In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. WebUSA. 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). 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. Call 1-855-835-2362to speak with a licensed Teladoc Health provider in minutes.*. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Dual Eligible Special Needs Plans (D-SNP). The member's benefit plan determines coverage. Generally speaking, the more diagnoses recorded, the higher the payment, Dr. Williams says. If you do not intend to leave our site, close this message. 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. 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.) Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. With 24/7 on-demand care, youll never have to. The information you will be accessing is provided by another organization or vendor. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Visit the secure website, available through www.aetna.com, for more information. CPT is a registered trademark of the American Medical Association. Maybe your concern can't wait until you see your doctor. Treating providers are solely responsible for medical advice and treatment of members. 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). If you do not intend to leave our site, close this message. Contact a health care professional with any questions or concerns about specific health care needs.. Whether youre a Pirate or a Philly, an Eagle or a Steeler, you need your health to be in tip-top shape. Fields marked with an asterisk (*) are required. All Rights Reserved. This information is neither an offer of coverage nor medical advice. This is the phone number for the Corporate Contact Center. If you need urgent or emergency care, call 911 and/or your doctor immediately. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The member's benefit plan determines coverage. Aetna handles premium payments through Payer Express, a trusted payment service. CPT only Copyright 2022 American Medical Association. Talk to one of our licensed insurance agents about your Medicare plan options. Want to see options for a different location? Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 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. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Your Payer Express log-in may be different from your Aetna secure member site log-in. [Narrator] And you'll get support for more than just your physical health. WebHear From Our Medicare Customers Secured and Trusted Featured On Have questions? Select a state below to update coverage details. 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. 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. Access your health information, lab results and personalized tips from anywhere with your health dashboard. WebTo learn more about Aetna Medicare Advantage plans in your area or to enroll in an Aetna Medicare Advantage plan, speak with a licensed insurance agent by calling 1-877-890-1409 TTY Users: 711 24 hours a day, 7 days a week. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Si tu intencin no era salir del sitio web, cierra este mensaje. Dual Eligible Special Needs Plans (D-SNP). 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. 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. Then, have your visit within 72 hours from wherever you are. 1-866-235-5660${tty} Dual Eligible Special Needs Plans (D-SNP). Medicare medical and dental plans - 1-800-624-0756 (TTY: 711) Non-Medicare If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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). Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Call your doctor with any questions or concerns about your health. Whatever you need help with, you can find us using the contact information below. 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 handles premium payments through Payer Express, a trusted payment service. 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. More Aetna articles Aetna Aetna Medicare plans Does Aetna Medicare cover prescription drugs? When billing, you must use the most appropriate code as of the effective date of the submission. Contact Member Services Member Help | Aetna Medicare Aetna Medicare members, contact us with questions about your Medicare plan. [Narrator]Your child has an earache at 2:00 AM? When you need care for minor illnesses or injuries, you dont have time to wait. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Disclaimer of Warranties and Liabilities. Get a virtual primary care appointment within days, not weeks. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Call 1-800-MEDICARE (1-800-633-4227) or ${tty}: 1-877-486-2048, 7 days a week, 24 hours a day.If you need help in a language other than English or Spanish, say Agent to This search will use the five-tier subtype. The information you will be accessing is provided by another organization or vendor. Why choose ${company} Medicare Solutions? This site has its own login. We're here to help. [Virtual care professional] It's my pleasure. [Narrator] Virtual care, telehealth. Aetna representatives will answer questions and address concerns about the calls authenticity. Go to the American Medical Association Web site. Or simply go to our Get Started page. 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. The member's benefit plan determines coverage. 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). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Well need to terminate your existing agreement with us. I tell everyone who is having a 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. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The Appointment of Representative form is on CMS.gov. Applicable FARS/DFARS apply. Unlisted, unspecified and nonspecific codes should be avoided. To view the form just select Continue. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Aetna has selected Caremark as the prescription management and mail delivery service for our members. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. It may be different from your Aetna secure member site log in. WebRequest a phone call with a Medicare advisor to learn more about our Medicare plans. For language services, please call the number on your member ID card and request an operator. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. 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. The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. Sometimes you need a quick answer to a health question. *For urgent and short-term care needs. The AMA is a third party beneficiary to this Agreement. CVS Health Virtual Care is all about you. Applicable FARS/DFARS apply. Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Complete the form below and a licensed agent will contact you to discuss our plans available in your area. CPT only copyright 2015 American Medical Association. 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. To be in tip-top shape more than just your physical health contact member services member help | Aetna Medicare Medicare... Cpbs include references to standard HIPAA compliant code sets to assist with search functions and facilitate... 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