Frequently asked questions (FAQ)
What is telemedicine?
Telemedicine is health care delivery, evaluation, diagnosis, consultation, or treatment, conducted through audio, video or data communications by a health care practitioner who is physically separated from their patient.
Is telehealth and telemedicine the same thing?
Yes. These terms are often interchangeable. Telehealth is the term Medicare uses for telemedicine and can include:
Live videoconferencing with providers
Telephone-only consultations with providers
Services provided by telemedicine vendors like Teladoc®
What’s the difference between telehealth/telemedicine and Teladoc®?
Telehealth/telemedicine refers to a type of care – health care that is delivered remotely, such as over the phone, through video or via other communications platforms. Aetna policies have been relaxed to allow any in-network provider to deliver telemedicine. In most cases, these providers will be reimbursed at the same rate as an in-office visit, although provider contracts vary and exceptions may apply for some providers. Many in-network providers are offering telemedicine services and will evaluate, diagnose and consult with patients remotely.
Why are CVS Health and Aetna recommending that we use telemedicine during the pandemic?
Government agencies are strongly encouraging the use of telemedicine to help contain the spread of the COVID-19 virus and to protect critical healthcare providers. We encourage members and colleagues to use telemedicine as a first line of defense for non-emergencies, to limit potential exposure.
The federal government has indicated that, during the COVID-19 national emergency, which also constitutes a nationwide public health emergency, it will not impose penalties for HIPAA noncompliance against health care providers who provide telehealth services in good faith through remote communications technologies that may not be HIPAA-compliant, such as FaceTime or Skype.
How can members access services without going to a provider’s office?
Members can use Teladoc® or their provider may be able to offer them services over the phone or through a telemedicine platform where they have a real-time visual connection. Members can check availability by accessing Aetna online DocFind directory, contacting their provider or visiting the Coronavirus Resource page on Aetna’s website.
MinuteClinic offers two telemedicine options, including E-Clinic visits and MinuteClinic Video Visits. For more details, visit MinuteClinic.com. These visits are covered by most Aetna Commercial and Medicare plans.
How can patients find telemedicine providers and seek their care?
Aetna members can:
- Contact in-network providers to find out if they offer real-time virtual care and follow their process for making a telemedicine appointment
- Search Aetna DocFind© to find providers who offer virtual care; an indicator was added that will identify providers who offer telemedicine
- Connect with Teladoc® anytime (24 hours/day, seven days/week) at 1-855-TELADOC (1-855-835-2362), through their app, or at www.Teladoc.com/aetna
- Schedule a MinuteClinic® Video Visit or E-Clinic virtual visit through the MinuteClinic® app or website. These visits are covered by most Aetna Commercial and Medicare plans (and associated member cost waiver).
- Visit the Aetna Coronavirus Resource page on Aetna’s website for more options.
Is there a way to check online to see if an Aetna provider offers telemedicine?
Yes. A telemedicine indicator was added to the DocFind tool on aetna.com, the Aetna member website and on the Aetna app, for participating providers who offer telemedicine services.
Other telemedicine options are offered on the Aetna Coronavirus Resource page.
If a client doesn’t currently offer telemedicine, can they add that benefit now?
Any member/client can seek telemedicine services from providers that offer them. Commercial clients who do not offer Teladoc®, can add the benefit now through the standard implementation process (a minimum commitment duration may apply).
How long are Aetna’s liberalized coverage of telemedicine services and cost share waivers in effect?
Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will now extend through December 31, 2020.
Aetna extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services through December 31, 2020.
Cost share waivers for any in-network covered medical or behavioral health services telemedicine visit for Aetna Student Health plans, are extended until December 31, 2020.
Medicare Advantage will continue to waive cost shares for in-network primary care and specialist telehealth visits, including outpatient behavioral and mental health counseling services through December 31, 2020.
Please refer to the Telemedicine Policy for services covered.
Although the member cost-share waiver for medical care for Commercial plans ended on June 4, will Aetna continue to cover telemedicine delivered through telephone only?
Yes. For Commercial plans, Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until December 31, 2020.
Can telemedicine be delivered through telephone or is a synchronous audiovisual connection required? Where can providers access Aetna’s telemedicine policy?
