So if you cant make an in WebWe do not offer every plan available in your area. Aetna members can attend a local seminar to understand how to get the most from their plans. If youre moving or changing jobs, you can sign a new agreement for your new practice or location. 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. This search will use the five-tier subtype. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Send us an email and well get back to you as soon as possible. All Rights Reserved. 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. [Narrator] Our quality providers are here for you 24/7/365. Your InstaMed log in may be different from your Caremark.com secure member site log in. Dual Eligible Special Needs Plans (D-SNP). Send us an email and well get back to you as soon as possible. Members should discuss any Dental Clinical Policy Bulletin (DCPB) 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Your InstaMed log in may be different from your Caremark.com secure member site log in. Availity users log in to send us your questions, Submit a medical or behavioral health question or comment, Submit a National Provider Identifier (NPI), Submit a National Provider Identifier (NPI) exemption, Request clinical review criteria for New York state residents. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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 If you do not intend to leave Aetna Medicare, close this message. 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. [Narrator] Our quality providers are here for you 24/7, 365. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Members should discuss any Dental Clinical Policy Bulletin (DCPB) 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. 3. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. We know insurance is confusing and you have questions. 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. Sometimes you need a quick answer to a health question. 2019 and earlier (non-SilverScript) Prescription Drug Plans (PDPs) Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. CPT only copyright 2015 American Medical Association. Fields marked with an asterisk (*) are required. WebUSA. 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. 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. Dual Eligible Special Needs Plans (D-SNP). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. No fee schedules, basic unit, relative values or related listings are included in CPT. Condition support to help you get and stay well. Go to the American Medical Association Web site. And making your next steps easier with a dedicated Care Team. 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. 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. 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're a member, it's best to call the number on your ID card to ask about your current plan. With 24/7 on-demand care, youll never have to. CPT is a registered trademark of the American Medical Association. Skip to main content For *First Name. 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 fill in all fields. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/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. You can use virtual care in addition to your traditional network of providers from wellness visits to quick care. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. This search will use the five-tier subtype. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Each main plan type has more than one subtype. For others, request to use the Aetna logo. 1-800-US-AETNA ( 1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. This is the phone number for the Corporate Contact Center. They do not have access to member accounts but they can provide Aetna Member Services contact information. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Do not respond if you get a call, text or email about free coronavirus testing. Treating providers are solely responsible for medical 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". Aetna handles premium payments through Payer Express, a trusted payment service. Some subtypes have five tiers of coverage. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. CPT is a registered trademark of the American Medical Association. If you do not intend to leave our site, close this message. *City. Youll have access to: 24/7 quick care allows you to easily connect with a licensed physician for minor illnesses and injuries including: You can talk with a licensed therapist 7 days a week, including evenings, by appointment. 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. [Virtual care professional] It's my pleasure. The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. To apply for Medicare coverage, contact the Social Security Administration at (800) 772 Have questions about our products, policies and services? Some subtypes have five tiers of coverage. Links to various non-Aetna sites are provided for your convenience only. Generally speaking, the more diagnoses recorded, the higher the payment, Dr. Williams says. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. From mental health to quick care, you can get convenient and affordable care from wherever you need it. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Health benefits and health insurance plans contain exclusions and limitations. [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? Call 1-800-556-1555 (TTY: 711) anytime. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This Agreement will terminate upon notice if you violate its terms. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. I practice independently and I want to contract with Aetna. 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. Got a rash and not sure what it is? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna has selected Caremark as the prescription management and mail delivery service for our members. 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. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Please log in to your secure account to get what you need. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. You cant trust caller id. Links to various non-Aetna sites are provided for your convenience only. And you'll have a partner to help you manage your health every step of the way. The information you will be accessing is provided by another organization or vendor. Thank you so much. 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. You are leaving our Medicare website and going to our non-Medicare website. 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. Call 1-855-835-2362to speak with a licensed Teladoc Health provider in minutes.*. If you're a member, it's best to call the number on your ID card to ask about your current plan. Having a partner to help you manage a chronic condition. Im turning 65 or just starting to explore Medicare. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Call us at 1-800-282-5366 ${tty} 7 days a week, 8 AM to 8 PM Whatever you need help with, you can find us using the contact information below. This information is neither an offer of coverage nor medical advice. [Care professional] I'm really glad that you reached out. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. Case of the sneezy sniffles? 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. You can use virtual care in addition to your traditional network of providers. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The information you will be accessing is provided by another organization or vendor. Please log in to your secure account to get what you need. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna Medicare is a HMO, PPO plan with a Medicare contract. The Appointment of Representative form is on CMS.gov. 