Members should discuss any matters related to their coverage or condition with their treating provider. If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. Whatever you need help with, you can find us using the contact information below. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. To view the form just select Continue. If you do not intend to leave our site, close this message. [Narrator] It's care on your schedule at your convenience. In case of a conflict between your plan documents and this information, the plan documents will govern. WebAetna Inc. 151 Farmington Avenue Hartford, CT 06156 USA Call us 1-800-US-AETNA ( 1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. All services deemed "never effective" are excluded from coverage. You've probably heard of them but what does it really mean for you? Got a rash and not sure what it is? The information you will be accessing is provided by another organization or vendor. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non-Medicare Some plans exclude coverage for services or supplies that Aetna considers medically necessary. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Froma24-hour nurse line to vision and fitness, youre covered. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. We know insurance is confusing and you have questions. Complete the form below and a licensed agent will contact you to discuss our plans available in your area. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. 7 days a week,24 hours a day, Address: Member Services and DSNP Customer Service, Pennsylvania Institutional Special Needs Plan (PA I-SNP), Address: Aetna Duals COE Member Correspondence. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. If you do not intend to leave Aetna Medicare, close this message. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Each main plan type has more than one subtype. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. **, Feelings of sadness, depression or anxiety, Post-traumatic stress disorder or other life challenge. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Contact a health care professional with any questions or concerns about specific health care needs.. [Narrator]Your child has an earache at 2:00 AM? Just like that. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. And we've got you. 1-800-358 Treating providers are solely responsible for dental advice and treatment of members. It's on-demand care, wherever you need it. Some subtypes have five tiers of coverage. When you need treatment for a short-term illness, its easy to connect with a doctor by phone or video and get care today. Visit the secure website, available through www.aetna.com, for more information. [Mom] I feel so much relief. (sneezes) Bless you. If you have questions about Medicare, call 1-800-MEDICARE (633-4227). Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Any information we provide is limited to those plans we do offer in your area. Access to CVS Health Virtual Primary Care is included in your health plan through Aetna, a CVS Health Company. New and revised codes are added to the CPBs as they are updated. CPT is a registered trademark of the American Medical Association. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. If you do not intend to leave our site, close this message. Aetna handles premium payments through Payer Express, a trusted payment service. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. And making your next steps easier with a dedicated Care Team. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Your InstaMed log in may be different from your Caremark.com secure member site log in. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Youll also find additional mental health services for: Limitations and restrictions may apply for certain services, locations, or patients. Teladoc is not available to all members. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Includes PPO, HMO, HMO-POS medical plans with or without drugs. [Narrator] Virtual care, telehealth. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Aetna handles premium payments through InstaMed, a trusted payment service. You can talk to our registered nurses day or night on our Medicare Nurse Hotline to get help with: If you need urgent or emergency care, call 911 and/or your doctor immediately. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Apple, the Apple logo, iPhone and Apple Watch are trademarks of Apple Inc., registered in the U.S. and other countries. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Visit the secure website, available through www.aetna.com, for more information. Scammers say you need to pay a fee for a new Medicare card or youll lose your Medicare coverage. The ABA Medical Necessity Guidedoes not constitute medical advice. WebIf you're a member, it's best to call the number on your ID card to ask about your current plan. If you do not intend to leave our site, close this message. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 7 days a week, 8 AM to 8 PM In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Well, for starters it means you'll have more options for care. Each main plan type has more than one subtype. After receiving a Medicare scam phone call that asks for your Medicare number or other personal information, reach out to To apply for Medicare coverage, contact the Social Security Administration at (800) 772 Select a state below to update coverage details. Please be sure to add a 1 before your mobile number, ex: 19876543210, Precertification lists and CPT code search, Participating provider precertification list for Aetna (PDF), Non-Medicare plans, including individual and family plans -, Mental health treatment - use phone number on member's ID card, Substance abuse treatment - use phone number on member's ID card, Non-Medicare, including individual and family plan precertification -, Specialty precertification (injectable drugs) for Medicare plans , Specialty precertification (injectable drugs) for non-Medicare, including individual and family plans , Pharmacy precertification (oral drugs) for Medicare plans , Pharmacy precertification (oral drugs) for non-Medicare, including individual and family plans , BRCA genetic testing (precertification and information) -, National Medical Excellence (transplant related care and cellular therapy services) for Medicare, non-Medicare, including individual and family plans , Participating providers can find more precertification phone numbers in, Availity help - registration questions, help with user name/password -, I am a non-physician health care professional who is not employed by an Aetna-contracted provider (physician group, hospital, etc.) Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. If you need urgent or emergency care, call 911 and/or your doctor immediately. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Disclaimer of Warranties and Liabilities. Medicare Supplement Insurance plans. Case of the sneezy sniffles? Web1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET.. This material is for information only. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This site has its own login. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Whether youve come down with a cold or need mental health counseling, CVS Health Virtual Care makes it simple. If youd like to learn more about our plans, explore our product pages for information. Please be sure to add a 1 before your mobile number, ex: 19876543210. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. The Appointment of Representative form is on CMS.gov. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). *For urgent and short-term care needs. The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. [Virtual care professional] I'm really glad that you reached out. If youre an Aetna member, you can call us for help. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. All fields marked with an asterisk (*) are required. I understand that I am not required to provide this consent as a condition of purchase or receiving insurance and that my consent can be revoked at any time. Applicable FARS/DFARS apply. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Dual Eligible Special Needs Plans (D-SNP). Medicare Advantage and Prescription Drug Plans. The ABA Medical Necessity Guidedoes not constitute medical advice. Unlisted, unspecified and nonspecific codes should be avoided. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Review the enrollment checklist with 4 to-do's before you choose a health plan. WebAetna Medicare Insurance for Pennsylvanians. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 7 days a week, 24 hours a day. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". WebRequest a phone call with a Medicare advisor to learn more about our Medicare plans. You are now being directed to CVS Caremark site. 1-877-543-6619 TTY users 711 Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. For you licensed agent will contact you to discuss our plans, explore our product for! Case of a State or the Federal government Code Search Tool are obtained Current. Are, therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers information... Directed to CVS health Virtual Primary care is included in your area, a trusted service! Which are subject to change, coverage may be different from your Caremark.com secure member site log in may mandated... Secure website, available through www.aetna.com, for more information of them but what does it really for! 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