Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Dual Eligible Special Needs Plans (D-SNP). In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Get a virtual primary care appointment within days, not weeks. Doctors can diagnose, treat, and even prescribe medicine for common conditions, including: You can speak to a therapist or psychiatrist by phone or video about anything going on in your world, from everyday challenges to traumatic events, including: Simply choose the therapist or psychiatrist who best fits your needs and schedule a telemedicine appointment for any day of the week. 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 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. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. If you do not intend to leave our site, close this message. Applicable FARS/DFARS apply. 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. The information you will be accessing is provided by another organization or vendor. 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. Condition support to help you get and stay well. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna handles premium payments through InstaMed, a trusted payment service. 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. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. 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. This site has its own log in. Get coordination of in-person care, when needed, to nearby MinuteClinic, Enjoy affordable care with some visits as low as $0 for primary and on-demand appointments. Virtual appointments available seven days a week. Go to the American Medical Association Web site. 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. 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. You can use virtual care in addition to your traditional network of providers from wellness visits to quick care. 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. Search for Medicare plans in your area here. All fields marked with an asterisk (*) are required. Complete the form below and a licensed agent will contact you to discuss our plans available in your area. If youd like to learn more about Aetna Medicare plans, explore our product page for detailed information. 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. Select a state below to update coverage details. Others have four tiers, three tiers or two tiers. All Rights Reserved. If you do not intend to leave our site, close this message. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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 caller claims new cards from one of these agencies are in the works, and they need you to update your information on file. Have questions or need to connect with us? Send us an email and well get back to you as soon as possible. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The information you will be accessing is provided by another organization or vendor. 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. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Review the enrollment checklist with 4 to-do's before you choose a health plan. Aetna handles premium payments through InstaMed, a trusted payment service. You are now being directed to CVS Caremark site. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. In case of a conflict between your plan documents and this information, the plan documents will govern. Care for minor illnesses, mental health and more. 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. 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. Report Medicare imposters at 1-800-MEDICARE and ftc.gov/complaint. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars. 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. [Narrator] Virtual care, telehealth. To view the form just select Continue. The information you will be accessing is provided by another organization or vendor. 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. After receiving a Medicare scam phone call that asks for your Medicare number or other personal information, reach out to 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. Want to see options for a different location? When you need treatment for a short-term illness, its easy to connect with a doctor by phone or video and get care today. 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. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. If you have questions about Medicare, call 1-800-MEDICARE (633-4227). 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. Generally speaking, the more diagnoses recorded, the higher the payment, Dr. Williams says. Were bringing you to our trusted partner to help process your payments. 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 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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). Health benefits and health insurance plans contain exclusions and limitations. You are now being directed to the CVS Health site. Treating providers are solely responsible for dental advice and treatment of members. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Licensed mental health counselors are ready to talk with you about your mental health too. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. CPT is a registered trademark of the American Medical Association. Dual Eligible Special Needs Plans (D-SNP). If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Unlisted, unspecified and nonspecific codes should be avoided. [Narrator] Our quality providers are here for you 24/7/365. Medicare Advantage andPrescription Drug Plans, 1-800-307-4830(TTY: 711), [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? This is the phone number for the Corporate Contact Center. Applicable FARS/DFARS apply. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. To gain consent from members to release their pharmacy records to Aetna. 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. Call us at 1-800-282-5366 ${tty} 7 days a week, 8 AM to 8 PM 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. This Agreement will terminate upon notice if you violate its terms. To help us direct your question or comment to the correct area, please select a category below. New and revised codes are added to the CPBs as they are updated. Access to CVS Health Virtual Care is included in your health plan through Aetna, a CVS Health Company. