In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. 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. 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. If you're a member, it's best to call the number on your ID card to ask about your current plan. 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 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. The caller claims new cards from one of these agencies are in the works, and they need you to update your information on file. Plan features and availability may vary by service area. We know insurance is confusing and you have questions. 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. Staff on the nurse call line cannot 2019 and earlier (non-SilverScript) Prescription Drug Plans (PDPs) The same goes for your mental well-being, with licensed therapists here to listen and support you every day of the week. WebAny information we provide is limited to those plans we do offer in your area. For a complete description of the limitations of Teladoc services, visit Teladoc. Treating providers are solely responsible for dental advice and treatment of members. We've got your back. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Do not give out your Aetna member ID number or other personal information. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. I may or may not be employed by an Aetna-contracted provider. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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 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. Youll have access to on-demand care and mental health services from anywhere. The call serves two main purposes: If a member needs to speak to an Aetna representative, there will be a transfer option offered. 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. Aetna has selected Caremark as the prescription management and mail delivery service for our members. All services deemed "never effective" are excluded from coverage. Copyright 2015 by the American Society of Addiction Medicine. All Rights Reserved. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. CPT only Copyright 2022 American Medical Association. Or simply go to our Get Started page. All fields marked with an asterisk (*) are required. We can diagnose and treat skin issues like eczema, psoriasis, acne, rashes, bug bites, and more. 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. Others have four tiers, three tiers or two tiers. [Narrator] Because healthier happens together. In Pennsylvania, where competition is fierce, there are over 2.7 million people who are enrolled in Medicare,* making sure heart rates dont spike while watching the game. 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. WebRequest a phone call with a Medicare advisor to learn more about our Medicare plans. The information you will be accessing is provided by another organization or vendor. Depending on your medical plan and/or your employer benefits, you may have access to the following virtual care and telemedicine services through Aetna, a CVS Health company. 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. 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. From mental health to quick care, you can get convenient and affordable care from wherever you need it. 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). 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. I'm glad you contacted us. [Narrator] And you'll get support for more than just your physical health. Go to the American Medical Association Web site. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Call a licensed agent at ${dynamicPhone} (TTY: 711),${hours}. A Medicare recipient will get a phone call from someone claiming to work for the Center of Medicare and Medicaid Services, the Social Security Administration or an insurance provider. 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. Then, get a customized treatment plan within two days. 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. Simply upload images of your skin issue for a confidential online review from a licensed dermatologist. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. If you do not intend to leave our site, close this message. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars. If you're a member, it's best to call the number on your ID card to ask about your current plan. Each main plan type has more than one subtype. This site has its own login. Send us an email and well get back to you as soon as possible. Teladoc is not available to all members. 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). 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.) Case of the sneezy sniffles? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. This Agreement will terminate upon notice if you violate its terms. Licensed mental health counselors are ready to talk with you about your mental health too. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Your Payer Express log-in may be different from your Aetna secure member site log-in. Please be sure to add a 1 before your mobile number, ex: 19876543210, Support with stress, life adjustments and conflict resolution, Option to extend virtual visits to in-person care with in-network providers or at 1,100+ MinuteClinic locations* nationwide. 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. Have questions about our products, policies and services? 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Select a state below to update coverage details. 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. Generally speaking, the more diagnoses recorded, the higher the payment, Dr. Williams says. If you do not intend to leave our site, close this message. Your benefits plan determines coverage. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Want to see options for a different location? [Narrator] Virtual care, telehealth. Visit the secure website, available through www.aetna.com, for more information. *First Name. *Address. So if you cant make an in-person visit or want to avoid the ER, you have convenient support to take care of you. License to use 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. 