Aetna clarifies updated telehealth policy does not apply to fully insured enrollees

December 11, 2023

Aetna recently announced it was excluding fully insured commercial plans in all 50 states from its new telehealth policy that took effect December 1, 2023, eliminating coverage for audio-only and asynchronous telehealth services. The new coverage exclusions will only apply to self-insured/ERISA plans.

Previously, the California Medical Association (CMA) had flagged for Aetna that its updated telehealth policy appeared to be inconsistent with California law, which requires fully insured plans/insurers to cover health care services appropriately delivered through telehealth on the same basis and to the same extent that the plan/insurer is responsible for coverage for the same service through in-person diagnosis, consultation or treatment. California’s law does not include a limitation or exception for audio only or asynchronous coverage.

Aetna did confirm to CMA via email that the policy wouldn’t apply to fully-insured plans in California and added language indicating state laws would supersede the policy. However, CMA was concerned the language was still unclear and urged Aetna to provide additional guidance about when the policy would apply.

Subsequently, in Aetna’s December OfficeLink Update, the payor clarified that fully insured commercial plans in all 50 states are exempt from the new policy as they are governed by state mandates. (Note that Aetna’s Medicare Advantage patients may be eligible for telemedicine services in accordance with Center for Medicare and Medicaid Services regulations.)

Under the new policy, audio-only and asynchronous telehealth services provided to Aetna self-insured/ERISA enrollees are considered non-covered services that are the responsibility of the patient, effective December 1, 2023.

For more details on the new policy, click here. Providers with questions can contact Aetna at (888) 632-3862.

For more on the current state of telehealth in California, see CMA’s Telehealth Policy Update, which is available free to CMA members.


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