- Aetna Copay Plans
- Does Aetna Have A Copay
- Aetna Copay For Specialist
- Aetna Prescription Copays
- Aetna No Copay Telemedicine
Members, Aetna is here to keep you informed during the coronavirus (COVID-19) pandemic. Visit our COVID-19 FAQ page for answers to the most frequently asked questions regarding the coronavirus and to get the latest information. Second opinion: $0 copay No limit. Telehealth: $0 copay No limit. Renal dialysis and hemodialysis services (outpatient): $0 copay No limit. Notes: All benefits provided must be medically necessary. Copays apply to all members, unless they are exempt. Copays are limited to no more than 5% of your family’s total income every three months.
Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.
Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.
Aetna Copay Plans
The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.
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Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.
“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.
But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.
Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.
Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.
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“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”
One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.
Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.
“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.
For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”
David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.
“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.
With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.
Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.
“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.
Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.
“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.
By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”
Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.
Does Aetna Have A Copay
At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.
Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.
Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.
With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.
“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”
Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.
“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”
A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.
Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.
Aetna Copay For Specialist
The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.
“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.
2021 Biweekly rates for zip code
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
| Open Access® HMO - Standard | Code | Non-Postal | Postal 1 | Postal 2 |
|---|
2021 Biweekly rates for zip code
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
| Open Access® HMO - High | Code | Non-Postal | Postal 1 | Postal 2 |
|---|
Your 2021 benefits - KS/MO
| Plan Details | Standard Option | High Option |
|---|---|---|
| Preventive care copay | $0 | $0 |
| Deductible | $2,000 Self $6,000 Self plus one or Self and family | $1,000 Self $3,000 Self plus one or Self and family |
| Primary care visit copay | $30, no deductible | $30, no deductible |
| Specialist visit copay | $60, no deductible | $60, no deductible |
| Maternity | ||
| Prenatal Care | $0 after first visit, no deductible | $0 after first visit, no deductible |
| Hospital Care | 30% | 25% |
| Inpatient hospital charges | 30% | 25% |
| Outpatient surgery copay | 30% | 25% |
| Emergency room copay | 30%, deductible applies | $300, no deductible |
| Urgent care center copay | $75, no deductible | $75, no deductible |
| Lab/X-ray/diagnostic services | 30% of our plan allowance | 25% of our plan allowance |
| Prescription drugs (for a 30-day supply at a retail pharmacy) | No deductible applies | No deductible applies |
| Generic formulary* | $12 | $12 |
| Brand-name formulary* | $50 | $50 |
| Non-formulary* | 20% up to $100 max | $75 |
For specialty drug information, see the federal plan brochure.* | ||
| Built-in Vision | ||
| Routine eye exam copay | $0 | $0 |
| Money toward prescription eyewear | You get $100 every 24 months | You get $100 every 24 months |
| Discounts on eyeglasses, contacts, eye exams and more | Included | Included |
| Built-in dental, too You pay $0 copay, for cleanings and X-Rays, when you use our dental preferred provider organization (PPO) network.*** | ||
*A formulary is a list of generic and brand-name drugs your health plan prefers. | ||
- Large nationwide Aetna HMO Network
- 24/7 access to doctors via phone or video with Teladoc®†
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists*
- Discounts on eyewear, LASIK surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
*** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
†Teladoc® is covered at the member cost share.
] Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
Aetna Prescription Copays
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Discount programs are neither offered nor guaranteed under our contract with the FEHB Program, but are made available to all enrollees and their families who become members under an Aetna Health Insurance Plan. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. Information is believed to be accurate as of the production date; however, it is subject to change.
Postal and Non-Postal rates
Aetna No Copay Telemedicine
- Non-Postal rates apply to most non-Postal employees.
- Postal rates apply to United States Postal Service employees.
- Postal Category 1 rates apply to career bargaining unit employees represented by the APWU, IT/AS, NALC and NPMHU.
- Postal Category 2 rates apply to career bargaining unit employees represented by the PPOA.
- Non-Postal rates apply to all career non-bargaining unit Postal Service employees and career employees represented by the NRLCA agreement.