Aetna Waiving Copays For Telehealth

Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans are extended until September 30, 2020. Medicare Advantage will continue to waive cost shares for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health.
Cost share waivers for any in-network covered medical and behavioral health services telemedicine visit for Aetna Student Health plans are active until January 31, 2021. For Individual Aetna Medicare Advantage members, copays are waived for in-network telehealth visits for primary care through the end of the Public Health Emergency.

Cost-share waivers for all telehealth visits (primary, speciality and behavioral services) with in-network providers, regardless of COVID-19 diagnosis: Dec. 31 UnitedHealthcare.

Aetna announcement effective March 6 on zero co-pay telemedicine visits for any reason for 90 days, please see below excerpt. Also attached is Aetna’s updated telemedicine policy that was new 1/1/1/20 that had coverage details and CPTs and has been updated to reflect this March 6th update. 2nd attachment is the Aetna Covid Press release. This announcement also is posted and available to providers on NaviNet and Availity with links to policy and press release as well.

Beginning March 6, 2020, Aetna will offer zero co-pay telemedicine visits for any reason for 90 days. We will waive the cost share for all video visits through the Aetna-covered Teladoc offerings and in-network providers delivering synchronous virtual care (live video-conferencing) for all Commercial plan designs*. Self-insured plan sponsors can opt-out of this program at their discretion.

*We will also cover G2010, G2012, 99441, 99442, and 99443 during the 90-day period.

For more information, see our press release below or at these links:

Additionally , more from Aetna:

March 17, 2020

Dear Valued Partner:

We share the same goal: to help people get and stay healthy. We are your partners in health care, and act to serve you and the millions of patients who rely on us for their health care needs.

In response to the rapidly evolving COVID-19 outbreak, CVS Health and Aetna are here to support you with timely answers and information. Through CVS Health and Aetna's combined resources and your partnership, we can best support your Aetna patients' health and well-being, ensure their access to medication and remove barriers to care.

We're here to help you, help your patients and recently announced these resources and enhancements when applicable:

If you request testing related to COVID-19, we'll waive your Aetna patient's cost sharing.

Aetna Commercial patients pay $0 for covered telemedicine visits until June 4, 2020.

Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes. With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video.

Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay.

Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna's Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient's ID card to register a recently diagnosed patient.

Patients won't have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.

Aetna is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all Aetna members as a fully-covered benefit.

We're waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.

Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we're waiving early refill limits for a 30-day supply.

Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

Please refer to the What You Need to Know About the Coronavirus (COVID-19) - Aetna Providers FAQs on Aetna.com for additional important information. There, you'll find information about codes related to COVID-19 and selected labs approved to do COVID-19 testing. This page will continually be updated with information as it becomes available to help you care for your patients.

Let's work together to provide your patients with a clear path to care. Thank you for your continued partnership.

Please see the updated attachments for additional and up to date information from Aetna.

Unless ordered otherwise, most commercial payers will return to business as usual Jan. 1, or sooner.

The COVID-19 public health emergency (PHE) continues, but will expanded telehealth coverage and cost sharing waivers? Some health insurers will stop paying for expanded telehealth services as soon as Oct. 1. Patient cost-sharing may resume soon, as well.

In the 2021 Physician Fee Schedule Proposed Rule the Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand certain telehealth flexibilities permanently. But other payers may adopt different policies with varying timelines. Take a look at where the top 10 health insurance companies stand on the matter right now.

Health Insurance Companies’ Stance on COVID-19 PHE Exceptions

UnitedHealthcare (UHC)

Under Medicare Advantage, individual, and fully insured group market plans, UHC extended the cost share waiver for telehealth services for in- and out-of-network providers through Oct. 22 for COVID-19 related services. For non-COVID-19 related services, UHC is ending cost sharing wavier Sept. 30. Beginning Oct. 1, benefits will be adjudicated in accordance with the member’s benefit plan.

For in-network providers, UHC extended the expansion of telehealth access (including virtual check-ins and electronic visits) for all services, per the CMS interim final rule, through Dec. 31. But out-of-network providers have until the end of the PHE, currently Oct. 22. This applies to Medicare Advantage and individual and fully insured group market health plans. The expansion of telehealth access ended July 24 for out-of-network providers.

Refer to UHC’s telehealth guide for full details.

Kaiser Foundation

Kaiser Permanente is upholding the cost sharing waivers for member out-of-pocket costs related to COVID-19 to all of its fully insured benefit plans in all markets through Dec. 31.

Anthem

From March 17 through Dec. 31, Anthem will waive member cost shares for telehealth visits from in-network providers, including visits for mental health and substance use disorders, for their affiliated health plans and Medicare Advantage and Medicaid plans, where permissible.

For out-of-network providers, cost sharing ended June 14.

Humana

Humana is waiving patient cost sharing for primary care office and telehealth visits, and also outpatient, non-facility based behavioral health visits, to Medicare Advantage members for the rest of 2020.

CVS Health (Aetna)

Aetna has extended through Dec. 31 all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their Medicare Advantage, commercial, and student health plans. Self-insured plans offer this waiver at their own discretion. Medicare Advantage patients may use telemedicine for any reason, not just COVID-19-related services. This coverage policy does not apply to out-of-network providers.

Health Care Service Corporation

Out-of-pockets costs are waived for outpatient care and for emergency care at an emergency facility from April 1 through Oct. 23.

Centene

Centene is waiving all cost sharing for in-network primary care, behavioral health, and telehealth visits for the remainder of the calendar year for Medicare Advantage members.

Cigna Health

Cigna is offering coverage through year-end, but cost shares ends Oct. 31 unless COVID-19 related. Effective Aug. 1, cost shares will be waived only when providers bill U07.1 COVID-19 Confirmed Cases, virus identified.

The payer has extended its interim virtual care and eConsult guidelines through “at least December 31, 2020.”

Wellcare (Centene)

“Any services that can be delivered virtually will be eligible for telehealth coverage,” the company says on its website, with zero cost sharing to patients. All prior authorization requirements for telehealth services are lifted for dates of service from March 17 through Oct. 25.

Molina Healthcare Inc.

Molina says it will pay providers “for a variety of modalities in lieu of in-person visits to support evaluation, assessment, and treatment of members.” These modalities include telemedicine for HIPAA compliant, interactive, real-time audio and video telecommunications, which are already covered, and other forms of telehealth such as online digital exchange through a patient portal, telephone call, FaceTime, Skype or email. Molina is also waiving out-of-pocket costs associated with COVID-19 testing and treatment for its Medicare, Medicaid, and Marketplace members through Dec. 31.

Aetna Copays Waived

Check Payer Policies

As you can see, insurers’ policies are all over the place. The only way you are going to code and bill correctly is to frequently check each company’s coverage policies for every plan they offer.

Key Considerations: