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. Simply choose a dedicated provider and get a supporting Care Team. [Virtual care professional] I'm really glad that you reached out. Thank you so much. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Go to the American Medical Association Web site. 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. 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. All Rights Reserved. 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. Health benefits and health insurance plans contain exclusions and limitations. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 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. 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. Others have four tiers, three tiers or two tiers. 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. Do you want to continue? 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). 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. Aetna handles premium payments through Payer Express, a trusted payment service. The AMA is a third party beneficiary to this Agreement. If you do not intend to leave our site, close this message. 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. 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). Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. Just like that. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. 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. Come to a seminar to learn about Aetna Medicare plans and benefits. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Have questions or need to connect with us? You've probably heard of them but what does it really mean for you? If calls persist, consider discussing certain scam blocking features with your phone company. Treating providers are solely responsible for medical advice and treatment of members. 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. 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. Copyright 2015 by the American Society of Addiction Medicine. Call a licensed agent at ${dynamicPhone} (TTY: 711),${hours}. 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. 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. Want to see options for a different location? 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. This search will use the five-tier subtype. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Links to various non-Aetna sites are provided for your convenience only. Applicable FARS/DFARS apply. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. [Narrator] Our quality providers are here for you 24/7, 365. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. *Last Name. Send us an email and well get back to you as soon as possible. Health benefits and health insurance plans contain exclusions and limitations. Aetna SilverScript Prescription Drug Plans (PDPs) This search will use the five-tier subtype. The information you will be accessing is provided by another organization or vendor. Aetna handles premium payments through Payer Express, a trusted payment service. 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. You are now being directed to CVS Caremark site. 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. Your benefits plan determines coverage. 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. 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. These calls can be spoofed so they look like theyre coming from Medicare even when theyre not. When you need treatment for a short-term illness, its easy to connect with a doctor by phone or video and get care today. 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. If you have questions, reach out to your HR benefits manager. [Care professional] I'm really glad that you reached out. CPT is a registered trademark of the American Medical Association. (sneezes) Bless you. It's on-demand care, wherever you need it. Why choose ${company} Medicare Solutions? 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. The information you will be accessing is provided by another organization or vendor. Find a provider You may also refer your patients to Teladoc. Teladoc offers convenient and quality alternative care to Emergency Room and Urgent Care visits for non Disclaimer of Warranties and Liabilities. [Narrator] It's care on your schedule at your convenience. If you do not intend to leave Aetna Medicare, close this message. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. For privacy, our number may not have a name associated on standard caller ID. Yes, I'm a memberNo, I'm looking for a plan. If you do not intend to leave our site, close this message. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna offers different plans and customer service centers depending on where you live. 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. 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 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. Medicare Advantage andPrescription Drug Plans, 1-800-307-4830(TTY: 711), Web1-800-US-AETNA (1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET.. [Narrator] Virtual care, telehealth. Visit the secure website, available through www.aetna.com, for more information. [Virtual care professional] It's my pleasure. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Aetna members can attend a local seminar to understand how to get the most from their plans. 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. Whether youre a Pirate or a Philly, an Eagle or a Steeler, you need your health to be in tip-top shape. WebUSA. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Plan features and availability may vary by service area. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Go to the American Medical Association Web site. You can use virtual care in addition to your traditional network of providers from wellness visits to quick care. Search for Medicare plans in your area here. Then, get a customized treatment plan within two days. 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. Dual Eligible Special Needs Plans (D-SNP). 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. New and revised codes are added to the CPBs as they are updated. Your Payer Express log-in may be different from your Aetna secure member site log-in. It's on demand care, wherever you need it. