What is the RelayHealth service?

RelayHealth is a secure, Web-based doctor-patient service that makes it easy for you to communicate with your doctor's office. You can request appointments, renew prescriptions, ask non-urgent questions, and receive lab results all from your home computer. No more sitting on hold, taking time to travel to your doctor's office, or wasting time in the waiting room for your appointment. Use a RelayHealth webVisit^® to consult your doctor about non-urgent medical care needs. A member's financial responsibility for a webVisit is the same as it is for an office visit. There is no cost for you to join or use the "convenience services." So try RelayHealth today - it may save you a trip to the doctor’s office!

What are the highlights of this online service?

• Aetna members are covered for secure, online doctor-to-patient consultations in all states where Aetna’s participating doctors are also enrolled in the RelayHealth service (View list of states).
• Aetna members can also make online appointments, get referrals, lab and test results, and order new prescriptions and refills electronically.
• These services are through a secure Internet connection, so members will have to register and log in to the RelayHealth website.
• This service is available with primary care physicians and certain specialists (See list of physician types).

When will covered webVisits and the other services be available to Aetna members and participating providers?

This online service is available to members in most medical products where Aetna's participating doctors are also enrolled in RelayHealth. It is not available to most Medicare members, but is available for members of Aetna's Medicare Advantage plan in California. Members must have an existing relationship with a participating physician to begin using this service. Members can use the service with primary care doctors and specialists. (Note: If your employer provides a "self-funded" health plan, you must check with your employer or Aetna Member Services to find out if this service is available to you.)

Why did Aetna decide to cover online consultations?

Aetna is committed to using technology to make it easier for physicians to do business, facilitate communications between physicians and their patients, and help improve patient safety.

How secure are online communications?

Unlike e-mail, RelayHealth uses a single, centrally managed database for doctor-patient communications. These communications cannot be read en route, deleted, copied or altered. The RelayHealth service requires a sign-in identification and password, and can only be accessed by registered users. Patients using the service can see an audit trail detailing who has looked at their record, and can end their online relationship with a doctor at any time. This prevents access to any medical information communicated via RelayHealth in the future.

RelayHealth's website includes office staff and assistants as people who can register to deliver care. Who within the doctors' office has the authority to reply to a member's communication? How do members know who is responding?

Physicians can grant access rights to office staff who can scan incoming messages and respond to or triage messages on a physician's behalf using RelayHealth's Group Inbox. When patients receive a reply from the physician's office, it will be clear who has responded--the message will either be sent "From [Physician]", or "By [staff member] on behalf of [Physician]". The practice can also establish rules that automatically direct RelayHealth messages by category to the most appropriate office staff member. For example, all prescription renewals can be sent directly to a registered nurse, appointment requests to the receptionist, and online consultations to the physician.

How quickly does a doctor need to respond to a member's online requests?

The RelayHealth format limits the consultation to non-emergency conditions. If the member has a medical emergency or something that requires an immediate answer, he or she should call the physician's office or seek emergency care. RelayHealth encourages doctors to respond within eight hours for each message type, and provides online tools for the practice/physician to monitor message response times. Each doctor and his/her staff have the ability to set their response time by message type.

What types of providers does this service include?

Primary care physicians — specifically, family practice, general medicine, internal medicine, pediatricians and Ob/Gyns, are included, along with certain specialists (View list of physician types).

Are any Aetna plans excluded from this offering?

At this time, coverage for online visits will not be available to members of plans administered by Strategic Resource Company (SRC) or Aetna Signature Administrators (ASA). Currently, members in Aetna's Medicare Advantage HMO plan in California are included, but Medicare members in other states are not eligible to participate. In addition, Aetna Student Health(ASH) members can participate in this service.

Aetna does not cover telephone consultations, in part because they do not include face-to-face interactions. Online visits also are not face-to-face. Why is this different?

This program is different in several ways. The interaction between patient and doctor is handled in a structured way for limited conditions, and the online consultations can be used only for non-emergency conditions. In addition, the online form provides a framework that helps ensure physicians can collect adequate, condition-specific information that will be useful for making clinically appropriate decisions.

How will Aetna members enroll and use these online services?

• To begin, a member must already have an established relationship with the physician before online services can be used. The member's physician also must already be registered as a participating provider in the RelayHealth physician network.
• The process of registering and using the RelayHealth webVisit feature is easy.
• A demonstration of how a member can use this online capability is available on www.RelayHealth.com. Members, plan sponsors and physicians can visit this website to view the online demo.
• Aetna's online provider directory, DocFind, includes a list of Aetna participating physicians enrolled with RelayHealth, and links to RelayHealth's website.

How will a member know if his or her doctor participates in this service ?

There are several ways a provider can be identified.

• Participating doctors can be found in DocFind. Members who search for PCPs or certain specialists will see related text that their provider is part of RelayHealths network.

