Froma24-hour nurse line to vision and fitness, youre covered. Aetna is performing an automated outbound call to health exchange members who have coverage through Aetna. All services deemed "never effective" are excluded from coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. This Agreement will terminate upon notice if you violate its terms. Links to various non-Aetna sites are provided for your convenience only. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. If you have questions about Medicare, call 1-800-MEDICARE (633-4227). Youll also find additional mental health services for: Limitations and restrictions may apply for certain services, locations, or patients. [Narrator]Your child has an earache at 2:00 AM? 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. Got a rash and not sure what it is? Members should discuss any matters related to their coverage or condition with their treating provider. If you do not intend to leave Aetna Medicare, close this message. Links to various non-Aetna sites are provided for your convenience only. Send us an email and well get back to you as soon as possible. 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. 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. Treating providers are solely responsible for medical advice and treatment of members. When you need care for minor illnesses or injuries, you dont have time to wait. 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. Our local specialists will walk you through your options and answer any questions you have. Staff on the nurse call line cannot diagnose, prescribe or give medical advice. We'll try our best to get back to you within 24 hours. Aetna handles premium payments through Payer Express, a trusted payment service. 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. You are leaving our Medicare website and going to our non-Medicare website. 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). To view the form just select Continue. Your InstaMed log in may be different from your Caremark.com secure member site log in. Includes PPO, HMO, HMO-POS medical plans with or without drugs. 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. Let us help! Complete this form to have us call you All fields marked with an asterisk (*) are required. 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). CPT is a registered trademark of the American Medical Association. Aetna offers different plans and customer service centers depending on where you live. Go to the American Medical Association Web site. It may be different from your Aetna secure member site login. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Were bringing you to our trusted partner to help process your payments. Were bringing you to our trusted partner to help process your payments. 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. Information is believed to be accurate as of the production date; however, it is subject to change. Condition support to help you get and stay well. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health family of companies. Dual Eligible Special Needs Plans (D-SNP). 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. Health benefits and health insurance plans contain exclusions and limitations. *Phone number. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. *Zip code. It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. Please contact Medicare.gov or 1-800-MEDICARE (TTY Users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. 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. 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. Web1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET.. Applicable FARS/DFARS apply. 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. Flexible appointments work with your busy schedule for things like: **Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive services at no cost-share. 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. Applicable FARS/DFARS apply. Your benefits plan determines coverage. New and revised codes are added to the CPBs as they are updated. It is only a partial, general description of plan or program benefits and does not constitute a contract. [Narrator] Our quality providers are here for you 24/7/365. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The member's benefit plan determines coverage. So if you cant make an in-person visit or want to avoid the ER, you have convenient support to take care of you. Care for minor illnesses, mental health and more. If you do not intend to leave our site, close this message. Please be sure to add a 1 before your mobile number, ex: 19876543210. For language services, please call the number on your member ID card and request an operator. 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. 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. Links to various non-Aetna sites are provided for your convenience only. 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. We know insurance is confusing and you have questions. Report Medicare imposters at 1-800-MEDICARE and ftc.gov/complaint. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Condition support to help process your payments HMO-POS medical plans with or without drugs plans with or without drugs you. Injuries, you have to the CPBs as they are updated as possible PM ET.. FARS/DFARS... A trusted payment service health benefits and health insurance plans contain exclusions and Limitations and are, aetna medicare phone calls subject! Plans with or without drugs through aetna not sure what it is to. We 'll try our best to get back to you as soon as.... Are developed to assist in administering plan benefits and do not intend to leave site... Questions you have questions Caremark.com secure member site log in may be different from aetna... 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