Maintaining optimal health often involves making informed dietary choices. Consulting a registered dietitian or nutritionist can provide personalized guidance to achieve wellness goals. For individuals with Aetna insurance, understanding the extent of their coverage for dietitian services is essential. This article delves into the specifics of Aetna's dietitian coverage, exploring various aspects, including coverage conditions, available programs, and strategies for finding the right provider.
Understanding Aetna's Coverage Policies
Aetna offers nutritionist coverage as part of preventive care for children and adults who are overweight, obese, and have other cardiovascular disease risk factors. However, it's important to note that many Aetna plan benefit descriptions specifically exclude services and supplies for or related to treatment of obesity or for diet and weight control. Under these plans, claims for weight reduction medications and for physician supervision of weight reduction programs may be denied based on that exclusion.
Weight Management and Counseling
Aetna considers up to a combined limit of 26 individual or group visits by any recognized provider per 12-month period as medically necessary for weight reduction counseling in adults who are obese (as defined by BMI greater than or equal to 30 kg/m2). Weight reduction medications should be used as an adjunct to caloric restriction, exercise, and behavioral modification, when these measures alone have not resulted in adequate weight loss. Weight loss due to weight reduction medication use is generally temporary. In addition, the potential for development of physical dependence and addiction is high. Individuals who cannot maintain weight loss through behavioral weight loss therapy and are at risk of medical complications of obesity are an exception to this; for these persons, the risk of physical dependence or other adverse effects may present less of a risk than continued obesity. Tests with weight loss drugs have shown that initial responders tend to continue to respond, while initial non-responders are less likely to respond even with an increase in dosage. If a person does not lose 2 kg (4.4 lbs) in the first four weeks after initiating therapy, the likelihood of long-term response is very low.
Exclusions and Limitations
Many Aetna benefit plans specifically exclude coverage of weight reduction medications under the pharmacy benefit and/or under the health benefits plan. The medical necessity criteria set forth below do not apply to health plans that specifically exclude services and supplies for or related to treatment of obesity or for diet or weight control. Nutrition counseling for certain conditions, like asthma and attention-deficit hyperactivity disorder (ADHD), is not covered by Aetna because the effectiveness of nutrition therapy has not been proven for these disorders.
Medical Necessity and Referrals
To use your Aetna benefits, a physician referral is not required when services are medically necessary to prevent or treat a condition. Aetna does require a physician referral that states nutrition services are medically necessary to prevent or treat a condition. The nutrition provider you choose must be credentialed, which includes licensed nutritionists and registered dietitians.
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Weight Reduction Medications Covered by Aetna
It's important to note that many Aetna benefit plans specifically exclude coverage of weight reduction medications under the pharmacy benefit and/or under the health benefits plan. The medical necessity criteria set forth below do not apply to health plans that specifically exclude services and supplies for or related to treatment of obesity or for diet or weight control.
Didrex (Benzphetamine Hydrochloride)
Didrex tablets contain the anorectic agent benzphetamine hydrochloride. Didrex is indicated in the management of exogenous obesity as a short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction in patients with an initial body mass index (BMI) of 30 kg/m2 or higher who have not responded to appropriate weight reducing regimen (diet and/or exercise) alone. Didrex is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to sympathomimetic amines, and glaucoma. Benzphetamine should not be given to patients who are in an agitated state or who have a history of drug abuse. Hypertensive crises have resulted when sympathomimetic amines have been used concomitantly or within 14 days following use of monoamine oxidase inhibitors. Didrex should not be used concomitantly with other CNS stimulants. Didrex may cause fetal harm when administered to a pregnant woman. Didrex is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Didrex should not be used in combination with other anorectic agents, including prescribed drugs, over-the-counter preparations and herbal products. Valvular heart disease associated with the use of some anorectic agents such as fenfluramine and dexfenfluramine has been reported. Possible contributing factors include use for extended periods of time, higher than recommended dose, and/or use in combination with other anorectic drugs.
Contrave (Naltrexone and Bupropion)
Contrave is a combination of naltrexone, an opioid antagonist, and bupropion, an aminoketone antidepressant, indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of: 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).