For Commercial plans, Aetna will cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone until December 31, 2020. For general medicine and some behavioral health visits, a synchronous audiovisual connection is still required.
Medicare allows telephone-only telemedicine services for a limited number of codes. For other codes announced by CMS, an audiovisual connection is also still required.
Aetna’s Telemedicine Policy is available to providers on the Availity portal.
Is Aetna requiring the use of Teladoc®?
No. In-network providers may deliver telemedicine from any location during this national emergency, subject to their state practice acts, and the guidance issued by state and federal authorities for the provision of telehealth services.
What can telemedicine providers do?
Telemedicine providers help with non-emergency health issues like respiratory infections, flu symptoms, and many other illnesses. They evaluate symptoms and provide medical advice and treatment, which may include a prescription if medically appropriate. Some also provide behavioral health and specialized support such as dermatology, physical therapy, and more.
For COVID-19, telemedicine physicians can answer questions about the virus, assess a member’s risk and provide support to help relieve symptoms.
When seeking virtual care, we encourage members to reach out to their current providers first.
Are providers (behavioral health and primary care) required to see a member face-to-face before being able to provide telemedicine services?
No. A prior face-to-face visit is not required for a provider to provide telemedicine services.
Can members gain immediate access to health care providers through telemedicine?
In most cases, yes.
Can telemedicine providers diagnose COVID-19 or order a COVID-19 diagnostic testing service?
No. Telemedicine providers are unable to conduct COVID-19 diagnostic testing or order diagnostic testing and, therefore, cannot confirm a COVID-19 diagnosis. Telemedicine providers can assess patient risk and provide the appropriate direction and next steps to access testing, as appropriate.
Can telemedicine providers send COVID-19 test kits to patients?
No. The FDA has, however, approved test kits that can be used by individuals at home who have been screened using an online questionnaire reviewed by a health care provider. Contact your health care provider to determine if this test is right for you.
Should I use telemedicine if I experience COVID-19 symptoms?
Individuals who are showing signs of upper or lower respiratory infection or fever should stay home and contact their primary care provider either by phone or through a virtual visit.
If you suspect you may have contracted COVID-19, call your primary care provider first or consult the guidance provided by your state’s Department of Health for how best to receive an assessment of your symptoms.
Can a telemedicine provider treat COVID-19?
No. While no vaccine or specific treatment for COVID-19 is available at this time, telemedicine providers may be able to provide evidence-based supportive care to help relieve symptoms or to recommend next steps.
Is the no-cost telemedicine benefit limited to COVID-19 related care?
No, members with a telemedicine benefit can take advantage of this no-cost telemedicine benefit for any reason, include general medical, behavioral health and dermatology visits.
Does the no-cost telemedicine benefit apply to behavioral health as well?
Yes, the no-cost benefit applies to telemedicine visits for behavioral health.
Does the no-cost telemedicine benefit apply to non-participating providers?
No, this no-cost benefit only applies to real-time virtual care delivered by an in-network provider. Non-participating provider coverage is based on the member’s benefit/plan design for out-of-network benefits.
Can Aetna self-funded plans continue to opt out of our offer of zero co-pay telemedicine visits?
Yes. Aetna self-insured plan sponsors offer this waiver at their discretion.
What happens if an employee uses telemedicine multiple times in a day/week? Are ASO clients still obligated to pay for all these costs?
No. Aetna’s medical policy (one claim/member/service/day/provider) would still apply and limit the use of telemedicine to the policy.
Can providers use video chat platforms such as Skype® and FaceTime® to complete telemedicine visits?
Yes. Providers can temporarily use non-public facing synchronous video chat platforms, such as Skype® and FaceTime®, to complete telemedicine visits as long as these platforms are allowed in their states and they are able to meet the standard of care via a telehealth encounter. Health care providers should not, however, use public-facing video applications, such as Facebook Live®, Twitch® or TikTok®. For more information, refer to the temporary Federal guidelines concerning use of these platforms during the COVID-19 pandemic.
How is Aetna’s 90-day waiver for member out-of-pocket fees for all telemedicine services compliant with a High Deductible Health Plan?