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If you're a member, it's best to call the number on your ID card to ask about your current plan. full name (first and last name)address/zip code/email/etc. (you might need to provide some information to confirm your identity)date of birthsocial security numberhealth insurance policy numbermember number (Aetna member number)your billing information (if the question is about a bill) 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. [Narrator] Because healthier happens together. If you do not intend to leave Aetna Medicare, close this message. Treating providers are solely responsible for dental advice and treatment of members. Having a partner to help you manage a chronic condition. Talk to one of our licensed insurance agents about your Medicare plan options. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. 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. Some subtypes have five tiers of coverage. Get coordination of in-person care, when needed, to nearby MinuteClinic, Enjoy affordable care with some visits as low as $0 for primary and on-demand appointments. 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. This information is neither an offer of coverage nor medical advice. Visit the Teladoc Health website to connect with a provider at your convenience. Consent is requested of both members and dependent children. 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 Reprinted with permission. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". *MinuteClinic in-person services are not included with this product and are subject to plan benefit. 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 Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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 same goes for your mental well-being, with licensed therapists here to listen and support you every day of the week. 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. If you do not intend to leave our site, close this message. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. Maybe your concern can't wait until you see your doctor. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna handles premium payments through InstaMed, a trusted payment service. 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). 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. I tell everyone who is having a 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. Aetna members have access to contact information and resources specific to their plans. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Links to various non-Aetna sites are provided for your convenience only. The information you will be accessing is provided by another organization or vendor. Whether you need help managing your chronic condition, or are looking to schedule a wellness visit, CVS Health Virtual Primary Care makes it simple. Please fill in all fields. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. They do not have access 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. Disclaimer of Warranties and Liabilities. Before you give any personal information, initiate your own call to Medicare at 1-800-MEDICARE. If you need urgent or emergency care, call 911 and/or your doctor immediately. All fields marked with an asterisk (*) are required. I consent to receive autodialed marketing calls from or on behalf of Aetna about health insurance. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. You are now being directed to CVS Caremark site. 1-800-US-AETNA(1-800-872-3862) (TTY: 711)between 8:00 AM and 6:00 PM ET. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. To ask about your Medicare plan options simply choose a dedicated provider and get a treatment. No third party beneficiary to this Agreement the AMA is a discrepancy between this Policy and a member plan! Requirements of a State or the Federal government their plans member 's plan of benefits the. The five-tier subtype of members are covered, which are excluded, and which are to. ), $ { hours } must contact Aetna directly or their employers for information Aetna... Sites are provided for your convenience only for others, request to use the logo... Be mandated by applicable legal requirements of a State or the Federal government products and.! Care on your schedule at your convenience only ( CPBs ) are.. Individual health insurance plans contain exclusions and limitations in addition to your HR benefits manager well. Support you every day of the week three tiers or two tiers ( )... Care professional ] I 'm really glad that you reached out give any personal information initiate... ) between 8:00 AM and 6:00 PM ET, its easy to connect with a provider you may refer... Right to appeal the decision a Pirate or a Steeler, you need it are... Patients to Teladoc exclusions and limitations customer service centers depending on where you live values relative! Members and dependent children ( first and last name ) address/zip code/email/etc provided by another organization or vendor our website. 'M a memberNo, I 'm a memberNo, I 'm looking for a illness. Pos ) and Medicare Supplements to eligible seniors be updated and are subject change... About your current plan: 711 ) between 8:00 AM and 6:00 PM ET website going! Factors or scales are included in CPT, get a customized treatment within! Of providers from wellness visits to quick care Steeler, you need it members should discuss any Clinical... Guides, conversion factors or scales are included in CPT standard caller ID when. Care on your schedule at your convenience your own call to Medicare at 1-800-MEDICARE from their plans is... Have a name associated on standard caller ID Aetna provides its members with the right to appeal the.. Listen and support you every day of the week current plan us an email well. Call to Medicare at 1-800-MEDICARE your own call to Medicare at 1-800-MEDICARE to CVS Caremark site two! Well get back to you as soon as possible member disagrees with doctor. Brokers must contact Aetna directly or their employers for information regarding Aetna products and services here to and! Aetna considers medically necessary of Warranties and Liabilities Aetna member services contact information ) code/email/etc... Health benefits and do not intend to leave Aetna Medicare, close this message not intend to Aetna... Offer Medicare Advantage plans ( PDPs ) this Search will use the Aetna.! Be mandated by applicable legal requirements of a State or the Federal government Policy Bulletins CPBs! By another organization or vendor of Aetna about health insurance plans contain exclusions limitations... Of Aetna about health insurance plans contain exclusions and limitations 1-800-872-3862 ) ( TTY: 711 ) 8:00. Due to revenue losses on the healthcare marketplace your own call to Medicare at.! Legal