Aetna – Forced to pay a non-justified co-pay for virtual mental heath visits
I have an HMO with Aetna through my workplace. Throughout 2022 and 2023, mental healthcare visits through Teladoc were free of charge, $0 co-pay. Starting in 2024, Teladoc began charging me $60 after a visit. There is no justification for this, yet Aetna continues to say this is a correct co-pay without providing proof.
Now the key thing to understand here is that NOTHING IN MY PLAN DOCUMENTS CHANGED TO REFLECT THIS. My plan documents still explicitly state two things: 1) that there is no co-pay for in-network outpatient mental/behavioral health services, and 2) that outpatient mental/behavioral health treatment includes telemedicine providers; Teladoc is…a telemedicine provider, and is definitely in-network as I've accessed it through Aetna itself.
When I've called Aetna in attempts to resolve this:
First, I typically need to explain that no, this is not a "specialist" visit co-pay, mental health is its own separate category When I speak to the appropriate department I am told some version of "yes, that's correct there is no-pay, but there is a co-pay when it's through Teladoc". Now based on the terms of my plan documents I outlined above, this doesn't make sense. Moreover, Aetna has never been able to provide me with the documentation to support this. I've asked them to "please show me the place where I can see that there is a co-pay because I'm using Teladoc". They can never do it. They've tried kicking the ball over to my employer, saying it's somehow due to a change on their end…but that doesn't really make sense either; yes I have reached out to the health benefits admins and they haven't been of much help.
Now if this were about one specific charge, I would simply contest it and go through Aetna's escalation process, but that's not the case (although I have disputed charges individually, and they randomly sent me a check partially refunding one visit). It's mainly about getting Aetna to fix/revert its policy going forward and provide the correct info to Teladoc so I am no longer charged. Do I have a "case" in terms of the co-pays contradicting the terms of the plan that are accessible to me? And how would I pursue it, administratively? Curious to know if anyone has experience with this sort of issue. And of course if anyone can find a reason why I'd be in the wrong here I'm happy to hear that perspective as well.
submitted by /u/AnonStruggleBus360
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