Aetna Waiving Copays

Posted : admin On 1/29/2022

The Surgery Center is not a contracted network provider with Aetna. By waiving the copay and deductible obligations, Aetna members can obtain services at the Surgery Center for approximately the same rate as they would pay at an in-network surgery center. For COVID-19 for treatment required prior to March 25, 2020, will cost sharing be waived for Aetna members? If Aetna waives a member cost-sharing obligation related to COVID-19 testing and/or treatment, will that reduce the amount the provider is paid?

Aetna announcement effective March 6 on zero co-pay telemedicine visits for any reason for 90 days, please see below excerpt. Also attached is Aetna’s updated telemedicine policy that was new 1/1/1/20 that had coverage details and CPTs and has been updated to reflect this March 6th update. 2nd attachment is the Aetna Covid Press release. This announcement also is posted and available to providers on NaviNet and Availity with links to policy and press release as well.

Beginning March 6, 2020, Aetna will offer zero co-pay telemedicine visits for any reason for 90 days. We will waive the cost share for all video visits through the Aetna-covered Teladoc offerings and in-network providers delivering synchronous virtual care (live video-conferencing) for all Commercial plan designs*. Self-insured plan sponsors can opt-out of this program at their discretion.

Can You Waive Copays

*We will also cover G2010, G2012, 99441, 99442, and 99443 during the 90-day period.

For more information, see our press release below or at these links:

Additionally , more from Aetna:

March 17, 2020

Dear Valued Partner:

We share the same goal: to help people get and stay healthy. We are your partners in health care, and act to serve you and the millions of patients who rely on us for their health care needs.

Copays

In response to the rapidly evolving COVID-19 outbreak, CVS Health and Aetna are here to support you with timely answers and information. Through CVS Health and Aetna's combined resources and your partnership, we can best support your Aetna patients' health and well-being, ensure their access to medication and remove barriers to care.

We're here to help you, help your patients and recently announced these resources and enhancements when applicable:

If you request testing related to COVID-19, we'll waive your Aetna patient's cost sharing.

Aetna Commercial patients pay $0 for covered telemedicine visits until June 4, 2020.

Until further notice, Aetna is also expanding coverage of telemedicine visits to its Aetna Medicare members, so they can receive the care they need from you without leaving their homes. With this change and new flexibilities announced by the Centers for Medicare and Medicaid Services to help combat the virus, Aetna Medicare members can now see their providers virtually via telephone or video.

Aetna is offering its Medicare Advantage brief virtual check-in and remote evaluation benefits to all Aetna Commercial members and waiving the co-pay.

Care packages will be sent to Aetna patients diagnosed with COVID-19. Through Aetna's Healing Better program, Aetna Commercial and Medicare Advantage members will receive CVS items to help relieve symptoms as well as personal and household cleaning supplies to help keep others in the home protected from potential exposure. Call the number on your Aetna patient's ID card to register a recently diagnosed patient.

Patients won't have to pay a fee for home delivery of prescription medications from CVS Pharmacy®.

Aetna is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all Aetna members as a fully-covered benefit.

We're waiving early refill limits on 30-day prescription maintenance medications for all Commercial members with pharmacy benefits administered through CVS Caremark.

Aetna Medicare members may request early refills on 90-day prescription maintenance medications at retail or mail pharmacies if needed. For drugs on a specialty tier, we're waiving early refill limits for a 30-day supply.

Is Aetna Waiving Copays For Mental Health

Through existing care management programs, Aetna will proactively reach out to your patients who are most at-risk for COVID-19.

Please refer to the What You Need to Know About the Coronavirus (COVID-19) - Aetna Providers FAQs on Aetna.com for additional important information. There, you'll find information about codes related to COVID-19 and selected labs approved to do COVID-19 testing. This page will continually be updated with information as it becomes available to help you care for your patients.

Let's work together to provide your patients with a clear path to care. Thank you for your continued partnership.

Please see the updated attachments for additional and up to date information from Aetna.

Aetna
Several private Medicare plan providers, including Cigna, Humana and Aetna, are waiving certain cost-sharing requirements for beneficiaries receiving treatment for COVID-19.

Published April 2, 2020

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.

Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.

Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.

COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.

These services can typically come with costs such as copays and deductibles.

With waived coinsurance and deductibles for COVID-19 treatment, savings can add up

Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.

Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).

While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.

Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:

  • Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
    There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days.
  • Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
    After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.

For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.

“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna1

“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.

Cigna’s cost-sharing waiver expires May 31, 2020.

“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”2

Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.

Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.

Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.

“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”3

Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.