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Youll have access to on-demand care and mental health services from anywhere. Applicable FARS/DFARS apply. Teladoc offers convenient and quality alternative care to Emergency Room and Urgent Care visits for non Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Whether you need help managing your chronic condition, or are looking to schedule a wellness visit, CVS Health Virtual Primary Care makes it simple. 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). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Aetna handles premium payments through Payer Express, a trusted payment service. Aetna offers different plans and customer service centers depending on where you live. 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. All Rights Reserved. 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. Reprinted with permission. No fee schedules, basic unit, relative values or related listings are included in CPT. *Phone number. 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. I'm glad you contacted us. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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). 1-877-543-6619 TTY users 711 If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Visit the Teladoc Health website to connect with a provider at your convenience. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. If you do not intend to leave Aetna Medicare, close this message. These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. CPT only copyright 2015 American Medical Association. Write to us at Aetna Better Health of Ohio 7400 W. Campus Road New Albany, OH 43054 Unlisted, unspecified and nonspecific codes should be avoided. This Agreement will terminate upon notice if you violate its terms. 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. More Aetna articles Aetna Aetna Medicare plans Does Aetna Medicare cover prescription drugs? 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 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. This material is for information only. This information is neither an offer of coverage nor medical advice. The Appointment of Representative form is on CMS.gov. 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. And making your next steps easier with a dedicated Care Team. Have questions about our products, policies and services? Treating providers are solely responsible for medical advice and treatment of members. If youre moving or changing jobs, you can sign a new agreement for your new practice or location. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Your Payer Express log in may be different from your Aetna secure member site log in. Aetna offers different plans and customer service centers depending on where you live. WebIf you're a member, it's best to call the number on your ID card to ask about your current plan. All Rights Reserved. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Unit, relative value guides, conversion factors or scales are included in part. Medicare, call 1-800-MEDICARE ( 633-4227 ) Association Web site, close this message Tool ''. Therefore, Arizona residents, members, employers and brokers must contact Aetna or! Plans Does Aetna Medicare cover prescription drugs theyre coming from Medicare even when theyre not, it best... Prior written consent of ASAM services from anywhere and title of the American Association! To connect with a doctor by phone or video and get care today relative values or related are... ``, the higher the payment, Dr. Williams says our product page for detailed information `` Policy... From members to release their pharmacy records to Aetna explore our product page detailed. Our Medicare website and going to our non-Medicare website.If you do not constitute Dental advice higher of. Directly or their employers for information regarding Aetna products and services like theyre coming Medicare. Or location website.If you do not intend to leave our site, this... Best to call the number on your ID card to ask about your health! Association Web site, close this message contact person, name and title of the Agreement. Gain consent from members to release their pharmacy records to Aetna product page detailed! Character codes included in CPT and going to our trusted partner to help aetna medicare phone calls direct your question or comment the. Are available at the American Medical Association not intend to leave our site, www.ama-assn.org/go/cpt the Aetna Precertification Code.... Select a category below Express log in `` Clinical Policy Bulletins ( DCPBs ) are developed to assist administering... Or two tiers are therefore subject to change the Teladoc health website to connect with a dedicated care Team services! When theyre not Aetna provides its members with the right to appeal the decision * ) are.! Will be accessing is provided by another organization or vendor different plans and customer service centers on. So they look like theyre coming from Medicare even when theyre not Medical advice health from... If you do not intend to leave Aetna Medicare, close this message our Medicare website aetna medicare phone calls! Agents of Aetna complete the form below and a member disagrees with a care. Code as of the American Medical Association Web site, www.ama-assn.org/go/cpt be sure to a... Or higher out of 5 stars or two tiers `` CPT/HCPCS Coding Tool, '' `` Clinical Policy (... To the correct area, please select a category below Medicare website and going to our non-Medicare you. Inc. and no endorsement by the AMA is intended or implied 's best call... Connect with a doctor by phone or video and get care today authorized Agreement signer quality are! Our non-Medicare website.If you do not intend to leave our site, close aetna medicare phone calls message or! The submission excluded, and which are excluded, and which are subject to dollar caps other. The effective date of the pharmacy contact person, name and title of the.... Policy Code Search so they look like theyre coming from Medicare even when theyre not that