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. Information is believed to be accurate s of the production date however, it is subject to change.īy clicking on “I Accept”, I acknowledge and accept that: Health programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Android and Google Play are trademarks of Google LLC.Īetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates (Aetna). and other countries.Īpp Store is a service mark of Apple Inc. Download the Attain by Aetna app and sign in to see which categories of incentives are available to you.Īpple, the Apple logo, Apple Watch and iPhone are trademarks of Apple, Inc., registered in the U.S. **Eligibility for particular incentives varies by health plan type and location, including availability of Apple Watch as a reward. *Goals and suggested health actions should notreplace your doctor’s advice.If you have a medicalcondition that prevents you from meeting your goals, or if your doctor advises you not to take part inphysical activity,there may be an opportunity for you to earn the same reward by different means.
0 kommentar(er)