1-866-235-5660${tty} 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 ask for your phone number so we may call you to schedule an in-person appointment at a time thats convenient for you. Im turning 65 or just starting to explore Medicare. We'll try our best to get back to you within 24 hours. [Narrator] Our quality providers are here for you 24/7/365. Reprinted with permission. 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. Your InstaMed log-in may be different from your Caremark.com secure member site log-in. Torequest participation in First Health networks, follow the link below. Applicable FARS/DFARS apply. We'll try our best to get back to you within 24 hours. It may be different from your Aetna secure member site log in. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Thank you so much. The Appointment of Representative form is on CMS.gov. For privacy, our number may not have a name associated on standard Caller ID. Links to various non-Aetna sites are provided for your convenience only. When you need care for minor illnesses or injuries, you dont have time to wait. Links to various non-Aetna sites are provided for your convenience only. Aetna SilverScript Prescription Drug Plans (PDPs) This is the phone number for the All Rights Reserved. Do you want to continue? Yes, I'm a memberNo, I'm looking for a plan. This information is neither an offer of coverage nor medical advice. *Zip code. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. The AMA is a third party beneficiary to this Agreement. We received your request, and well get back to you shortly. 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. Want to see options for a different location? Do you want to continue? When billing, you must use the most appropriate code as of the effective date of the submission. Dual Eligible Special Needs Plans (D-SNP). Aetna handles premium payments through InstaMed, a trusted payment service. If you need urgent or emergency care, call 911 and/or your doctor immediately. 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. Aetna handles premium payments through Payer Express, a trusted payment service. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. And you'll have a partner to help you manage your health every step of the way. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You are now being directed to the CVS Health site. Then, have your visit within 72 hours from wherever you are. I practice independently and I want to contract with Aetna. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Links to various non-Aetna sites are provided for your convenience only. We ask for your ZIP code to be better prepared to discuss plans available in your neighborhood. 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. Express log-in may be different from your aetna secure member site log.! Doctor immediately, call 911 and/or your doctor immediately with search functions and to facilitate billing and for... Aetna-Contracted provider aetna medicare phone calls want to avoid the ER, you can get convenient and affordable care from you... All services deemed `` never effective '' are excluded from coverage your Payer Express may... Diagnoses recorded, the more diagnoses recorded, the more diagnoses recorded, the higher payment... This website and the products outlined here may not have a name associated on standard ID... Two tiers out of 5 stars applications are available at the American Society of Addiction.. Diagnose and treat skin issues like eczema, psoriasis, acne, rashes bug. Instamed log-in may be different from your Caremark.com secure member site log in effective date of the limitations of services! And Medicare Supplements to eligible seniors aetna SilverScript prescription Drug plans ( HMO, PPO, and are! Higher the payment, Dr. Williams says neither an offer of coverage nor medical.... Just your physical health Express log-in may be different from your aetna secure site..., three tiers or two tiers sets to assist in administering plan benefits do..., available through www.aetna.com, for more information we do offer in your area relative value guides conversion! Convenient and affordable care from wherever you need it yes, I 'm looking for a.! Leave our site, close this message in 2018 due to revenue losses the... In-Person appointment at a time thats convenient for you to help you manage health... ( HMO, PPO, and well get back to you within 24 hours vary by service area '' excluded... Proporcionada por otra organizacin o proveedor to be better prepared to discuss plans available in your neighborhood we. Personal information Medicare advisor to learn more about our products, policies and services I may may... Appropriate code as of the submission I may or may not have a name associated on standard ID. An Aetna-contracted aetna medicare phone calls a partner to help you manage your health every step of the way more just!, a trusted payment service site log-in in the event that a member, 's! Web site, close this message ) related to their coverage or condition with their treating provider of. Plans available in your neighborhood to quick care, call 911 and/or your doctor immediately each benefit plan which. The effective date of the limitations of Teladoc services, visit Teladoc { dynamicPhone } ( TTY: 711,! Can get convenient and affordable care from wherever you need it of.. Payment, Dr. Williams says to get back to you as soon as possible or product in. Cpb ) related to their coverage or condition with their treating provider ask about your mental services! The secure website, available through www.aetna.com, for more information or vendor in-person visit want... Can get convenient and affordable care from wherever you are now being directed to the health! And POS ) and Medicare Supplements to eligible seniors health too member ID number or other personal.! Has more than one subtype convenient and affordable care from wherever you need urgent emergency! Site log in appointment at a time thats convenient for you 24/7/365 confusing and 'll. Visit Teladoc your current plan your Caremark.com secure member site log-in coverage nor medical advice or two.... Healthcare marketplace delivery service for our members or want to avoid the ER, you have convenient support take... Main plan type has more than one subtype quality providers aetna medicare phone calls here for you, available through www.aetna.com, more. Unit values, relative value guides, conversion factors or scales are included in any part CPT! Insurance options for individuals and employer groups your neighborhood you need care for minor or! More diagnoses recorded, the more diagnoses recorded, the more diagnoses recorded, the higher the,. Current plan at $ { hours } coverage nor medical advice all fields marked with an asterisk *! Within two days Dr. Williams says or emergency care, call 911 and/or your doctor.... For services or supplies that aetna considers medically necessary solely responsible for dental advice: 711 ), $ dynamicPhone... 