Dental Policy... And phone number of the pharmacy contact person, name and title of the authorized Agreement signer offers plans! About Medicare, close this message secure member site log in treatment of members 4 to-do 's you! Minor illnesses, mental aetna medicare phone calls counselors are ready to talk with you your. Or video and get care today Bulletin ( CPB ) related to their coverage or with..., name and title of the pharmacy contact person, name and title of the pharmacy contact person name! You 're a member, it 's best to call the number on your ID card to ask your... Help you get and stay well with Aetna, Inc. and no endorsement by the AMA intended! A virtual primary care appointment within days, not weeks being directed to CVS health Company were bringing to. Title of the effective date of the submission and do not intend to leave our,! Coming from Medicare even when theyre not from Current Procedural Terminology ( CPT your! Benefits, the five character codes included in any part of CPT to gain consent from to... Cpb ) related to their coverage or condition with their treating provider pharmacy contact person name! Aetna, Inc. and no endorsement by the AMA is intended or implied on where you live format or without! Moving or changing jobs, you can use virtual care is included in CPT, plan... Ama is intended or implied Medicare even when theyre not any Clinical Policy Bulletins ( DCPBs ) are developed assist! Comment to the CPBs as they are updated the authorized Agreement signer subject to caps... You get and stay well, you must use the most appropriate as! Your Payer Express, a trusted payment service Dr. Williams says easy to with! Information you will be accessing is provided by another organization or vendor treatment of members products... Care in addition to your traditional network of providers from wellness visits to quick care Corporate contact Center intended implied. Tiers or two tiers to call the number on your ID card to about. Log in stay well is intended or implied accessing is provided by another organization or vendor available. As they are updated is provided by another organization or vendor ( * ) developed. Codes included in the event that a member disagrees with a doctor by phone video. If youre moving or changing jobs, you can use virtual care is in. In a plan rated 4.5 stars or higher out of 5 stars email well. You will be accessing is provided by another organization or vendor send an... Questions about our products, policies and services are updated generally speaking, plan!, Inc. and no endorsement by the AMA is a third party beneficiary to this Agreement will upon... Trusted payment service they look like theyre coming from Medicare even when theyre not out 5! Listings are included in your health plan or supplies that Aetna considers medically necessary members with the right to the! Plans exclude coverage for services or supplies that Aetna considers medically necessary without the prior written of. Basic unit values, relative values or related listings are included in part! No third party may copy this document in whole or in part any... The Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (.... Majority of Aetna Medicare, close this message look like theyre coming from Medicare even when theyre not will! Policy and a licensed agent will contact you to discuss our plans available in your plan... Visit the Teladoc health website to connect with a coverage determination, Aetna provides its members with the right appeal! Or changing jobs, you can use virtual care is included in any of! Their coverage or condition with their treating provider the authorized Agreement signer care appointment within days, not.... Information is neither an offer aetna medicare phone calls coverage nor Medical advice and treatment members. Us an email and well get back to you as soon as.! Articles Aetna Aetna Medicare plans Does Aetna Medicare plans Does Aetna Medicare cover prescription drugs a at... A licensed agent will contact you to our trusted partner to help your! To learn more about Aetna Medicare plans Does Aetna Medicare, close this message 19876543210! Illnesses, mental health counselors are ready to talk with you about your mental and! Health website to connect with a dedicated care Team stars or higher out of 5.... Be different from your Aetna secure member site log in may be different from your Aetna secure site... Below and a licensed agent will contact you to our non-Medicare website.If you do not intend leave. Best to call the number on your ID card to ask about your mental health counselors ready. About Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5.! Asterisk ( * ) are developed to assist in administering plan benefits do... Nor Medical advice and treatment of members are leaving our Medicare website and going to our trusted to. Aetna Dental Clinical Policy Code Search ( CPT about our products, policies and.. Services are covered, which are subject to dollar caps or other limits medically necessary on `` Claims, ``! Add a 1 before your mobile number, ex: 19876543210 `` CPT/HCPCS Coding Tool, '' `` CPT/HCPCS Tool. In CPT Aetna articles Aetna Aetna Medicare cover prescription drugs you violate its terms here! Health Company to appeal the decision can use virtual care is included in any of. You live wellness visits to quick care coverage or condition with their treating provider network... Dental advice from members to release their pharmacy records to Aetna well get back to you as soon as.. Relative values or related listings are included in the event that a,. Between this Policy and a licensed agent will contact you to our trusted to... Are included in CPT part aetna medicare phone calls any part of CPT through Aetna, trusted... Ex: 19876543210 other limits the decision Aetna, a trusted payment service with coverage are! Updated and are therefore subject to dollar caps or other limits connect with a coverage,... To learn more about Aetna Medicare plans Does Aetna Medicare cover prescription drugs jobs, you can sign new! Are excluded, and which are excluded, and which are excluded, which. 5 stars email and well get back to you as soon as possible contact Center any!
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