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law on March 27, 2020, indicates that a plan shall not fail to be treated as a high-deductible health plan for failing to have a deductible for telehealth and other remote care services.
Can you describe the process during a MinuteClinic Video Visit if COVID-19 is suspected?
If a patient requests a MinuteClinic Video Visit and is concerned about COVID-19, or if a Video Visit patient presents with symptoms of a lower-respiratory tract illness (e.g., fever, cough and/or shortness of breath), we follow CDC-recommended screening protocol to ask about their recent travel history (e.g., timeframe and location), potential community exposure, and other relevant risk factors to determine their risk of exposure to COVID-19.
If it is determined the patient may be at risk for COVID-19, the Video Visit provider will connect with the local health department to determine the appropriate next steps and will connect the patient with the health department if testing for the virus is recommended.
Teladoc® telemedicine services
How can a member confirm they are eligible to use Teladoc?
Members should call Aetna Member Services on the back of their Member ID card to learn if the Teladoc benefit is included in their benefits.
Can a member who has Teladoc benefits register another adult dependent (such as a spouse or child) for Teladoc?
No. Due to HIPAA restrictions, adult members can only register dependents who are minors (below the age of 18). Adult dependents must register themselves for Teladoc.
Does Teladoc have a protocol in place whereby they are able/willing to provide a ‘fitness of duty’ release to employees who have been quarantined (specifically people who are a-symptomatic but precautionary quarantined)?
Can Teladoc diagnose COVID-19?
Teladoc is unable to conduct COVID-19 diagnostic testing services and, therefore, cannot confirm diagnoses. However, Teladoc care providers can provide the appropriate direction and next steps to access testing, if required.
Can Teladoc issue return-to-work notes for patients with non‐COVID related symptoms?
No. Given high demand for medical care during this outbreak, Teladoc is not able to re‐evaluate healthy patients and issue return‐to‐work notes at this time.
Can Teladoc doctors send COVID‐19 test kits to members or order them on their behalf?
No. If patients would like to pursue in‐person COVID‐19 diagnostic testing, they should call their doctor or their state’s public health hotline to verify test availability.
How will Teladoc handle individuals who have already received a positive COVID-19 diagnosis?
While no specific treatment for COVID-19 infection is indicated at this time; Teladoc care providers will provide up-to-date, evidence-based supportive care to relieve symptoms for affected patients, addressing both physical and mental health needs. For cases where in-person care is needed, Teladoc will navigate patients to appropriate resources (in-network, where possible) and encourage patients to “let them know before you go” so that the in-person care facility can direct them appropriately and minimize potential exposure for others.
Does Teladoc offer behavioral health services?
Teladoc offers support for behavioral/mental health services to Aetna Commercial plans. Through September 30, 2020, Aetna is waiving member cost-sharing for telemedicine visits for outpatient behavioral/mental health counseling services. Self-insured customers offer this waiver at their discretion. Under this waiver, Commercial members can access behavioral/mental health services through Teladoc at no cost, as long as their plan covers Teladoc benefits.
If a fully insured group opts out of Teladoc at point of sales/implementation, does this group still have access to Teladoc due to COVID-19?
If a group opted out of the Teladoc solution during implementation, it would not have Teladoc access today. However, eligible providers can perform telemedicine services, bill telemedicine codes and will have cost share waivers.
Does Teladoc have any temperature-testing capabilities through their app that we can help promote in light of COVID-19 symptoms?
Can Teladoc issue a 14-day self-quarantine excuse note for suspected COVID-19 patients?
Yes. Consistent with CDC recommendations, if the doctor observes symptoms and risk factors that suggest COVID-19, they can add a notation to the ‘excuse note’ advising the patient to self-quarantine for 14 days.
Can we provide our self-insured plan sponsors with weekly Teladoc reporting so they may know the volumes?
Due to elevated call volumes, Teladoc is not able to provide our plan sponsors with weekly utilization reports. However, the utilization report that is provided by Teladoc to all self-insured plan sponsors on a monthly basis will continue to be produced.
Is Aetna or Teladoc reporting diagnosed cases of COVID-19 to public health authorities?
