New Limits On Insurance Coverage

About 80 types of virtual care services are losing insurance coverage in December under a new Aetna policy. Coverage ends for some behavioral care services, ophthalmological care, services related to end-stage renal disease and more, according to a notice the insurer sent to healthcare workers. Aetna will also end audio-only coverage of nearly 60 services, including psychotherapy, counseling for alcohol use disorder, and obesity counseling. One of the services no longer covered will be intensive outpatient programs provided virtually. “We are not ending telemedicine coverage for all behavioral health therapy,” confirmed Alex Kepnes, Aetna’s executive director of communications for health care benefits. “We will continue to cover outpatient behavioral health therapy via telemedicine as outlined in our policy and based on the billing code.”  This will include services using real-time audio “visual” services when medically necessary for alcohol and/or drug treatment reasons, as well as intensive outpatient programs and intensive outpatient psychiatric services paid per diem.”  Kepnes said telemedicine services that remain covered for Aetna’s commercial plan employer sponsors are actually more extensive than what was provided pre-pandemic because of the access and value these services clearly bring to their members and providers. About 40 million people have health related insurance through Aetna.