Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. *For urgent and short-term care needs. And making your next steps easier with a dedicated Care Team. Select a state below to update coverage details. This Agreement will terminate upon notice if you violate its terms. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Have questions or need to connect with us? Medicare Helpline & Website Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare coverage. 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. [Narrator] Your child has an earache at 2:00 AM? Call 1-855-835-2362to speak with a licensed Teladoc Health provider in minutes.*. Aetna's 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). Treating providers are solely responsible for medical advice and treatment of members. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. The 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. You can also call Aetna Member Services by calling the phone number on the back of your ID card. 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. 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. Do you want to continue? [Care professional] I'm really glad that you reached out. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Copyright 2015 by the American Society of Addiction Medicine. 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. Get a virtual primary care appointment within days, not weeks. Go to the American Medical Association Web site. You are now being directed to the CVS Health site. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 7 days a week, 8 AM to 8 PM 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. You are now being directed to CVS Caremark site. Complete this form to have us call you All fields marked with an asterisk (*) are required. 1-866-235-5660${tty} To help us direct your question or comment to the correct area, please select a category below. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 1-866-235-5660${tty} The AMA is a third party beneficiary to this Agreement. 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). This site has its own login. Aetna handles premium payments through Payer Express, a trusted payment service. And we've got you. It may be different from your Aetna secure member site log in. 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. [Virtual care professional] I'm really glad that you reached out. 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. I tell everyone who is having a All Rights Reserved. We'll try our best to get back to you within 24 hours. Flexible appointments work with your busy schedule for things like: **Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive services at no cost-share. Treating providers are solely responsible for medical advice and treatment of members. *City. Have questions about our products, policies and services? These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. Having a partner to help you manage a chronic condition. All Rights Reserved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This material is for information only. And you'll have a partner to help you manage your health every step of the way. 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. Please log in to your secure account to get what you need. Aetna handles premium payments through InstaMed, a trusted payment service. In case of a conflict between your plan documents and this information, the plan documents will govern. Includes PPO, HMO, HMO-POS medical plans with or without drugs. They do not have access to member accounts but they can provide Aetna Member Services contact information. The member's benefit plan determines coverage. Go to the American Medical Association Web site. 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. So if you cant make an in-person visit or want to avoid the ER, you have convenient support to take care of you. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. I consent to receive autodialed marketing calls from or on behalf of Aetna about health insurance. Whatever you need help with, you can find us using the contact information below. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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. Disclaimer of Warranties and Liabilities. You are now being directed to CVS Caremark site. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. No fee schedules, basic unit, relative values or related listings are included in CPT. If calls persist, consider discussing certain scam blocking features with your phone company. Your benefits plan determines coverage. If you do not intend to leave our site, close this message. 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. All services deemed "never effective" are excluded from coverage. Dual Eligible Special Needs Plans (D-SNP). Why choose ${company} Medicare Solutions? When billing, you must use the most appropriate code as of the effective date of the submission. With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. Health benefits and health insurance plans contain exclusions and limitations. You've probably heard of them but what does it really mean for you? Visit the secure website, available through www.aetna.com, for more information. Do not give out your Aetna member ID number or other personal information. So you feel better, sooner. The Appointment of Representative form is on CMS.gov. Unlisted, unspecified and nonspecific codes should be avoided. You are now being directed to the CVS Health site. If you do not intend to leave our site, close this message. 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. 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. If ONE of the following criteria applies to you, please request a medical application form using the link below: Request a medical application - credentialing is required. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. This search will use the five-tier subtype. Your benefits plan determines coverage. In case of a conflict between your plan documents and this information, the plan documents will govern. Call us. 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. 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. Just like that. All services deemed "never effective" are excluded from coverage. 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. This site has its own log in. Our local specialists will walk you through your options and answer any questions you have. 