Does Aetna Cover Telemedicine or Online Treatment?

Aetna is a large insurance provider that is telemedicine friendly. (Learn More) The company provides discounted costs for some services. (Learn More)

Aetna lists a wide variety of insurance plans and services that you may seek through telemedicine formats. (Learn More) Services will be subject to state regulations regarding telemedicine. (Learn More)

Aetna has made it a point to provide extensive telemedicine services to its customers as well as to people with other insurance coverage. (Learn More)

Aetna, Inc

Aetna, Inc. offers coverage to millions of Americans. It is one of the older private insurance companies in the United States, being founded in the 1800s.

The company recently withdrew its services from the health care marketplace established under President Obama, but it is subject to the specifications regarding insurance coverage that are defined under the Affordable Care Act.

Aetna and Telemedicine 

Like many private insurance providers, Aetna has attempted to make itself telemedicine friendly. It describes telemedicine as the virtual delivery of services that are provided via a computer, smartphone, or tablet.

Services must involve real-time audiovisual interactions in order to be covered. They cannot consist of emails, faxes, or audio telephone conversations only. 

Aetna offers its own telemedicine service, Teledoc, that offers a vast array of video consultation sessions that can include the following:

  • Behavioral health services
  • Dermatology services
  • Nonemergency medical services
  • Educational, preventive, and other consultations

The provision of dermatology services uses a store-and-foreword approach, where the data is collected at one site and forwarded to another site for evaluation. Very often, other regulations on telemedicine do not allow for telemedicine coverage to use a store-and-forward approach.

According to its website, the nonemergency medical services Aetna offers include treatment of the following:

  • Allergies
  • Respiratory infections or bronchitis
  • Common illnesses, such as influenza or the common cold
  • Skin problems (dermatology)
  • Other sinus issues

Dental services are not covered through the telemedicine program.

Other telemedicine consults may be covered depending on your specific policy and the regulations for telemedicine in the state where the service is provided (see below).

Good News if You Belong to an Aetna Program

Aetna members get special rates for many of the Teledoc services, and Teledoc services may be covered by other insurance providers.

Your particular policy with Aetna or your other insurance provider will determine the exact amount you pay, but Aetna states that its members will not pay more than $40 for many consults for common physical problems. Behavioral health services and dermatology services will typically cost more.

phone and health

Different Coverage Levels Offered by Aetna

Aetna offers a wide variety of insurance plans that can be viewed on their website. These plans will dictate the types of coverage, deductibles, copays, and other specifics you may be subject to if you engage in telemedicine services.

The insurance coverage of many issues, including those addressed by telemedicine services, is often determined by the notion of medical necessity. This means that the intervention or treatment is deemed appropriate for you given the circumstances, and the treatment has research-based evidence to support its use for a specific situation.

Variability in Telemedicine Regulations From State to State

Certain state regulations regarding telemedicine services can affect what is covered, what types of specialists you can see, and related issues.

There are no standardized regulations that apply across all 50 states regarding the use of telemedicine services. This means that there may be some issues associated with the delivery of services in your specific case. 

  • There may be limits on the specific type of provider you can see. For instance, some states limit telemedicine services to only licensed physicians.
  • Licensing is always an issue with telemedicine. At the current time, most states require the treatment provider to have a license in the state where the patient lives in order to provide services.
  • In some states, there is no requirement that telemedicine services must be equal to the coverage that the insurance company provides for in-person services. This may affect your coverage in some instances. 
  • There are some limitations on the types of services that can be delivered by telemedicine in some states.
  • Although Aetna advertises that you can get prescriptions through its Teledoc program, in the majority of states, all controlled substances cannot be prescribed based on a telemedicine visit alone. An in-person visit is required for these.
  • Many services are only covered with an in-person consultation. Check if you need to have an actual in-person consult for your specific situation.

States may impose other regulations that may affect the coverage and services you can receive via a telemedicine consult.

You can find out more about any regulations on telemedicine in your state that apply to services Aetna covers by visiting your state website or the Federation of State Medical Boards.

The Bottom Line

The good news is that Aetna offers its own telemedicine program and covers many standard services and nonemergency services delivered via telemedicine.

Not all services are covered, and state regulations can further limit the actual types of services you can have covered or even receive through the use of a telemedicine format.

If you have any questions, contact your insurance representative.

References 

You Don’t Join Us, We Join You. (2019). Aetna, Inc. 

About the Affordable Care Act. U.S. Department of Health & Human Services. 

Aetna Offers Members Expanded Services Through Teladoc. (September 2017). Aetna, Inc. 

Remote Healthcare Can Treat Many Common Health Issues. (2019). Teledoc. 

Easy-to-Access Care Just Got Easier. (2019). Aetna, Inc. 

Telemedicine Policies. Federation of State Medical Boards. 

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