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There may be a time when you have a health problem that can't be treated by your primary care physician (PCP) alone. Sometimes you may need specialty care or to see a specialist. Prior authorization PDF Opens In New Window is a request to Aetna for you to get special services or see a specialist.
Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient's health plan before moving ahead with a particular treatment, procedure, or medication. Different health plans have different rules in terms of when prior authorization is required.
If you're facing a prior-authorization requirement, also known as a pre-authorization requirement, you must get your health plan's permission before you receive the healthcare service or drug that requires it. If you don't get permission from your health plan, your health insurance won't pay for the service.
Call our customer service center to determine if the service you are requesting requires pre- certification. VO: A Letter of Authorization allows Aetna to make sure you're getting the right treatment, and then to assess that treatment before services are received or costs are incurred.
There may be a time when you have a health problem that can't be treated by your primary care physician (PCP) alone. Sometimes you may need specialty care or to see a specialist. Prior authorization PDF Opens In New Window is a request to Aetna for you to get special services or see a specialist.
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Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.
Call our customer service center to determine if the service you are requesting requires pre- certification. VO: A Letter of Authorization allows Aetna to make sure you're getting the right treatment, and then to assess that treatment before services are received or costs are incurred.
Retrospective review is available when: Precertification/notification requirements were met at the time the service was provided, but the dates of service do not match the submitted claim.

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