The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. This is the phone number for the Send us an email and well get back to you as soon as possible. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. This Agreement will terminate upon notice if you violate its terms. And you'll have a partner to help you manage your health every step of the way. Aetna members have access to contact information and resources specific to their plans. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. CPT is a registered trademark of the American Medical Association. You can use virtual care in addition to your traditional network of providers from wellness visits to quick care. 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. You are now being directed to CVS Caremark site. Plan features and availability may vary by service area. CPT is a registered trademark of the American Medical Association. Froma24-hour nurse line to vision and fitness, youre covered. 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. Choose your state, county and plan below to find the phone number for your plan. 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. Each main plan type has more than one subtype. Includes PPO, HMO, HMO-POS medical plans with or without drugs. For 2022, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.29 out of 5 stars. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. [Narrator] Your child has an earache at 2:00 AM? Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Please log in to your secure account to get what you need. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". And we've got you. 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. 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). This virtual care option is in addition to your traditional network of providers. 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. Before you give any personal information, initiate your own call to Medicare at 1-800-MEDICARE. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". We're here to help. Your InstaMed log in may be different from your Caremark.com secure member site log in. If you do not intend to leave our site, close this message. 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. You are leaving our Medicare website and going to our non-Medicare website.If you do not intend to leave our site, close this message. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If you do not intend to leave our site, close this message. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. WebContact Aetna Get the answers you need here If you have questions related to COVID-19, including those on our telemedicine policy, testing, coding for COVID-19 related visits, and additional resources Aetna is sharing to support you during this pandemic, please check our Provider COVID-19 FAQ website. *MinuteClinic in-person services are not included with this product and are subject to plan benefit. Sometimes you need a quick answer to a health question. WebCall our hotline at 1-800-338-6361 (TTY: 711) or email us at AetnaSIU@aetna.com We speak your language We have free interpreter services to answer questions you may have about Im turning 65 or just starting to explore Medicare. If you do not intend to leave our site, close this message. This Agreement will terminate upon notice if you violate its terms. Im turning 65 or just starting to explore Medicare. [Mom] I feel so much relief. The information you will be accessing is provided by another organization or vendor. Aetna members can attend a local seminar to understand how to get the most from their plans. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. New and revised codes are added to the CPBs as they are updated. Search for Medicare plans in your area here. Well, for starters, it means you'll have more options for care. It's on-demand care, wherever you need it. For Providers Health & wellness Contact Us Call Member Services/Provider Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week (and during all holidays). Contact a health care professional with any questions or concerns about specific health care needs.. Have questions about our products, policies and services? Your Payer Express log-in may be different from your Aetna secure member site log-in. So you feel better, sooner. 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. Monday to Friday, 8 AM to 9 PM ET. *For urgent and short-term care needs. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Yes, I'm a memberNo, I'm looking for a plan. Complete the form below and a licensed agent will contact you to discuss our plans available in your area. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please fill in all fields. 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. Yes, I'm a memberNo, I'm looking for a plan. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 have questions about Medicare, call 1-800-MEDICARE (633-4227). You can also call Aetna Member Services by calling the phone number on the back of your ID card. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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. I'm glad you contacted us. It may be different from your Aetna secure member site login. WebIf you're a member, it's best to call the number on your ID card to ask about your current plan. 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. Staff on the nurse call line cannot Others have four tiers, three tiers or two tiers. If you do not intend to leave our site, close this message. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. Disclaimer of Warranties and Liabilities. Dual Eligible Special Needs Plans (D-SNP). Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. [Virtual care professional] It's nice to see you. 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. 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. 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. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. 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. For language services, please call the number on your member ID card and request an operator. You are leaving our Medicare website and going to our non-Medicare website. Applicable FARS/DFARS apply. 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. All Rights Reserved. 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. Why choose ${company} Medicare Solutions? Please be sure to add a 1 before your mobile number, ex: 19876543210. Skip to main content For Web1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET.. 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. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Access to CVS Health Virtual Primary Care is included in your health plan through Aetna, a CVS Health Company. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. You are now being directed to the CVS Health site. Do you want to continue? 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. Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. The call is free. WebUSA. Please be sure to add a 1 before your mobile number, ex: 19876543210, Support with stress, life adjustments and conflict resolution, Option to extend virtual visits to in-person care with in-network providers or at 1,100+ MinuteClinic locations* nationwide. Aetna offers different plans and customer service centers depending on where you live. Case of the sneezy sniffles? [Narrator]Your child has an earache at 2:00 AM? Let us help! If you do not intend to leave our site, close this message. I consent to receive autodialed marketing calls from or on behalf of Aetna about health insurance. For a complete description of the limitations of Teladoc services, visit Teladoc. Im turning 65 or just starting to explore Medicare. 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. With the right to appeal the decision back of your ID card to about. Please be sure to add a 1 before your mobile number, ex:.! 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