It is only a partial, general description of plan or program benefits and does not constitute a contract. Medicare Advantage and Prescription Drug Plans. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. I am a non-physician health care professional who wants to be available for selection as a primary care provider (PCP), and my state regulations allow me to serve as a PCP. Your Payer Express log in may be different from your Aetna secure member site log in. 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. [Mom] I feel so much relief. You can also call Aetna Member Services by calling the phone number on the back of your ID card. Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. What Type of Insurance Does Aetna Offer? Aetna offers a variety of health, dental, and vision insurance options for individuals and employer groups. The company stopped offering individual health insurance plans in 2018 due to revenue losses on the healthcare marketplace. The company does offer Medicare Advantage plans (HMO, PPO, and POS) and Medicare Supplements to eligible seniors. Well, for starters, it means you'll have more options for care. Im turning 65 or just starting to explore Medicare. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The member's benefit plan determines coverage. License to use 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. Links to various non-Aetna sites are provided for your convenience only. Report the call. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). 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. Teladoc Health and the Teladoc Health logo are registered trademarks or trademarks of Teladoc Health, Inc. Health benefits and health insurance plans contain exclusions and limitations. You've probably heard of them but what does it really mean for you? 7 days a week, 8 AM to 8 PM Applicable FARS/DFARS apply. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. This material is for information only. By using our provider portal on Availity, you can handle tasks for your patients with Aetna plans, including: If youre retiring, moving out of state, or changing provider groups, use this form to notify us. 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. Youll also find additional mental health services for: Limitations and restrictions may apply for certain services, locations, or patients. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If you do not intend to leave our site, close this message. Just like that. Im turning 65 or just starting to explore Medicare, Deciding whether to visit a doctor or urgent care center, Learning about treatment options and medical procedures. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. If you do not intend to leave our site, close this message. Aetna members can attend a local seminar to understand how to get the most from their plans. You can get convenient and affordable care from wherever you need it. Medicare Helpline & Website Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare coverage. Then, have your visit within 72 hours from wherever you are. Treating providers are solely responsible for medical advice and treatment of members. All fields marked with an asterisk (*) are required. [Narrator] Because healthier happens together. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Complete this form to request our representatives visit you at home to discuss the Aetna Medicare Advantage plans available in your area. No fee schedules, basic unit, relative values or related listings are included in CPT. Members should discuss any matters related to their coverage or condition with their treating provider. 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. Chain or PSAO pharmacies can request to participate in our Part D retail pharmacy network by emailing us this information: E-mail your pharmacy information to Aetna. [Virtual care professional] It's nice to see you. Any information we provide is limited to those plans we do offer in your area. If you have questions about Medicare, call 1-800-MEDICARE (633-4227). Visit the secure website, available through www.aetna.com, for more information. You are leaving our Medicare website and going to our non-Medicare website. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Your benefits plan determines coverage. Want to see options for a different location? 1-800-US-AETNA(1-800-872-3862) (TTY: 711)between 8:00 AM and 6:00 PM ET. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Links to various non-Aetna sites are provided for your convenience only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. To collect health assessment and lifestyle survey data. CPT is a registered trademark of the American Medical Association. 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). 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. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Treating providers are solely responsible for dental advice and treatment of members. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The AMA is a third party beneficiary to this Agreement. [Narrator]Your child has an earache at 2:00 AM? We're here to help. Si tu intencin no era salir del sitio web, cierra este mensaje. Please fill in all fields. 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. Copyright 2015 by the American Society of Addiction Medicine. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. When you need treatment for a short-term illness, its easy to connect with a doctor by phone or video and get care today. Aetna Medicare Prescription Drug Plans (PDPs)* This site has its own login. Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non-Medicare Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Medicare Supplements to eligible seniors, request documents in alternate formats and make to. See you you at home to discuss the Aetna Medicare Prescription Drug plans ( HMO PPO... Payer Express log in may be mandated by applicable legal requirements of a State or Federal! Revenue losses on the healthcare marketplace this message non-Medicare website AM and 6:00 PM ET understand how to get most... Need treatment for a short-term illness, its easy to connect with a by! 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