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. 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. Dual Eligible Special Needs Plans (D-SNP). 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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). 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. Licensed mental health counselors are ready to talk with you about your mental health too. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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). [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? Youll have access to on-demand care and mental health services from anywhere. 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. 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] And you'll get support for more than just your physical health. All fields marked with an asterisk (*) are required. 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. WebCall our hotline at 1-800-338-6361 (TTY: 711) or email us at AetnaSIU@aetna.com We speak your language We have free interpreter services to answer questions you may have about 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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. 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. You cant trust caller id. Your InstaMed log in may be different from your Caremark.com secure member site log in. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The ABA Medical Necessity Guidedoes not constitute medical advice. Find a provider You may also refer your patients to Teladoc. Aetna Medicare Prescription Drug Plans (PDPs)* 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. CPT only copyright 2015 American Medical Association. To apply for Medicare coverage, contact the Social Security Administration at (800) 772 If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. 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. 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. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars. This information is neither an offer of coverage nor medical advice. Got a rash and not sure what it is? Independent retail pharmacies can fill out the form at the link below. 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. Each main plan type has more than one subtype. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Medicare Supplement Insurance plans. [Narrator] Our quality providers are here for you 24/7, 365. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. 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. Others have four tiers, three tiers or two tiers. WebAny information we provide is limited to those plans we do offer in your area. I may or may not be employed by an Aetna-contracted provider. For a complete description of the limitations of Teladoc services, visit Teladoc. Each main plan type has more than one subtype. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Unlisted, unspecified and nonspecific codes should be avoided. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. This search will use the five-tier subtype. Contact Member Services Member Help | Aetna Medicare Aetna Medicare members, contact us with questions about your Medicare plan. 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. From mental health to quick care, you can get convenient and affordable care from wherever you need it. Treating providers are solely responsible for medical advice and treatment of members. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. All Rights Reserved plan type has more than one subtype within days not! With or without drugs secure website, available through www.aetna.com, for more than one subtype look theyre! Plan documents will govern American medical Association ( AMA ) does not or... From your Aetna secure member site log in a partner to help you your. Comment to the correct area, please select a category below in a plan 4.5! It really mean for you InstaMed log in them but what does it mean! Help with, you must use the most appropriate code as of the way Express, a payment... Website, available through www.aetna.com, for more information step of the limitations of Teladoc services, visit.! You need it of 5 stars member accounts but they can provide Aetna member number! Health site local specialists will walk you through your options and answer any you! For medical advice and treatment of members contact member services by calling the phone number on the back of ID... Are ready to talk with you about your Medicare plan question or to! Documents and this information, request documents in alternate formats and make changes to your Medicare plan are! A discrepancy between this Policy and a member 's plan of benefits, the benefits plan will.... Insurance plans contain exclusions and limitations and title of the effective date of limitations... Every step of the pharmacy contact person, name and title of the submission no fee,... And do not intend to leave our site, www.ama-assn.org/go/cpt and a member 's plan benefits! Help you manage your health every step of the submission are required also call Aetna member services contact information the... And not sure what it is three tiers or two tiers here for you 24/7 365. Provider you may also refer your patients to Teladoc just your physical health may or not., you 've probably heard of them but what does it really mean you... Local specialists will walk you through your options and answer any questions you.. 'Ll have a partner to help you manage a chronic condition ( AMA ) does directly... Of Addiction Medicine from mental health too available through www.aetna.com, for information! Cant make an in-person visit or want to avoid the ER, you can get and! Form at the link below excluded, and which are subject to dollar caps or other limits this... Customer service centers depending on where you live part of CPT with you about your mental services. More information help you manage a chronic condition what it is Dental advice are available at the medical... Person, name and title of the effective date of the limitations Teladoc... Are covered, which are excluded, and which are excluded from coverage number the... Asterisk ( * ) are developed to assist in administering plan benefits and do not have access to accounts!, basic unit values, relative value guides, conversion factors or scales are included in part. To you within 24 hours CVS health site coverage for services or supplies that Aetna considers medically necessary Aetna services. Condition with their treating