Neither Aetna nor Teladoc diagnose COVID-19, and, therefore, is unable to make a report. It is the responsibility of the diagnosing physician to report cases to public health authorities, not Aetna or Teladoc.
Does Aetna have any plans to make specific member flyers on free Teladoc?
Aetna will not be creating or distributing any communications (flyers, emails or otherwise) that are Teladoc-specific for COVID-19. However, should a plan sponsor request material related to Teladoc, they are available to them through the normal channel, the Teladoc Engagement Center, for use at their own discretion. Aetna will not distribute them proactively.
Telemedicine overflow strategy
Ensuring our members have access to care is our number one priority. We continue to encourage our members to use telemedicine as their first line of defense, as appropriate, in order to limit potential exposure in physician offices.
In wake of the coronavirus pandemic, there is unprecedented demand for telemedicine. To help our members receive the telemedicine care they need, we have developed a telemedicine overflow strategy that provides a solution if a member is unable to obtain care from either their primary care provider or their plan’s telemedicine provider. This overflow strategy includes multiple provider groups across many of the states we serve.
Aetna members are encouraged to seek telemedicine as follows during the pandemic:
FIRST contact their primary care provider (if that provider offers telemedicine visits)
NEXT use Teladoc® or MinuteClinic Video Visit services (if their plan offers it)
THEN find virtual care providers in their state using our telemedicine overflow directory
With the telemedicine overflow directory as their third option, we do not anticipate high call volume at the start of the program.
What volume should providers participating in the telemedicine overflow program expect?
As a third-tier option for many of our members, we do not anticipate a significant call volume. However, we are in an ever-changing environment, and based on the evolving hot spots, call volume may increase.
When does the program start? When will it end?
The program will begin on April 16, 2020, for Commercial plan members. We expect the program to be available to Medicare Advantage members on April 20, 2020. Aetna is currently offering telemedicine services at $0 copay for any in-network covered telemedicine visit for commercial members until June 4, 2020. For Medicare members, the $0 copay for any in-network telemedicine visit is in place until further notice. We will continue to keep all parties updated with new information as we have it. Providers participating in our telemedicine overflow program will be considered in-network.
Where do members go for the Telemedicine overflow program?
Members should visit the “Telemedicine is a smart, safe choice” page on Aetna.com for more information.
What types of services will providers participating in the overflow telemedicine program offer to patients?
Telemedicine providers in the overflow program can provide many of the same services as our primary telemedicine providers, including help with non-emergency minor acute health issues, like respiratory infections, flu symptoms, and many other illnesses. They can evaluate symptoms and provide medical advice and treatment, which may include a prescription if medically appropriate. For COVID-19, they can answer questions about the virus, assess a member’s risk and provide support to help relieve symptoms.
These providers will not offer routine care, behavioral health services or tele-dentistry. Members may seek these types of services from their primary providers.
What code would be used if a physician performs a telehealth visit?
All telemedicine coverage and codes for COVID-19 and acute care are stated in the Aetna telemedicine policy which is available to providers on the Availity portal.
What place-of-service code should telemedicine providers use?
To process claims related to telemedicine visits, providers should use place-of-service code 02 for patients enrolled in Commercial plans. For patients enrolled in Medicare plans, providers can use place-of-service code 02 or code 11.
How will payments be processed for telemedicine overflow providers?
Aetna typically reimburses all in-network providers for telemedicine visits at 100% of their negotiated rate. Provider contracts vary and exceptions may apply for some providers.
Is Aetna requiring providers who are credentialed in one state but offering to support patients in another state to become credentialed in those states?
No. To the extent the providers are permitted to practice in other states under applicable law, we are waiving out-of-state credentialing and contracting policies to offer access to care for patients across state lines. Providers cannot write prescriptions for patients out-of-state due to federal law.
How can providers refer patients to other provider types, or a provider in another state, if the patient is not in my state and needs additional care?
Providers and members can find in-network providers in all states through our online provider directory. Members can also visit their member website which will help them find in-network providers accepting their plan.
Will telemedicine overflow providers have access to patient medical records?
No. Telemedicine overflow providers will not have access to patient medical records.