Aetna Tightening Virtual Appointment Coverage Benefits
About a month ago Aetna, sent out an email to its various subscribers and a copy of it ended up in my Inbox. The gist of it was that they would no longer be providing policy coverage for virtual, or telehealth appointments. Let that soak in! It wasn't clear if this new policy applied to mental health virtual calls or just those delivered by primary care physicians, so I called them.
Took a few minutes but I finally got someone on the line who felt comfortable answering my questions and I was clearly informed that the new policy DID NOT apply to 95 and GT modifiers. It did not appear to apply to virtual appointments provided by mental health counselors.
Aetna Tightening Virtual Appointment Coverage Benefits
Last week I was verifying coverage for one of my Aetna clients and was informed that my client's particular Aetna policy did not cover virtual calls. So either my call alerted someone to a hole in their policy or their policy simply changed. Either way, Aetna is now not covering virtual mental health calls on some of its policies.
Now What?
1. It's always a best practice to verify benefits but for sure it's a darn good idea to do with with Aetna using the proper modifying coding that you're using, especially if its a virtual appointment. I think it's obvious why that is.
2. If you're not already doing so it might be a good idea to start verifying benefits through all of your providers. Aetna is one of the big dogs and what one of them does the others tend to quickly follow suit.
3. Alert your staff to this possibility with Aetna policyholders.
4. Place something in a prominent place on your website (in close proximity to your appt scheduling mechanism) so that your Aetna clients get a heads up regarding the possible lack of coverage for virtual appointments.
Summary
Get in the habit of verifying benefits being especially specific right now when it comes to virtual calls. Train your staff and update your website to reflect this payment possibility, and get back in your brick and mortar office seeing people face-to-face!
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About the Author
Kathleen Mills is a fire-breathing, 32+ year veteran of the counseling world. People react in one of two ways when evil touches their lives: some retreat in fear, and some advance without pause to engage it. Kathleen falls firmly in the latter group. She owns and operates Life Tree Counseling in Frisco, TX, possesses a tireless work-ethic, and eagerly awaits your arrival into her growing army of warriors.
