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The document is a Member Authorization form for the Release of Protected Health Information (PHI) by Aetna Life Insurance Company. It allows members to authorize the disclosure of their PHI to specified individuals or companies, detailing the necessary member and subscriber information, the purpose of the authorization, and the types of information to be shared. The form emphasizes that signing is voluntary and outlines the rights of members regarding their health information, including revocation of consent and legal implications for unauthorized disclosure.

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2014	4.8 Satisfied (146 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the number for 1 800 282 5366?

If youd like to get a total for the number of appeals, grievances and exceptions filed with Aetna Medicare, call us at 1-800-282-5366 (TTY: 711). Calls are answered 7 days a week, 8 AM to 8 PM.

How do I call Aetna prior authorization?

For more help understanding what you need prior authorization for, call the Member Services number on your member ID card, 1-833-570-6670 (TTY: 711). Were available between 8 AM and 8 PM, 7 days a week. Are you happy with your Aetna plan?

What is a prior authorization request form?

Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part.

How to get authorization for Aetna?

To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. Then theyll share the request with Aetna.

What is the number for 1 800 238 6279?

Call one of our Aetna pharmacy customer service professionals. You can reach them toll-free at 1-800-238-6279 (TTY: 711).

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What number is 1 800 624 0756?

National Medicare Dentist Line: Have a question? Call the National Medicare Dentist Line at 1-800-624-0756.

What is the phone number for Aetna prior authorization?

Please call the appropriate number below and select the option for precertification: 1-888-MD-AETNA (1-888-632-3862) (TTY: 711) for calls related to indemnity and PPO-based benefits plans. 1-800-624-0756 (TTY: 711) for calls related to HMO-based benefits plans.

Does Aetna use eviCore for authorization?

Aetna has contracted with eviCore healthcare, an independent specialty medical benefits management company, to administer prior authorization for Enhanced Clinical Review program.

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Got questions?

What is the number for 1 800 282 5366?

How do I call Aetna prior authorization?

What is a prior authorization request form?

How to get authorization for Aetna?

What is the number for 1 800 238 6279?

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What number is 1 800 624 0756?

What is the phone number for Aetna prior authorization?

Does Aetna use eviCore for authorization?

aetna prior authorization form outpatient

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