Whether youre a Pirate or a Philly, an Eagle or a Steeler, you need your health to be in tip-top shape. 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. WebTo learn more about Aetna Medicare Advantage plans in your area or to enroll in an Aetna Medicare Advantage plan, speak with a licensed insurance agent by calling 1-877-890-1409 TTY Users: 711 24 hours a day, 7 days a week. 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. Links to various non-Aetna sites are provided for your convenience only. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. 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. 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. If you do not intend to leave our site, close this message. [Narrator] And you'll get support for more than just your physical health. For privacy, our number may not have a name associated on standard caller ID. We know insurance is confusing and you have questions. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Note: If you are a hospital based provider seeking to join an already contracted group, you do not need to complete the application independently. New and revised codes are added to the CPBs as they are updated. 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. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. New and revised codes are added to the CPBs as they are updated. Aetna offers different plans and customer service centers depending on where you live. Includes PPO, HMO, HMO-POS medical plans with or without drugs. You can talk to our registered nurses day or night on our Medicare Nurse Hotline to get help with: If you need urgent or emergency care, call 911 and/or your doctor immediately. The 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. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. From mental health to quick care, you can get convenient and affordable care from wherever you need it. Aetna handles premium payments through Payer Express, a trusted payment service. 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. Name, address and phone number of the pharmacy contact person, Name and title of the authorized agreement signer. The information you will be accessing is provided by another organization or vendor. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Want to see options for a different location? Get started with Teladoc Health through the Aetna HealthSMapp. Monday to Friday, 8 AM to 9 PM ET. CPT only Copyright 2022 American Medical Association. Call 1-800-556-1555 (TTY: 711) anytime. Youll also find additional mental health services for: Limitations and restrictions may apply for certain services, locations, or patients. Whether youve come down with a cold or need mental health counseling, CVS Health Virtual Care makes it simple. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna handles premium payments through InstaMed, a trusted payment service. 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. Unlisted, unspecified and nonspecific codes should be avoided. Reprinted with permission. 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. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The information you will be accessing is provided by another organization or vendor. Get a virtual primary care appointment within days, not weeks. You cant trust caller id. Report the call. Report Medicare imposters at 1-800-MEDICARE and ftc.gov/complaint. If youd like to learn more about Aetna Medicare plans, explore our product page for detailed information. If you do not intend to leave our site, close this message. Please report any scams by calling 1-800-447-8477 or online at https://tips.oig.hhs.gov/. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Members should discuss any matters related to their coverage or condition with their treating provider. Why choose ${company} Medicare Solutions? We received your request, and well get back to you shortly. Treating providers are solely responsible for medical advice and treatment of members. This site has its own log in. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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). Applicable FARS/DFARS apply. 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. [Mom] I feel so much relief. WebTelehealth Services for Aetna Members Care anytime, anywhere With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. If you do not intend to leave Aetna Medicare, close this message. We ask for your ZIP code to be better prepared to discuss plans available in your neighborhood. Please log in to your secure account to get what you need. Were bringing you to our trusted partner to help process your payments. [Virtual care professional] I'm really glad that you reached out. 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. If youre an Aetna member, you can call us for help. The member's benefit plan determines coverage. [Care professional] I'm really glad that you reached out. 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. When you need care for minor illnesses or injuries, you dont have time to wait. 2019 and earlier (non-SilverScript) Prescription Drug Plans (PDPs) CPT is a registered trademark of the American Medical Association. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Were available Monday through Friday, 9 AM to 6 PM ET. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Plan features and availability may vary by service area. 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. Reprinted with permission. Eligibility for Teladoc Health telemedicine offerings is dependent on your specific plan. CVS Health Virtual Care is all about you. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Medicare Advantage andPrescription Drug Plans, 1-800-307-4830(TTY: 711), Complete the form below and a licensed agent will contact you to discuss our plans available in your area. WebUSA. Your InstaMed log-in may be different from your Caremark.com secure member site log-in. 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. Convenient care for short-term health needs. New and revised codes are added to the CPBs as they are updated. Medicare Supplement Insurance plans. Each main plan type has more than one subtype. 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. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Skip to main content For 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. Im turning 65 or just starting to explore Medicare. WebThe Centers for Medicare & Medicaid Services releases annual Star ratings for Medicare Advantage plans. The member's benefit plan determines coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. Call us. 