AETNA - Updates on Telemedicine, Post Acute and Hospital Admissions

March 30, 2020

Some important AETNA  news updates

 

1. Yesterday evening Aetna announced  temporary changes to reduce requirements for prior authorizations for post-acute care and long-term acute care hospital admissions  (please see details attached).

 

2.    A couple days ago Aetna announced will also (in addition to telemedicine) be waiving member cost-sharing for inpatient admissions at all in-network facilities for treatment of COVID-19 or health complications associated with COVID-19. This policy applies to all Aetna-insured commercial plan sponsors and is effective immediately for any such admission through June 1, 2020.

 

3. We also made some additional changes to our Telemedicine policy yesterday afternoon to expand short term coverage of clinical and behavioral health services so to provide for member and provider accommodations.  In addition, the Telemedicine policy was updated to reflect short term coverage associated with Commercial and Medicare Advantage:

 

Updated March 26, 2020 (full updated policy also attached for your records)

 

Commercial:

For the next 90 days, until June 4, 2020, Aetna will waive member cost sharing for any covered telemedicine visit - regardless of diagnosis. Aetna members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc virtual visits. Cost sharing will also be waived for covered real-time virtual visits* offered by in-network providers (live video-conferencing and telephone-only telemedicine services) for all Commercial plan designs. Members may use telemedicine services for any reason, not just COVID-19 diagnosis. Self-insured plan sponsors will be able to opt-out of this program at their discretion.

 

Medicare:

Until further notice, Aetna will offer zero co-pay for covered telemedicine visits for any diagnosis to all Individual and Group Medicare Advantage members. Aetna Medicare Advantage members should use telemedicine as their first line of defense to limit potential exposure in physician offices. Cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for covered real-time virtual visits offered by in-network providers (live video conferencing or telephone-only telemedicine services). Medicare Advantage members may use telemedicine for any reason, not just COVID-19 diagnosis.

 

*In addition to the covered Two-way, Synchronous (i.e. real-time) Audiovisual Interactive Medical Services – Modifier GT/95, the codes below will allow and waive cost share during the 90-day period.

 

The following codes were added per the update:

These are attached below

 

The policy will continue to be revised as necessary to align with provider capabilities and CMS revisions.

Policy detail is also available via NaviNet and Availity.    The link below may also be useful.

 

https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html