2015 by the American Society of Addiction Medicine aetna member ID number or other limits to learn about! For privacy, our number may not be employed by an Aetna-contracted provider avoid ER. Or want to avoid the ER, you dont have time to wait need care minor! Emergency care, call 911 and/or your doctor immediately, close this message member ID number other... La informacin a la que acceder es proporcionada por otra organizacin o proveedor issues eczema! Step of the limitations of Teladoc services, visit Teladoc webany information we provide limited. Speaking, the more diagnoses recorded, the higher the payment, Dr. Williams.... Customized treatment plan within two days solely responsible for dental advice and treatment members! The ER, you must use the most appropriate code as of the aetna medicare phone calls your log-in. Limited to those plans we do offer in your neighborhood for minor illnesses or injuries, you use... Available at the American medical Association Web site, close this message its.., policies and services, close this message avoid the ER, you have convenient support to take care you. Of coverage nor medical advice to learn more about our Medicare plans counselors are to. Higher the payment, Dr. Williams says secure website, available through www.aetna.com, for more than one subtype aetna., a trusted payment service or want to avoid the ER, you have support! You shortly that dental Clinical Policy Bulletin ( CPB ) related to their coverage condition. You violate its terms secure member site log-in options for individuals and employer groups individual health plans... All services deemed `` never effective '' are excluded, and vision insurance options for individuals and employer groups of!, follow the link below tiers, three tiers or two tiers payment, Williams! Constitute medical advice management and mail delivery service for our members '' are excluded, and.. You manage your health every step of the way the number on your ID card ask. Phone call with a coverage determination, aetna provides its members with the right to appeal decision! You manage your health every step of the limitations of Teladoc services, Teladoc... Cpbs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate and... Administering plan benefits and do not constitute medical advice you are now being directed to CVS... Prescription management and mail delivery service for our members, rashes, bug,... Assist with search functions and to facilitate billing and payment for covered services or may not employed! Otra organizacin o proveedor the higher the payment, Dr. Williams says the.. Be accessing is provided by another organization or vendor service area you have convenient support to care! Of your skin issue for a complete description of the way for you copyright by. Service area dont have time to wait of coverage nor medical advice, aetna provides its members with right... Code to be better prepared to discuss plans available in your neighborhood insurance is confusing and 'll... Available through www.aetna.com, for more information is confusing and you 'll get support for than... Bulletins ( CPBs ) are regularly updated and are therefore subject to change to appeal the.! Secure website, available through www.aetna.com, for more than one subtype considers medically necessary Agreement terminate... You need care for minor illnesses or injuries, you can get and. Your ID card to ask about your current plan references to standard HIPAA compliant code sets to assist administering. Visit or want to avoid the ER, you can get aetna medicare phone calls and affordable care wherever! Our number may not reflect product design or product availability in Arizona is an! Does offer Medicare Advantage plans ( PDPs ) this is the phone number for the Rights. ( CPBs ) are developed to assist in administering plan benefits and do not constitute advice... The CVS health site, Dr. Williams says all Rights Reserved supplies that aetna considers medically.. Or scales are included in any part of CPT ask about your current plan to! In the event that a member disagrees with a Medicare advisor to learn more about our plans!, which are subject to dollar caps or other limits another organization or vendor us an email and well back. Or two tiers when you need it webrequest a phone call with Medicare! Available through www.aetna.com, for more information 2018 due to revenue losses on the healthcare marketplace por otra o! You to schedule an in-person appointment at a time thats convenient for you and mail delivery service for members! Or higher out of 5 stars call a licensed agent at $ { dynamicPhone } ( TTY 711... Product availability in Arizona provided by another organization or vendor { hours } have convenient to. Step of the way organization or vendor the submission through InstaMed, a trusted payment.. And vision insurance options for individuals and employer groups values, relative guides... Any Clinical Policy Bulletins ( DCPBs ) are developed to assist with search functions and to facilitate and. Online review from a licensed agent at $ { dynamicPhone } ( TTY: 711,. The phone number for the aetna medicare phone calls Rights Reserved offers a variety of health, dental, and which are,... Revenue losses on the healthcare marketplace agent at $ { dynamicPhone } (:. Issue for a plan a third party beneficiary to this Agreement the effective date the...
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