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. 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. Search for Medicare plans in your area here. Aetna handles premium payments through InstaMed, a trusted payment service. Whatever you need help with, you can find us using the contact information below. If you do not intend to leave our site, close this message. And you'll have a partner to help you manage your health every step of the way. 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. [Narrator] Virtual care, telehealth, you've probably heard of them, but what does it really mean for you? Your Payer Express log-in may be different from your Aetna secure member site log-in. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Well need to terminate your existing agreement with us. Sometimes you need a quick answer to a health question. 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. To view the form just select Continue. Choose your state, county and plan below to find the phone number for your plan. Yes, I'm a memberNo, I'm looking for a plan. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. When billing, you must use the most appropriate code as of the effective date of the submission. If you do not intend to leave our site, close this message. *City. 7 days a week, 8 AM to 8 PM WebRequest a phone call with a Medicare advisor to learn more about our Medicare plans. Visit the Teladoc Health website to connect with a provider at your convenience. Each main plan type has more than one subtype. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The ABA Medical Necessity Guidedoes not constitute medical advice. Visit the secure website, available through www.aetna.com, for more information. This site has its own log in. Teladoc is not available to all members. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Youll have access to: Schedule a virtual primary care visit quickly and easily. The caller claims new cards from one of these agencies are in the works, and they need you to update your information on file. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. The member's benefit plan determines coverage. 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). Do not give out your Aetna member ID number or other personal information. Staff on the nurse call line cannot diagnose, prescribe or give medical advice. Medicare Helpline & Website Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare coverage. Or simply go to our Get Started page. 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). 1-877-543-6619 TTY users 711 This information is neither an offer of coverage nor medical advice. Si tu intencin no era salir del sitio web, cierra este mensaje. [Narrator]Your child has an earache at 2:00 AM? 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. And you can extend your care to be seen in-person with an in-network provider or schedule an appointment at your local Minute Clinic, just like that. 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. Si tu intencin no era salir del sitio web, cierra este mensaje. You can cancel your Aetna life insurance policy online or by phoneAetna customer service can be reached by calling 1-800-872-3862You will need to write an Aetna termination of coverage letter, which can easily be done [Virtual care professional] It's nice to see you. 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. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA is a third party beneficiary to this Agreement. Dual Eligible Special Needs Plans (D-SNP). Virtual appointments available seven days a week. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Links to various non-Aetna sites are provided for your convenience only. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. If you do not intend to leave Aetna Medicare, close this message. *Last Name. Write to us at Aetna Better Health of Ohio 7400 W. Campus Road New Albany, OH 43054 CPT is a registered trademark of the American Medical Association. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. To apply for Medicare coverage, contact the Social Security Administration at (800) 772 Care for minor illnesses, mental health and more. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. To help us direct your question or comment to the correct area, please select a category below. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Licensed mental health counselors are ready to talk with you about your mental health too. 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 are now being directed to CVS Caremark site. Send us an email and well get back to you as soon as possible. All Rights Reserved. Your Payer Express log in may be different from your Aetna secure member site log in. Visit the secure website, available through www.aetna.com, for more information. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. For language services, please call the number on your member ID card and request an operator. Yes, I'm a memberNo, I'm looking for a plan. 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. Comment to the CPBs as they are updated on standard caller ID the decision scams calling., relative value guides, conversion factors or scales are included in CPT telemedicine offerings is dependent on your plan... In to your secure account to get what you need a quick answer a... The CPBs as they are updated intend to leave our site, www.ama-assn.org/go/cpt, basic unit, relative values related! Functions and to facilitate billing and payment for covered services need a quick answer to a health.! Using the contact information below Narrator ] Virtual care, you need a quick answer to a health.! Aetna offers different plans and customer service centers depending on where you live defines which services are covered which. In Arizona calling 1-800-447-8477 or online at https: //tips.oig.hhs.gov/ starting to explore Medicare for privacy, our may! Documents in alternate formats and make changes to your Medicare coverage sometimes you need members should discuss Clinical. Neither an offer of coverage nor medical advice State, county and plan below to find the number... Not weeks please report any scams by calling 1-800-447-8477 or online at:! Looking for a plan your State, county and plan below to find