  By clicking on the hyperlinked text, it will bring you to additional content and instructions on how you can register to communicate online with your doctor.

• Members can ask their doctors if they participate. We expect that RelayHealth participating providers may contact their established patients to tell them about their relationship with RelayHealth.

Is there a charge for members to use this service?

You will pay the same cost-sharing for a webVisit as you would for an office visit. Any required copays or deductibles will be charged as if they were office visits. This includes plans that have health reimbursement or health savings accounts when the fund limit in those accounts is exhausted. Physicians will be paid for services provided according to the terms of their contract. As always, a member’s financial responsibility depends on the terms of his or her plan, which may vary. A webVisit will be covered by Aetna if your employer has signed up for this service. Check with your employer or Aetna Member Services to see if this service is available to you.

What is the cost of a webVisit, and can it vary for any reason?

A member's financial responsibility for a webVisit is the same as it is for an office visit. Any required copays or deductibles will be charged in the same manner they are applied for office visits. This includes plans that have health funds, when the fund limit has been reached. As always, a member's responsibility depends on the terms of his or her plan, which may vary.

How is member responsibility calculated in a consumer-directed health plan (CDHP)?

Members in CDHPs who have used up their fund will be responsible for the cost of the webVisit, just as they would be for an office visit. If a member has not yet met the plan's deductible, the webVisit charge will be applied to the deductible, just as a charge for an office visit would be applied.

Will disputes over claims related to this program be handled like other Aetna claims?

Yes, members and physicians can use Aetna's existing processes for claim disputes related to online consultations.

How do Aetna members benefit from these services?

Aetna members can benefit from greater access to their physicians, reduced waiting time for test results, and faster routine communications such as appointment scheduling. In addition, by interacting with their physician online, members can avoid leaving work for an office visit. Online communications offers members the flexibility to contact their doctors' office at any time of the day or night. Since physicians can send prescriptions and refills online, consumers also avoid additional trips to the pharmacy. In addition, members who use their RelayHealth Personal Health Record can work with their doctor to more actively manage their own care.

If a patient uses the "convenience service" to schedule an office visit, is the patient reminded of his or her visit through a follow up email message?

Yes. The provider may set a "rule" while scheduling the visit to send a reminder notification to the patient regarding their scheduled appointment. This rule can be set to send notification for one or two days in advance of the scheduled appointment. The patient will receive a message in their specified email box letting them know they have a message waiting for them in their RelayHealth account.

How can a physician be sure that a webVisit accurately captures a patient’s true health status or concerns, so that appropriate treatment is recommended to the patient during the webVisit?

The interaction between patient and doctor through a webVisit is handled in a structured way for limited conditions. The online consultation can be used only for non-emergency conditions. The online form provides a framework that helps physicians collect adequate, condition-specific information that will be useful for making clinically appropriate decisions.

Aetna and RelayHealth consider it to be the individual physician’s responsibility to decide how to handle a particular patient’s medical treatment, based on the information and specific symptoms the patient provides through the structured online consultation web screens. The member needs to take this into consideration when deciding how to communicate his or her health concern to the health care provider. The member can choose to use the webVisit, or can contact the health care provider and schedule an office visit. Members can request an office visit appointment using the RelayHealth online communication capabilities at no charge.

Note: if the physician determines an office visit is needed in addition to the webVisit, the member is responsible for both copays, as described in her or her plan. It is important to point out that the member’s physician can waive the fee for a webVisit in these situations. Members can discuss this with their physician, as they would discuss any other financial responsibility matters at any time.

Disputes over claims related to this program are handled like other Aetna claims. Members and physicians can use Aetna’s existing processes for claim disputes related to online consultations.

How is the online service offered through RelayHealth different from Aetna's Informed Health® Line?

Aetna's Informed Health Line nurses provide information on various health topics by telephone. However, they cannot treat a member, or prescribe medications. A webVisit through RelayHealth is actually an online visit between an individual patient and his or her doctor. Just as a member would have a financial responsibility for an actual office visit, there is a similar responsibility for an online visit. A call into the Informed Health Line is not the same as a visit to the doctor's office.

Aetna's Informed Health Line provides members and their families with telephone access to registered nurses 24 hours a day, 7 days a week. Using an advanced health information database, Informed Health Line nurses provide information on a variety of health topics including prevention strategies, chronic conditions and complex medical situations. They also help members understand health issues and work more effectively with their physicians.

If a member uses the reimbursable webVisit feature, and the doctor then determines an office visit is required, will the member be charged both the webVisit and office visit copays? If the member is charged twice, is there any recourse?

Aetna and RelayHealth consider it to be the individual physician's responsibility to decide how to handle a particular patient's medical treatment, based on the information and specific symptoms the patient provides through the structured, online consultation Web screens.