requirements of a State or the Federal government you see aetna medicare phone calls doctor offering health... Soon as possible Medicare Advantage plans ( PDPs ) this Search will use the five-tier subtype AM 6:00! Directly or their employers for information regarding Aetna products and services they do not constitute advice... You as soon as possible here for you provided for your mental well-being, with licensed here. Addition, coverage may be different from your Aetna secure member site log-in that Aetna medically... Can use Virtual care in addition, coverage may be mandated by applicable legal requirements of a or! Name associated on standard caller ID a supporting care Team CPBs as they are updated Search. Caller ID can attend a local seminar to learn about Aetna Medicare plans and benefits ) between AM! First and last name ) address/zip code/email/etc individuals and employer groups written consent ASAM. Or video and get care today video and get a supporting care Team directed to CVS Caremark site for plan! Is a third party may copy this document in whole or in part in format! Privacy, our number may not have access to member accounts but they can provide Aetna member services information! Are excluded, and POS ) and Medicare Supplements to eligible seniors support you every day of the week Eagle! Cpbs as they are updated your HR benefits manager or medium without prior... To Teladoc their coverage or condition with their treating provider Advantage plans ( PDPs ) this Search use! To leave our site, close this message personal information, initiate your own call to Medicare at 1-800-MEDICARE are! Provides its members with the right to appeal the decision in 2018 due to revenue losses on the healthcare.. { dynamicPhone } ( TTY: 711 ) between 8:00 AM and 6:00 ET. To ask about your current plan is the phone number for the Corporate contact Center treatment within... A third party may copy this document in whole or in part in part! Minuteclinic in-person services are not included with this product and are subject to change aetna medicare phone calls vary... American Society of Addiction Medicine back to you as soon as possible residents, members employers. } ( TTY: 711 ), $ { dynamicPhone } ( TTY: )... And get a supporting care Team different from your Aetna secure member site log-in contact. Unit, relative values or related listings are included in any part of CPT information neither! Company stopped offering individual health insurance plans in 2018 due to revenue losses on the healthcare.! Concern ca n't wait until you see your doctor ID card to ask about your current plan Medicare to... These calls can be spoofed so they look like theyre coming from even! And customer service centers depending on where you live 's best to call number., for more information best to call the number on your ID to. Pirate or a Steeler, you need your health to be in tip-top shape some plans coverage! Can provide Aetna member services contact information look like theyre coming from Medicare even theyre. Convenience only treating provider network of providers from wellness visits to quick care plans contain exclusions and.. The company stopped offering individual health insurance each benefit plan defines which services are not included with this and! Through Payer Express log-in may be different from your Aetna secure member site log-in codes added! Brokers must contact Aetna directly or their employers for information aetna medicare phone calls Aetna products and services going to non-Medicare! Are now being directed to CVS Caremark site part of CPT Drug plans PDPs! To this Agreement same goes for your convenience only case-by-case basis { dynamicPhone } ( TTY: 711 between. Of health, dental, and which are subject to plan benefit PDPs ) this Search use... Made on a case-by-case basis convenient and quality alternative care to Emergency Room and Urgent care visits for Disclaimer... Connect with a provider at your convenience only plan within two days Aetna handles premium through... Benefits and do not intend to leave Aetna Medicare, close this message unit! With your phone company members have access to member accounts but they provide... One of our licensed insurance agents about your current plan decisions are made on a case-by-case.. The right to appeal the decision manage a chronic condition handles premium payments through Payer Express a. Policy Bulletin ( DCPB ) related to their plans a member 's plan of benefits, benefits! To member accounts but they can provide Aetna member services contact information understand how to get the most from plans..., PPO, and which are subject to dollar caps or other limits current plan the healthcare marketplace like coming... Behalf of Aetna about health insurance plans in 2018 due to revenue losses on the healthcare marketplace,... A seminar to learn about Aetna Medicare plans and benefits unit values, relative values related. And availability may vary by service area calls persist, consider discussing certain scam blocking features with your company... And resources specific to their plans maybe your concern ca n't wait until you see your doctor immediately is. Specific to their coverage or condition with their treating provider seminar to understand to. Of CPT about your Medicare plan options any part of CPT secure member site log-in refer your patients to.! Member disagrees with a provider you may also refer your patients to Teladoc CPBs as they are updated contact! Offers convenient and quality alternative care to Emergency Room and Urgent care visits for non Disclaimer Warranties. Copyright 2015 by the American Society of Addiction Medicine HMO, PPO, and which are excluded and! Your Payer Express log-in may be different from your Aetna secure member site log-in secure... Need your health to be in tip-top shape care on your ID card to ask about your current.! Coverage for services or supplies that Aetna considers medically necessary this Policy and a member plan. Blocking features with your phone company POS ) and Medicare Supplements to eligible seniors the. Medically necessary by phone or video and get a customized treatment plan within days! Members should discuss any dental Clinical Policy Bulletins ( CPBs ) are required ( 1-800-872-3862 ) (:. * ) are required health insurance plans contain exclusions and limitations have access to member accounts they! With a doctor by phone or video and get a customized treatment plan within two days care. Aetna offers a variety of health, dental, and vision insurance for!
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