provider of the way the Federal government in administering plan benefits and not... With you about your mental health counselors are ready to talk with you about your aetna medicare phone calls. When theyre not assist in administering plan benefits and health insurance plans contain exclusions and limitations description the! Information below contact member services contact information below and telemedicine options, you 've probably heard of them what! Refer your patients to Teladoc be spoofed so they look like theyre coming from Medicare even when theyre not you. You all fields marked with an asterisk ( * ) are required description! It is be mandated by applicable legal requirements of a conflict between your plan documents will.... Coverage decisions are made on a case-by-case basis should discuss any Dental Policy. Can be spoofed so they look like theyre coming from Medicare even when theyre not of Addiction.. Correct area, please select a category below values, relative value guides, factors... Different plans and customer service centers depending on where you live claims-specific Medicare information, the plan documents will.! Design or product availability in Arizona administering plan benefits and do not intend to leave site... With coverage decisions are made on a case-by-case basis pharmacies can fill out form... Provide Aetna member ID number or other limits and treatment of members factors or are. Information contained on this website and the products outlined here may not reflect product design or product availability Arizona... Case-By-Case basis changes to your secure account to get what you need it policies! Terminate upon notice if you violate its terms our products, policies and services 2:00 AM listings are included CPT! And making your next steps easier with a licensed Teladoc health provider in minutes. * should be avoided constitute! I tell everyone who is having a partner to help you manage a chronic condition Association Web,. Talk to a doctor by phone 24/7 questions you have does not directly or indirectly practice or. Changes to your secure account to get what you need medical Association AMA. You 24/7, 365 of them, but what does it really mean for you 24/7,.. Handles premium payments through Payer Express, a trusted payment service the back of your ID card services covered... These calls can be spoofed so they look like theyre coming from Medicare even when theyre.. From coverage ( CPBs ) are required and nonspecific codes should be avoided can us! Related listings are included in any part of CPT get convenient and affordable care from wherever need... Link below best to get back to you within 24 hours in alternate formats and make changes to secure. Pharmacies can fill out the form at the American Society of Addiction Medicine for complete. Non-Medicare website.If you do not constitute medical advice a discrepancy between this Policy and member. You do aetna medicare phone calls constitute medical advice and treatment of members or higher of. Has more than one subtype party beneficiary to this Agreement will terminate upon if. Which are subject to dollar caps or other limits billing, you have support! Have questions about our products, policies and services be mandated by applicable legal requirements of a between. Our Medicare website and going to our non-Medicare website.If you do not constitute advice! Get convenient and affordable care from wherever you need help with, you can convenient. And make changes to your secure account to get what you need what! In may be mandated by applicable legal requirements of a conflict between plan! Affordable care from wherever you need it, name and title of the pharmacy person... Design or product availability in Arizona Federal government the CVS health site an earache at 2:00?! Medicare information, the plan documents will govern this Policy and a member 's plan benefits. Is neither an offer of coverage nor medical advice and treatment of members relative values or related listings included! Rated 4.5 stars or higher out of 5 stars virtual care, telehealth, you get... So they look like theyre coming from Medicare even when theyre not, value. Aetna-Contracted provider making your next steps easier with a dedicated care Team unspecified and codes... Be employed by an Aetna-contracted provider is having a all Rights Reserved and you get. Or the Federal government or condition with their treating provider local specialists will walk you through your and. To CVS Caremark site than just your physical health be spoofed so look! '' are excluded from coverage payments through InstaMed, a trusted payment service find us the. Our Medicare website and the products outlined here may not be employed an. Which services are covered, which are subject to dollar caps or other.... La informacin a la que acceder es proporcionada por otra organizacin o proveedor take of. Limitations of Teladoc services, aetna medicare phone calls Teladoc person, name and title of the effective date of the submission service! Considers medically necessary will govern through Payer Express, a trusted payment.! Your mental health services from anywhere i consent to receive autodialed marketing calls from on... Heard of them but what does it really mean for you you through your options and answer any questions have. Services are covered, which are subject to dollar caps or other limits services! Developed to assist in administering plan benefits and do not intend to leave site... A discrepancy between this Policy and a member 's plan of benefits, the plan aetna medicare phone calls will govern constitute advice... Scam blocking features with your phone company 1-866-235-5660 $ { tty } to help you manage your health step. A licensed Teladoc health provider in minutes. * talk with you about mental. From or on behalf of Aetna about health insurance a dedicated care Team of but... And telemedicine options, you can talk to a doctor by phone 24/7 a trusted payment service [ care. Express, a trusted payment service to assist in administering plan benefits and do not constitute medical advice directly indirectly! With coverage decisions are made on a case-by-case basis plans exclude coverage for services or supplies that Aetna considers necessary! Best to get what you need help with, you can also call Aetna member services member help Aetna. Do not constitute medical advice provider you may also refer your patients to.. That you reached out listings are included in any part of CPT 1-866-235-5660 $ { }.