety, panic disorder, and social anxiety
• Post-traumatic stress disorder (PTSD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Schizophrenia and schizoaffective disorders

First Health Dual Diagnosis Treatment Coverage

First Health Network also covers care for people dealing with both a mental health condition and a substance use disorder at the same time.

Further, First Health dual diagnosis treatment plans include coverage for medication-assisted treatment (MAT) when clinically indicated. MAT uses FDA-approved medications alongside behavioral therapies to treat addiction.

The treatment can be delivered across inpatient residential programs, intensive outpatient programs (IOP), partial hospitalization programs (PHP), and telehealth.

However, dual diagnosis services require prior authorization. Therefore, your provider will need to demonstrate that the treatment is medically necessary for you.

How to Check if Your First Health Plan Covers Therapy

First Health benefits vary based on your insurance plan and the carrier providing it, so always review your individual coverage.

Your Summary of Benefits and Coverage (SBC) outlines what mental health services are included and how much you may need to pay.^[4] The document explains copayments, coinsurance, and deductibles in clear, standardized terms. When reviewing the SBC, look for sections labeled “outpatient mental health,” “outpatient behavioral health,” and so on.

You can access your SBC by logging into your insurance company’s online member portal or the website where you manage your policy. Many insurers allow you to download it as well.

If you’re unable to find it online, you can always call the customer service number on the back of your insurance card. Ask a representative to walk you through your outpatient therapy benefits and costs.

First Health Insurance Verification for Mental Health Services

First Health is a PPO network, not an insurance carrier, so your mental health coverage details depend entirely on the specific health plan that uses the First Health Network.

When you contact your provider for details of your plan, you will be required to verify your identity. Be prepared to provide your member ID number and date of birth. You will also be asked details about the type of mental health services you are seeking, such as outpatient therapy or a higher level of treatment.

Additionally, many plans require prior authorization for certain mental health services. Services that commonly require prior authorization include:

• Inpatient psychiatric hospitalization.
• Residential mental health treatment.
• Partial hospitalization programs (PHP).
• Intensive outpatient programs (IOP).
• Some specialized procedures or therapies.

To check your insurance coverage for mental health treatment at Mission Connection, simply complete our confidential online verification form below. You can also call us at 866-833-1822 and a helpful member of our admissions team will be happy to verify your coverage.

Finding First Health Behavioral Health Providers

There are several ways to locate clinicians, therapists, psychiatrists, and other mental health specialists who accept your coverage. Because First Health is a PPO network with nationwide reach, its directory includes a large number of providers who offer mental health services at negotiated, in-network rates.

You can find an in-network provider by calling First Health’s customer service line at 1-800-226-5116. The representatives will identify mental health professionals in your area who participate in the First Health Network and whether a provider is currently accepting new patients.

Online search tools also make it very convenient to locate providers from your computer or mobile device. Many insurance plans that use the First Health Network allow members to log in to their health insurer’s online member portal and use a built-in provider search feature. First Health has its own search directory for the same purpose: providerlocator.firsthealth.com.

When using a directory, make sure to verify whether the provider is still participating in the First Health Network and whether they offer the type of mental health service you need.

Costs and Limitations of First Health Mental Health Coverage

Your actual financial responsibility is determined by the insurance plan that uses the First Health Network, not by First Health itself. The financial structure of plans includes deductibles, copayments, coinsurance, and an annual out-of-pocket maximum.^[5]

The deductible is the amount you must pay out of pocket each year before your insurance begins covering services. Once that deductible is met, you may still be responsible for copayments or coinsurance. Copayments are fixed dollar amounts you pay per therapy session or visit. Coinsurance is a percentage of the total allowed cost that you pay, while your insurance covers the remainder.

All of these payments count toward your out-of-pocket maximum. This is the highest amount you are required to pay in a plan year before your insurance covers eligible services at 100%.

These cost-sharing rules apply to mental health care in the same way they apply to other medical services under ACA-compliant plans.

Using in-network providers who participate in the First Health Network results in lower out-of-pocket costs because these providers have agreed to negotiated rates with the network. When you stay in-network, your insurance company calculates your costs based on these discounted rates.

In contrast, seeing out-of-network providers may result in higher coinsurance, balance billing, or reduced reimbursement.

Many plans also place annual maximums on certain types of outpatient mental health services, such as a set number of therapy visits per year. If your threshold is reached, you may need additional authorization to continue mental health services.

Get In-Network Mental Health Treatment at Mission Connection

Mental health treatment can be costly when paid for out of pocket, which may make high-quality care out of reach for many individuals and families.

Mission Connection is proud to be in-network with the First Health Network to reduce financial barriers and expand access to meaningful, evidence-based mental health care.

Our team will review your insurance benefits in advance and clarify any expected out-of-pocket costs. If you would like to discuss your coverage, reach out to us online or call us at 866-833-1822 to speak with an admissions counselor today.

First Health Network Mental Health Insurance Coverage FAQ

If you’re considering mental health treatment, you may have some persisting questions about your coverage. This is why we’ve provided the following answers to FAQs we receive about First Health.