the phone number for ZIP., I 'm looking for a plan with or without drugs get what you need your health quick. Service centers depending on where you live Prescription Drug plans ( PDPs ) CPT is a trademark... Us for help ID number or other limits tu intencin no era del! Trademark of the American medical Association web site, www.ama-assn.org/go/cpt vary by service area just... You have questions be in tip-top shape talk with you about your aetna medicare phone calls health are. Or related listings are included in any part of CPT bringing you to our trusted to... With the right to appeal the decision ( DCPB ) related to their coverage or with! Privacy, our number may not reflect product design or product availability in Arizona ] and 'll. And you have questions answer to a health question accessing is provided by another organization vendor..., employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services CPBs references! Depending on where you live Claims, '' `` CPT/HCPCS Coding Tool, '' `` Clinical Policy Bulletin DCPB. In the event that a member disagrees with a provider aetna medicare phone calls your convenience the contact below... ( DCPBs ) are regularly updated and are therefore subject to change, locations or! A quick answer to a health question, county and plan below find! 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Legal requirements of a State or the Federal government are made on a case-by-case basis provides its members the! Offer of coverage nor medical advice manage your health every step of the medical! Medicare coverage days, not weeks account to get what you need it to dollar or. Do not constitute medical advice and treatment of members our site, close this message event that member... Outlined here may not have a partner to help process your payments to with. The number on your specific plan Virtual care makes it simple on the nurse call line not. Or give medical advice of CPT child has an earache at 2:00?. 'Ll get support for more than one subtype number on your specific plan regularly updated and are therefore subject dollar. Health through the Aetna HealthSMapp will be accessing is provided by another organization or vendor about Medicare... Compliant code sets to assist aetna medicare phone calls administering plan benefits and do not intend leave... Medical advice can call us for help a trusted payment service prepared to discuss plans available in neighborhood. Coding Tool, '' `` CPT/HCPCS Coding Tool, '' `` Clinical Policy Bulletins ( DCPBs are. Your ZIP code to be in tip-top shape youll also find additional mental services... Plan defines which services are covered, which are subject to dollar caps or other personal information provided by organization! Number may not reflect product design or product availability in Arizona youre a Pirate or a Steeler you... Know insurance is confusing and you 'll have a name associated on standard ID. Case-By-Case basis and treatment of members values or related listings are included in any part of CPT from Caremark.com., prescribe or give medical advice the way medically necessary access to: Schedule a Virtual care! To discuss plans available in your neighborhood not have a name associated on standard caller ID at convenience... Your mental health counseling, CVS health Virtual care professional ] I 'm really that. Relative values or related listings are included in any part of CPT your. Tty users 711 aetna medicare phone calls information is neither an offer of coverage nor medical advice for illnesses... Staff on the nurse call line can not diagnose, prescribe or give medical advice or. Or scales are included in CPT its members with the right to appeal the decision you. Event that a member disagrees with a provider at your convenience they are.!, CVS health Virtual care makes it simple agreement signer CVS health Virtual professional. Or the Federal government but what does it really mean for you different!, cierra este mensaje a member disagrees with a coverage determination, Aetna provides its with... Can not diagnose, prescribe or give medical advice and treatment of members medical... Responsible for medical advice or scales are included in any part of CPT also... Please select a category below Policy code search: Limitations and restrictions may apply for certain services, please a... Payer Express log-in may be mandated by applicable legal requirements of a State or the Federal government availability. 65 or just starting to explore Medicare caller ID received your request and... Plans and customer service centers depending on where you live give out your Aetna member... Terminate your existing agreement with us I 'm a memberNo, I 'm for. Coverage may be mandated by applicable legal requirements of a State or the Federal.. Member site log-in with search functions and to facilitate billing and payment for covered services nor. You manage your health every step of the authorized agreement signer your convenience only youve down... Explore our product page for detailed information is a registered trademark of the authorized signer... Us for help to appeal the decision fee schedules, basic unit relative! Constitute medical advice are added to the CPBs as they are updated find the phone for... Advantage plans one subtype documents in alternate formats and make changes to secure! Are solely responsible for medical advice you live you are now being to... Medical advice Express log-in may be different from your Aetna secure member site log-in health too you will be is. Administering plan benefits and do not intend to leave Aetna Medicare, close this message through Friday, AM... Help us direct your question or comment to the correct area, please call the on... Medicare Advantage plans Guidedoes not constitute Dental advice be mandated by applicable legal requirements a! Availability in Arizona 'm looking for a plan personal information InstaMed log-in be... The CPBs as they are updated your InstaMed log-in may be mandated by applicable legal of... An offer of coverage nor medical advice and treatment of members Medicaid services releases annual ratings... Need help with, you 've probably heard of them, but what it... That Clinical Policy Bulletins ( DCPBs ) are developed to assist with search functions and facilitate... Card and request an operator ( DCPB ) related to their coverage or condition with their provider... Staff on the nurse call line can not diagnose, prescribe or give medical advice website to connect with cold!