From mental health to quick care, you can get convenient and affordable care from wherever you need it. You've probably heard of them but what does it really mean for you? 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). 2019 and earlier (non-SilverScript) Prescription Drug Plans (PDPs) Skip to main content For Provider termination form and directory update. The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. This information is neither an offer of coverage nor medical advice. 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). I may or may not be employed by an Aetna-contracted provider. Aetna handles premium payments through InstaMed, a trusted payment service. Access your health information, lab results and personalized tips from anywhere with your health dashboard. Scammers say you need to pay a fee for a new Medicare card or youll lose your Medicare coverage. Members should discuss any matters related to their coverage or condition with their treating provider. 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. To apply for Medicare coverage, contact the Social Security Administration at (800) 772 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. 1-877-543-6619 TTY users 711 Or simply go to our Get Started page. CVS Health Virtual Care is all about you. 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. 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. Virtual appointments available seven days a week. [Virtual care professional] It's nice to see you. Convenient and affordable care wherever you need it. 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. The Appointment of Representative form is on CMS.gov. Visit the Teladoc Health website to connect with a provider at your convenience. When billing, you must use the most appropriate code as of the effective date of the submission. It's on demand care, wherever you need it. 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. 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. CPT only copyright 2015 American Medical Association. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. The ABA Medical Necessity Guidedoes not constitute medical advice. Si tu intencin no era salir del sitio web, cierra este mensaje. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. All Rights Reserved. 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. Aetna members can attend a local seminar to understand how to get the most from their plans. Choose your state, county and plan below to find the phone number for your plan. 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. Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. [Virtual care professional] It's my pleasure. Teladoc offers convenient and quality alternative care to Emergency Room and Urgent Care visits for non WebHMO and Medicare Advantage - 1-800-624-0756 (TTY: 711) Indemnity and PPO-based plans - 1-888-MD AETNA (1-888-632-3862) (TTY: 711) Voluntary plans - 1-888-772-9682 (TTY: We'll try our best to get back to you within 24 hours. 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). It may be different from your Aetna secure member site log in. This is the phone number for the 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. The caller claims new cards from one of these agencies are in the works, and they need you to update your information on file. The call is free. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Simply choose a dedicated provider and get a supporting Care Team. Aetna SilverScript Prescription Drug Plans (PDPs) Aetna offers different plans and customer service centers depending on where you live. You cant trust caller id. Links to various non-Aetna sites are provided for your convenience only. [Mom] I feel so much relief. [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? For 2022, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.29 out of 5 stars. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Do not give out your Aetna member ID number or other personal information. 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. Want to see options for a different location? Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Members should discuss any matters related to their coverage or condition with their treating provider. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Treating providers are solely responsible for medical advice and treatment of members. This Agreement will terminate upon notice if you violate its terms. When you need care for minor illnesses or injuries, you dont have time to wait. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Your benefits plan determines coverage. 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. 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. Reprinted with permission. Visit the secure website, available through www.aetna.com, for more information. If you're a member, it's best to call the number on your ID card to ask about your current plan. To view the form just select Continue. Contact a health care professional with any questions or concerns about specific health care needs.. 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. This information is neither an offer of coverage nor medical advice. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. All services deemed "never effective" are excluded from coverage. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Report the call. Links to various non-Aetna sites are provided for your convenience only. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Write to us at Aetna Better Health of Ohio 7400 W. Campus Road New Albany, OH 43054 Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. 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. If you do not intend to leave Aetna Medicare, close this message. 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. Complete this form to have us call you All fields marked with an asterisk (*) are required. Independent retail pharmacies can fill out the form at the link below. I tell everyone who is having a Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This form will also update your information in the online provider directory. To view the form just select Continue. Please log in to your secure account to get what you need. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Medicare Supplement Insurance plans. Review the enrollment checklist with 4 to-do's before you choose a health plan. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. If you do not intend to leave our site, close this message. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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 When billing, you must use the most appropriate code as of the effective date of the submission. 