Orlistat (Xenical, Alli)
Orlistat is a reversible inhibitor of gastric and pancreatic lipases. Binding of orlistat to these enzymes forms inactive intermediates in the gut. This non‐systemic action does not allow fat to be broken down and absorbed. Rather, an oil phase that includes triglycerides and cholesterol is excreted in feces. This effect may lead to weight loss. Xenical (orlistat) is indicated for obesity management including weight loss and weight maintenance when used in conjunction with a reduced‐calorie diet. It is also indicated to reduce the risk for weight regain after prior weight loss. Orlistat is available as Xenical in 120mg capsules and as Alli in 60mg capsules. Alli is available over‐the‐counter. Recommended dosage of Xenical is one 120-mg capsule three times a day with each main meal containing fat (during or up to 1 hour after the meal). Supplementation with fat‐soluble vitamins (A, D, E, K) and beta carotene is recommended in some patients as these may not be adequately absorbed when given orlistat therapy. Comorbidities associated with obesity appear to be improved through weight loss in orlistat treated patients. Other than orlistat (Xenical), which is approved for use in adolescents aged 12 years or older, weight reduction medications have not been proven to be safe and effective for treatment of obesity in children and adolescents. Orlistat (Xenical) is contraindicated in persons with chronic malabsorption syndromes and cholestasis.
Qsymia (Phentermine and Topiramate)
Qsymia (phentermine and topiramate) is contraindicated in pregnancy, glaucoma, hyperthyroidism, hypersensitivity to sympathomimetic amines, and within 14 days of taking monoamine oxidase inhibitors. Qsymia is a combination of phentermine, a sympathomimetic amine anorectic, and topiramate extended-release, an antiepileptic drug, indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of: 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
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Belviq (Lorcaserin)
Belviq (lorcaserin) is contraindicated in pregnancy. Belviq was approved in June 2012 by the FDA as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related co-morbid condition, and was launched in the United States in June 2013. Food and Drug Administration (FDA), based on the Agency’s completed analysis of data from the CAMELLIA-TIMI 61 trial. CAMELLIA-TIMI 61 was a randomized, double-blind, placebo-controlled clinical trial to study approximately 12,000 men and women over five years with established cardiovascular disease or at high risk for cardiovascular disease. The study aimed at evaluating long-term cardiovascular and metabolic safety and efficacy of lorcaserin as part of a post-marketing requirement by the FDA. Although in this trial lorcaserin facilitated sustained weight loss without a higher rate of major cardiovascular events than that with placebo, the FDA reviewed that data and concluded that the potential risks of lorcaserin outweigh its benefits. More specifically, the FDA noted there was a numerical imbalance in the number of patients with malignancies. FDA's analysis of the study found that during the course of the trial, 462 (7.7 percent) patients treated with lorcaserin were diagnosed with cancers compared to the placebo group, in which 423 (7.1 percent) patients were diagnosed with cancers (Eisai, 2020). In addition, there were more reports of severe hypoglycemia among patients taking lorcaserin than placebo (0.4 percent vs 0.1 percent) (Echouffo Tcheugui and Ahima, 2019). The FDA’s February 13, 2020 Drug Safety Communication advised patients to stop taking Belviq and Belviq XR and talk to their health care professional about alternative weight-loss medications and weight management programs (Eisai, 2020).
Liraglutide (Saxenda)
The FDA approved liraglutide [rDNA origin] injection (Saxenda), a once-daily injection of a glucagon-like peptide-1 (GLP-1) receptor agonist, for chronic weight management (Novo Nordisk, 2014). The FDA approval of liraglutide was based upon the SCALE (Satiety and Clinical Adiposity−Liraglutide Evidence in Non-diabetic and Diabetic adults) phase 3 clinical trial program, which included study participants who have obesity (BMI ≥30 kg/m2) or who are overweight (BMI ≥27 kg/m2) with comorbidities (Novo Nordisk, 2014). The SCALE phase 3 clinical trial program of the safety and effectiveness of liraglutide for chronic weight management included three clinical trials that included approximately 4,800 obese and overweight patients with and without significant weight-related conditions (FDA, 2014). Results from a clinical trial that enrolled patients without diabetes showed that patients had an average weight loss of 4.5 percent from baseline compared to treatment with a placebo at one year (FDA, 2014). In this trial, 62 percent of patients treated with liraglutide lost at least 5 percent of their body weight compared with 34 percent of patients treated with placebo. Results from another clinical trial that enrolled patients with type 2 diabetes showed that patients had an average weight loss of 3.7 percent from baseline compared to treatment with placebo at one year. The FDA approved labeling states that patients using liraglutide should be evaluated after 16 weeks to determine if the treatment is working (Novo Nordisk, 2020). Saxenda is a glucagon-like peptide-1 (GLP-1) receptor agonist and should not be used in combination with any other drug belonging to this class, including Victoza, a treatment for type 2 diabetes. Saxenda and Victoza contain the same active ingredient (liraglutide) at different doses (3 mg and 1.8 mg, respectively). Saxenda has a boxed warning stating that liraglutide causes thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Saxenda causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Saxenda is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Finding a Registered Dietitian or Nutritionist
Several platforms and resources can assist in finding a registered dietitian or nutritionist covered by Aetna.