If the physician determines an office visit is needed in addition to the webVisit, the member is responsible for both copays, as described in his or her plan. The member needs to take this into consideration when deciding how to communicate his or her health concern to the health care provider. The member can choose to use the webVisit, or can contact the health care provider and schedule an office visit. Members can request an office visit appointment using the RelayHealth online communication capabilities at no charge.

It is important to point out that the member's physician can waive the fee for a webVisit in these situations. Members can discuss this with their physician, as they would discuss any other financial responsibility matters, at any time.

Aetna and RelayHealth are monitoring how such situations are being handled. The results will be analyzed to understand frequency of such occurrences and trending patterns. If the results indicate adverse impacts, Aetna and RelayHealth will consider opportunities to reduce the frequency, and to help physicians and members better understand the best way to use online consultations.

Can members use physicians who may be in RelayHealth's network, but not in Aetna's network?

Aetna members must use an Aetna-participating physician in order to be reimbursed for a webVisit.

Is confidential patient information, such as lab data results, protected?

Yes. Unlike e-mail, which relies on multiple servers across the Internet, RelayHealth uses a single, centrally managed database for doctor-patient communications. These communications cannot be read en route, deleted, copied or altered. The RelayHealth service requires a sign-in identification and password, and can only be accessed by registered users. Patients using the service can see an audit trail detailing who has looked at their record, and can end their online relationship with a doctor at any time. This prevents access to any medical information communicated via RelayHealth in the future.

How many doctors in the Aetna network participate in RelayHealth's networks? How many RelayHealth doctors, including specialists, could Aetna members potentially contact for other services such as scheduling online appointments, and prescription refills?

Members in any state where participating doctors in the Aetna network are also enrolled in the RelayHealth service can use RelayHealth participating physicians, including specialists, for "free" online services.

The number of participating physicians changes from month to month. Members can go to DocFind on Aetna's website to find participating physicians. For more information about RelayHealth's network physicians, visit www.RelayHealth.com.

Is there a list of the types of webVisits that are available?

Yes, there are over 145 webVisit interviews, including both chronic and non-urgent acute symptoms, available through RelayHealth. In addition, physicians can customize the list of which webVisits to make available to their patient panel. Click here for a list of current symptoms.

How will members know which AMA-approved service is covered when interacting with the RelayHealth website?

Only an actual webVisit is reimbursable. When preparing to complete a webVisit, the RelayHealth website will inform the patient about what aspects of the online visit will be covered. The website also informs the patient of payment options (credit card; debit card, etc). There is no charge for the "convenience services" - setting up an appointment, obtaining a refill, requesting lab results.

Can a member join at any time?

Aetna members who have an established relationship with a doctor who is contracted with Aetna and RelayHealth may register with RelayHealth for the services at any time. Online registration is available through the RelayHealth website.

At what point during a webVisit does the member eligibility verification occur?

Members first register and then can log in any time. Once logged in, they can choose any of the message categories that their physician offers - such as scheduling an appointment or conducting a webVisit. When they choose the webVisit option, they select the physician they want to send the webVisit to, and then verify their health plan. The eligibility verification occurs before the member begins answering any questions related to the webVisit. If they are eligible, the webVisit is permitted. If not, the member receives a message telling them they are not eligible to conduct the webVisit.

How does RelayHealth prevent a member who is not eligible for coverage of a webVisit from submitting one after registering on the RelayHealth website?

RelayHealth runs an eligibility check any time a patient attempts a webVisit. During the eligibility check, RelayHealth will look at the Group Number and determine that the member is not eligible for coverage of the webVisit. RelayHealth will alert the member that Aetna will not cover the visit, but give the member the option to conduct the visit at his or her own cost. Any member who may already have a relationship with a provider who is contracted with RelayHealth can use the "convenience services" for free even if a plan sponsor does not offer this service to its employees.

Using this service for prescription drug orders/refills

Can RelayHealth support prescription drug orders and refills utilizing non-Aetna pharmacy programs?

Yes, the current online program can support non-Aetna pharmacy plans.

How does the e-prescribing work?

When a member registers to use the RelayHealth service, he/she can select a preferred pharmacy, including Aetna's Rx Home Delivery® service, to which the doctor's office should send prescriptions. If a pharmacy has not been selected, the prescription will be directed to the member with a one-time option to electronically route the specific prescription to a pharmacy of their choice. The patient cannot print or alter the prescription. Prescriptions are faxed to the selected pharmacy.

Does RelayHealth support electronic routing of prescriptions to a pharmacy for refills?

Yes, members may send the prescription one time.

In addition to supporting Aetna Pharmacy Management (APM) prescriptions, does RelayHealth support interaction with other retail pharmacies? Are there any exclusions?

Members may use this service to obtain prescriptions from a large list of pharmacies on RelayHealth's website, including most retail pharmacies and APM. The standard Aetna exclusions apply.

Will this service support Aetna Specialty Pharmacy® prescriptions with a one-time fill at retail?

At this time, Aetna Specialty Pharmacy prescriptions are not supported through this service.