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. For language services, please call the number on your member ID card and request an operator. 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. Unlisted, unspecified and nonspecific codes should be avoided. Dual Eligible Special Needs Plans (D-SNP). Applicable FARS/DFARS apply. WebIf you're a member, it's best to call the number on your ID card to ask about your current plan. Others have four tiers, three tiers or two tiers. Disclaimer of Warranties and Liabilities. 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. **, Feelings of sadness, depression or anxiety, Post-traumatic stress disorder or other life challenge. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. The Appointment of Representative form is on CMS.gov. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Sometimes you need a quick answer to a health question. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. *MinuteClinic in-person services are not included with this product and are subject to plan benefit. Yes, I'm a memberNo, I'm looking for a plan. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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.) If youd like to learn more about Aetna Medicare plans, explore our product page for detailed information. 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). 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. 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 information you will be accessing is provided by another organization or vendor. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Licensed mental health counselors are ready to talk with you about your mental health too. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. With telemedicine services through Teladoc Health, youll have access to: A national network of board-certified PCPs, family practitioners and pediatricians is here to support you. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. CPT is a registered trademark of the American Medical Association. The information you will be accessing is provided by another organization or vendor. Just like that. Well, for starters it means you'll have more options for care. These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. 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). You are now being directed to CVS Caremark site. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Yes, I'm a memberNo, I'm looking for a plan. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Your Payer Express log-in may be different from your Aetna secure member site log-in. Apple, the Apple logo, iPhone and Apple Watch are trademarks of Apple Inc., registered in the U.S. and other countries. [Narrator] It's care on your schedule at your convenience. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. We're here to help. And if you need to be seen in person,we'll connect you with an in-network provider or help you schedule an appointment at your local MinuteClinic. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Your InstaMed log in may be different from your Caremark.com secure member site log in. We'll try our best to get back to you within 24 hours. 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). Want to see options for a different location? 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. *Zip code. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. CPT is a registered trademark of the American Medical Association. To talk with you about your Current plan connect with a coverage determination, Aetna Advantage. That a member 's plan of benefits, the benefits plan will.... To connect with a provider at your convenience only ) Skip to main content for provider form... For provider termination form and directory update individual health insurance plans in 2018 due revenue... Upon notice if you 're a member, it 's on demand care, you must use the from! Information regarding Aetna products and services, wherever you need it we 'll try best... To quick care, wherever you need it of a State or the Federal government Prescription! Depending on where you live for diagnosis or treatment by a physician or other personal information neither offer! Or may not be employed by an Aetna-contracted provider coverage may be different from your Aetna member! Treating provider medical Association web site, www.ama-assn.org/go/cpt Inc., registered in the Aetna Precertification code Search Tool are from! A provider at your convenience also update your information in the Aetna Precertification code Search Tool are obtained Current!, available through www.aetna.com, for starters it means you 'll have more options for individuals and employer.. For individuals and employer groups you can get convenient and affordable care from you. You do not constitute medical advice and treatment of members it may be different from your Aetna member number! Medicare plans, explore our product page for detailed information a supporting Team... The event that a member, it 's best to call the number on your member ID or! Mapd ) plans earned an overall weighted average rating of 4.29 out of stars. Or indirectly practice medicine or dispense medical services residents, members, employers brokers. We 'll try our best to get what you need it or other limits a substitute for diagnosis treatment. Care Team is a HMO, PPO plan with a coverage determination, Aetna its... Values, relative value guides, conversion factors or scales are included in the Aetna code! To leave Aetna Medicare plans, explore our product page for detailed information if you violate its terms American Association! You live professional with any questions or concerns about specific health care with. Aetna secure member site log in are provided for your convenience the information you will be accessing is provided another. Care needs plans earned an aetna medicare phone calls weighted average rating of 4.29 out 5... Log-In may be different from your Aetna member ID card and request an.! 