Health Loft
Health Loft connects individuals with Aetna nutritionists or dietitians to help them reach their wellness goals. It offers individualized telehealth sessions covered by insurance plans. Health Loft confirms insurance eligibility and handles billing on the client's behalf. They also offer virtual consultations with a nutritionist covered by Aetna. Some states’ licensure regulations restrict dietitians from offering services - including virtual care - from one state to another, which means they can only work with clients in certain locations. Your Aetna insurance coverage will also dictate the costs of your online appointments. Sessions for preventative care may be free of charge, while you may be asked to shoulder a co-pay for others.
Nourish
Nourish helps you develop healthy habits that last. All over telehealth and covered by your insurance. Nourish dietitians will provide personalized recommendations so you can reach your weight loss goals. Track your progress in the Nourish app and keep a food log to share with your dietitian. They offer virtual one-on-one sessions with dietitians to discuss preventative actions that can be taken to address your health concerns. They educate, assess lifestyle changes, help plan your nutrition, and support our clients toward long-lasting success using personalized nutrition counseling.
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Fay
Fay helps you find the best Registered Dietitian Nutritionists covered by your insurance. Dietitians you find on Fay are vetted and available for virtual or in-person sessions near you.
Aetna's Member Page
To find a registered dietitian who accepts your Aetna plan, log in to your member page, where you can search for in-network healthcare providers.
Virtual Consultations and Telehealth
Aetna covers virtual visits, or telehealth services, at the same cost as in-person provider visits. Coverage varies by plan, but virtual nutrition counseling provided by registered dietitians is typically covered. Nutrition telehealth services covered by Aetna include individual and group medical nutrition therapy, which is when a dietitian provides evidence-based recommendations for a specific health condition. Before scheduling a virtual visit with a dietitian through Aetna, it’s important to ensure your provider is licensed to practice in your state. Telehealth and licensure laws vary from state to state, and many states don’t allow dietitians to practice across state lines.
Preparing for Your First Consultation
During your initial consultation, your dietitian will ask a lot of questions and gather a lot of information. This is so that your dietitian can get to know you, your story, and learn what your long term nutritional goals are. From there, you will work together to create a plan to help you achieve your goals in a healthy and sustainable manner.
Cost of Appointments
Most Aetna plans offer 100% coverage for nutritional counseling under preventive services, while some require patients to shoulder a small co-pay, co-insurance, or out-of-pocket cost.
Conditions Treated by Dietitians
Nourish dietitians accept Aetna insurance and specialize in a wide range of conditions from gut health to diabetes to eating disorders.
Additional Considerations
The Role of Behavioral Psychology
The role of behavioral psychology in weight loss is paramount, as it influences habits, food choices, and overall adherence to dietary plans. Seeking the guidance of a nutritionist or dietitian who specializes in weight loss and behavioral techniques can be immensely beneficial. These professionals integrate psychological insights into their approach, helping individuals identify and address emotional triggers, stress-related eating patterns, and other behavioral factors that impact weight. A specialized nutritionist can collaborate with clients to set realistic goals, develop sustainable habits, and cultivate a positive relationship with food.
Specialized Diets and Medical Conditions
Another example of a common medical condition requiring a specialized diet is celiac disease (also called gluten-sensitive enteropathy and non-tropical sprue), with a prevalence of almost 1 % of the population (Fasano et al, 2003).