Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Meritain Health is an Aetna company that administers health benefits for employers who fund their own plans. Rather than buying a standard insurance policy, these employers pay claims directly and hire Meritain to handle claims processing, customer service and related administration. Many kinds of organizations use this arrangement, from private businesses to public employers.
Promises Dallas-Fort Worth is in network with Aetna, including Meritain Health. If your card carries the Meritain name, the information below can help you understand what your plan may cover and how to confirm it.
How Meritain Health Fits Our Aetna Contract
Our in-network agreement with Aetna specifically includes Meritain Health. Because Meritain is a third-party administrator, though, each employer decides which provider network its plan uses. Some Meritain plans use an Aetna network, while others rely on a different network.
Check your card for a network name or logo, usually on the front or back. That detail, along with your plan document, determines which rates apply at our Lewisville facility. If you aren’t sure how to read it, our admissions team can sort it out during verification.
What a Meritain-Administered Plan May Cover
Since your employer designs the plan, benefits vary. Subject to plan terms, medical necessity and prior authorization, coverage may include:
- Medical detox for withdrawal from alcohol, opioids such as fentanyl and heroin, benzodiazepines, stimulants and other substances
- Residential treatment for substance use disorders, mental health conditions such as depression, anxiety or PTSD, and co-occurring disorders
- Partial hospitalization (PHP) in person at our Lewisville campus
- Virtual intensive outpatient (IOP) care online for adults anywhere in Texas
Some self-funded plans use a separate company to manage behavioral health reviews. If your Meritain card lists a different phone number for mental health or substance use services, that company may handle prior authorization for treatment.
Your Plan Document Is the Rulebook
With a self-funded plan, the plan document and summary plan description govern coverage, not a standard insurance policy. These documents explain covered services, exclusions, how medical necessity is determined and the steps for appealing a decision. Many private-employer self-funded plans follow federal rules, including federal mental health parity requirements, which generally prevent a plan from limiting behavioral health care more strictly than comparable medical care. If a request is denied, the plan document tells you how to ask for reconsideration and what deadlines apply.
Steps to Verify Your Benefits
- Locate your card and write down your member ID, group number and the network listed.
- Call Meritain’s member services line, or the behavioral health line if one is listed, and ask whether Promises Dallas-Fort Worth is in network for your plan.
- Ask about your deductible, coinsurance, out-of-pocket maximum and prior authorization rules for detox, residential, PHP and IOP.
- Request your summary plan description from HR if you want to read the exact plan language, including how appeals work.
Or let us do the legwork. Our insurance verification is free and confidential, and it can spare you from sorting through plan documents during a stressful time.
Frequently Asked Questions
Is Meritain Health the same as Aetna?
Meritain is an Aetna company, and it’s named in our Aetna in-network contract. Your specific coverage, however, comes from your employer’s plan.
Why can’t Meritain tell me exactly what I’ll pay?
Final costs depend on the services you receive, how long you stay and the results of medical necessity reviews. Verification gives you a picture of your benefits, not a final bill.
Can I get help for a mental health condition without a substance use problem?
Yes. Promises DFW admits adults for primary mental health treatment. Learn more about our mental health treatment programs.
Does my family’s coverage work the same way?
Dependents on your plan generally share the same plan design, network and rules. Each person’s care is reviewed separately for medical necessity.
Contact Promises Dallas-Fort Worth
You can view every plan we’re in network with on our insurance options page, contact us online, or call (469) 546-9303 to speak with admissions any hour of the day.