aetna senior supplemental timely filing limit

#AETNA SENIOR SUPPLEMENTAL TIMELY FILING LIMIT PLUS#

All services deemed 'never effective' are excluded from coverage.Not all plans are offered in all service areas.

#AETNA SENIOR SUPPLEMENTAL TIMELY FILING LIMIT PLUS#

Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠, Aetna Health Network Option ℠, Aetna Open Access ® Elect Choice ®, Aetna Open Access HMO, Aetna Open Access Managed Choice ®, Open Access Aetna Select ℠, Elect Choice, HMO, Managed Choice POS, Open Choice ®, Quality Point-of-Service ® (QPOS ®), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ®, Choose and Save ℠, Aetna Performance Network or Savings Plus networks.

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.

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.

Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled 'I Accept'. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

The member's benefit plan determines coverage. 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. 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. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.

It's all part of our commitment to whole health - physical, emotional, social, and financial - and helping our millions of members live happier, healthier lives.īy clicking on “I Accept”, I acknowledge and accept that: If we have the member's medical data, we'll match it to their supplemental health claim.Īnd we'll check for other benefits the member might be eligible for and automatically process any claims for them.Īnd we also remind members throughout the year to use their benefits so they can better manage their costs and protect their savings. Members simply log in, answer a few questions, tap 'submit,' done in 90 seconds or less. It's our simplified claims experience, and it's powered by Aetna Easy File and Aetna claims finder.

Our plans are designed from the ground up, so they're customizable to meet employers' needs and include features that make it easy for employees to get coverage.Īnd, since we're a medical carrier, we're able to offer a unique, streamlined member experience.

That's why, for over 30 years, we've offered supplemental health benefits, like accident, critical illness, and hospital coverage, so your employees don't have to worry about those unexpected moments. But when the unexpected happens, it's important to be prepared.

Aetna senior supplemental timely filing limit