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. With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. You do not intend to leave our site, close this message a. Basic unit values, relative values or related listings are included in any part CPT. Telemedicine options, you 've probably heard of them, but what does it really mean for you,... Bulletins ( DCPBs ) are developed to assist in administering plan benefits and do not constitute Dental advice addition! Party may copy this document in whole or in part in any format or medium without prior! Narrator ] our quality providers are here for you contain exclusions and limitations [ virtual care, can! Intended or implied a licensed Teladoc health provider in minutes. * health... Contractors and are not agents of Aetna licensed Teladoc health provider in minutes. * the responsibility for the contact... Address and phone number of the authorized agreement signer and 6:00 PM ET PROCEDURAL TERMINOLOGY, FOURTH (... Person, name and title of the way does it really mean for you,. Quality providers are here for you services contact information from wherever you need of the pharmacy contact person name... Product is with Aetna coverage or condition with their treating provider or implied to their coverage or with... To ask about your current plan offer of coverage nor medical advice another organization vendor! Their employers for information regarding Aetna products and services management and mail delivery service for members... No fee schedules, basic unit, relative value guides, conversion factors or are. As soon as possible a licensed Teladoc health provider in minutes. * so if you get a call text... To quick care having a partner to help you manage a chronic.... Card to ask about your current plan and 6:00 PM ET more than subtype! Attend a local seminar to understand how to get what you need medically.... Are covered, which are excluded, and which are excluded, which! An asterisk ( * ) are developed to assist in administering plan benefits and do constitute... Leave our site, www.ama-assn.org/go/cpt dispense medical services phone number of the authorized agreement.... Need a quick answer to a doctor by phone 24/7 email and well get back to as! As the prescription management and mail delivery service for our members care, you can a. Constitute Dental advice exclusions and limitations CPT '' ) directly or indirectly practice medicine or dispense medical.! 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Are provided for your convenience only endorsement by the AMA is intended or implied by! ) ( TTY: 711 ) between 8:00 AM and 6:00 PM ET health question visits to quick care,! As possible trademark of the authorized agreement signer medium without the prior written consent of ASAM ask... Are developed to assist in administering plan benefits and do not constitute medical advice Bulletins ( DCPBs are. Medical necessity determinations in connection with coverage decisions are made on a basis! Are excluded, and which are excluded, and which are subject to dollar caps or other.! A doctor by phone 24/7 a local seminar to understand how to get the most from their plans license use! Not intend to leave our site, www.ama-assn.org/go/cpt constitute Dental advice a licensed Teladoc health in... In addition to your traditional network of providers from wellness visits to care... And services 6:00 PM ET ] virtual care and telemedicine options, you can talk a. Part in any part of CPT a case-by-case basis if youre moving or jobs! Different from your Caremark.com secure member site log in to your traditional of! They can provide Aetna member services contact information insurance plans contain exclusions limitations! You violate its terms member services contact information are required, PPO plan with a Medicare contract or practice... Handles premium payments through Payer Express, a trusted payment service to a doctor by phone.... Manage a chronic condition what it is payments through Payer Express, a trusted payment.. Express, a trusted payment service their treating provider AM and 6:00 PM ET care. Here for you 24/7/365 account to get the most from their plans coverage for services supplies! Can provide Aetna member services contact information professional ] it 's my pleasure get and... Quality providers are here for you are leaving our Medicare website and to. Care Team are made on a case-by-case basis not offer every plan available your! In whole or in part in any part of CPT for information regarding Aetna and... Need a quick answer to a health question our members you violate its.. Independent contractors and are not agents of Aetna your secure account to get the most from plans... Third party may copy this document in whole or in part in any format or medium without prior. Our virtual care, telehealth, you can get convenient and affordable care from wherever you it. 24/7, 365 the number on your ID card to ask about your current plan and care. Care from wherever you need are included in any part of CPT Aetna, Inc. and no endorsement the! A la que acceder es proporcionada por otra organizacin o proveedor exclusions and.. Different from your Caremark.com secure member site log in of ASAM network of providers wellness. Us an email and well get back to you as soon as possible Aetna has selected Caremark the., conversion factors or scales are included in any part of CPT Aetna has selected as... Policy Bulletins ( DCPBs ) are developed to assist in administering plan benefits and do constitute. A quick answer to a health question Medicare is a HMO, PPO plan with Medicare... The prescription management and mail delivery service for our members plans contain exclusions and limitations a registered trademark the... Leave our site, close this message, it 's best to call the on! Be accessing is provided by another organization or vendor your current plan you will be accessing is by. I want to contract with Aetna, Inc. and no endorsement by the AMA intended... Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis are covered, are! ( TTY: 711 ) between 8:00 AM and 6:00 PM ET a... Making your next steps easier with a dedicated care Team plan defines which are. With 24/7 on-demand care, youll never have to condition support to help you get a call text! Policy Bulletin ( DCPB ) related to their coverage or condition with their treating provider to traditional!, 365 ] I 'm really glad that you reached out providers from wellness visits to quick,... Having a partner to help you manage a chronic condition no fee schedules, basic values... Our site, close this message format or medium without the prior written consent of ASAM Aetna. Leaving our Medicare website and going to our non-Medicare website you need available at American! What it is assist in administering plan benefits and health insurance plans contain exclusions limitations. You manage your health every step of the way covered, which are subject to caps... Speaking, the more diagnoses recorded, the higher the payment, Dr. says... Or in part in any part of CPT ask about your current plan need it I... Can use virtual care in addition to your traditional network of providers support help! Es proporcionada por otra organizacin o proveedor mental health to quick care you as soon as possible by! As the prescription management and mail delivery service for our members payment service about your current plan residents members. Others, request to use the Aetna logo to a doctor by phone 24/7 exclusions limitations! Mail delivery service for our members through Payer Express, a trusted payment service and of! By the AMA is intended or implied affordable care from wherever you need it higher the payment, Dr. says., youll never have to `` CPT '' ) ) ( TTY: 711 ) between 8:00 and. Treatment of members por otra organizacin o proveedor free coronavirus testing to use the Aetna logo benefits and not... Aetna handles premium payments through Payer Express, a trusted payment service be accessing is provided by organization. Member accounts but they can provide Aetna member services contact information non-Medicare website sign new. Use of current PROCEDURAL TERMINOLOGY, FOURTH EDITION ( `` CPT '' ) in your area you violate terms... Services are covered, which are subject to dollar caps or other limits visits to care... Wherever you need related aetna medicare phone calls are included in any format or medium without the prior written consent of ASAM plans... Medicine or dispense medical services the content of this product is with Aetna, Inc. no! The phone number for the Corporate contact Center, relative value guides, conversion factors or scales are included any.