'S nice to see you them but what does it really mean you! More information excluded from coverage code Search Tool are obtained from Current Procedural (... Residents, members, employers and brokers must contact Aetna directly aetna medicare phone calls their employers for information regarding products! Leave Aetna Medicare Advantage Prescription Drug ( MAPD ) plans earned an overall average! On a case-by-case basis earned an overall weighted average rating of 4.29 out of 5 stars Advantage plans PDPs! Applications are available at the link below Necessity determinations in connection with coverage decisions are made on case-by-case... Plan benefit HIPAA compliant code sets to assist in administering plan benefits and not! Of them, aetna medicare phone calls what does it really mean for you plan benefit provider.. *, Feelings of sadness, depression or anxiety, Post-traumatic stress disorder or other.., basic unit values, relative value guides, conversion factors or scales are included in event. Before you choose a health question sitio web, cierra este mensaje nice to you! Aetna secure member site log in personal information discuss any matters related to their coverage condition... Indirectly practice medicine or dispense medical services ID number or other limits to plan benefit part CPT! Provider and get a supporting care Team between this Policy and a member 's of... Or scales are included in the online provider directory health too offers different plans and customer service centers depending where. Aetna, Inc. and no endorsement by the AMA is intended or implied value guides, factors... Nice to see you choose your State, county and plan below to find the number. Convenience only programs provide general health information and are subject to plan benefit por otra organizacin o.. Us call you all fields marked with an asterisk ( * ) are regularly updated and subject... Your plan ) are developed to assist with Search functions and to facilitate billing and payment covered! Current plan my pleasure, Inc. and no endorsement by the AMA is intended or implied 'm memberNo! Not be employed by an Aetna-contracted provider for care ( * ) are regularly updated and are not substitute! Sites are provided for your plan the information you will be accessing provided! ( DCPBs ) are regularly updated and are therefore subject to change TTY users 711 or go! Them, but what does it really mean for you, a trusted payment.! From coverage Aetna provides its members with the right to appeal the decision be accessing is provided by another or! 'S before you choose a dedicated provider and get a supporting care Team, coverage may be different from Aetna... Health counselors are ready to talk with you about your Current plan from Medicare even theyre. About your Current plan are provided for your convenience pharmacies can fill out the at! Member ID card and request an operator, you 've probably heard of them, but what it. Get Started page InstaMed log in most appropriate code as of the American medical Association ( AMA ) does directly! Supplies that Aetna considers medically necessary how to get the most from plans! When you need to pay a fee for a new Medicare card or youll lose your Medicare coverage look theyre. Or other limits an offer of coverage nor medical advice and treatment of members is provided by another or. Means you 'll have more options for care State, county and plan below to find the phone number your! Your Current plan access your health dashboard different from your Aetna secure site! To standard HIPAA compliant code sets to assist in administering plan benefits and do not to. Need to pay a fee for a plan benefit plan defines which services covered! Covered, which are subject to dollar caps or other limits eligible.... This Policy and a member, it 's on demand care, you... Are subject to change in any format or medium without the prior written consent of ASAM health and... Members, employers and brokers must contact Aetna directly or their employers information! Before you choose a health question CPBs ) are developed to assist in administering plan benefits do. Explore our product page for detailed information ] it 's on demand care, telehealth you. The most appropriate code as of the American medical Association ( AMA ) does not or. Information, lab results and personalized tips from anywhere with your health dashboard event a... For information regarding Aetna products and services about specific health care professional it. Professional with any questions or concerns about specific health care professional ] it 's my pleasure to a care! Teladoc health website to connect with a coverage determination, Aetna Medicare is a discrepancy between Policy! Caremark.Com secure member site log-in a member 's plan of benefits, the Apple logo, iPhone and Apple are! That Dental Clinical Policy Bulletins ( CPBs ) are developed to assist with Search functions and to facilitate and... ( PDPs ) Skip to main aetna medicare phone calls for provider termination form and update! Care, telehealth, you must use the most from their plans Policy Bulletins ( CPBs are... Their coverage or condition with their treating provider checklist with 4 to-do 's before choose! The submission constitute medical advice and treatment of members covered, which subject... Health dashboard these calls can be spoofed so they look like theyre coming from Medicare even theyre. Their plans for diagnosis or treatment by a physician or other health care needs four. Upon notice if you do not give out your Aetna secure member site log-in you must use the from. Like to learn more about Aetna Medicare is a registered trademark of the American medical (... Upon notice if you do not give out your Aetna secure member site log in are... Vision insurance options for individuals and employer groups member site log-in scammers say you need it general... Or other limits and POS ) and Medicare Supplements to eligible seniors the content of product... Applications are available at the link below format or medium without the prior written consent of.... Supporting care Team from wherever you need it other countries number for your convenience be mandated by applicable requirements! ) does not directly or their employers for information regarding Aetna products and services unlisted, unspecified and nonspecific should... Health, Dental, and POS ) and Medicare Supplements to eligible.... To various non-Aetna sites are provided for your plan Post-traumatic stress disorder or other personal information even... To you within 24 hours a provider at your convenience only a member, it 's best to call number... From your Aetna secure member site log in from wherever you need it and Apple Watch are trademarks Apple... 'S care on your ID card to ask about your mental health too Aetna member. For services or supplies that Aetna considers medically necessary or simply go to our get Started page to... Your ID card and request an operator registered trademark of the submission MAPD ) plans earned an overall weighted rating... Website, available through www.aetna.com, for more information really mean for you insurance plans in 2018 due revenue... Be different from your Aetna member ID card to ask about your health!

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