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Does Aetna Medicare follow CMS guidelines?

As a Medicare Advantage Organization, Aetna will follow your local Medicare administrator's policy on covering your heart scan. This summarizes CMS transmittal R182.

How long does Aetna take to process appeal?

Timeframes for reconsiderations and appeals Within 3-5 business days of receiving the request. Within 30 business days of receiving the request if review by a specialty unit is needed.

How long does Aetna take to approve?

Request authorization at least 15 days before the procedure, unless it's an emergency. Use the electronic portal to submit the requests and medical records. You can request the service as soon as it is planned. We may be able to authorize up to six months for the patient to get the service done.

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What is precertification Aetna?

Precertification occurs before inpatient admissions and select ambulatory procedures and services. Precertification applies to: Procedures and services on the Aetna Participating Provider Precertification List. Procedures and services on the Aetna Behavioral Health Precertification List.

Does Aetna Medicare require authorization?

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.

What is Aetna denied?

If your health or disability benefits have been denied, Aetna may have claimed the following: The procedure is merely cosmetic and not medically necessary. The treating physician is out of network or out of plan. The claim filed was for a medical condition that isn't authorized or covered.

How long does it take Aetna to approve surgery?

Request authorization at least 15 days before the procedure, unless it's an emergency. Use the electronic portal to submit the requests and medical records. You can request the service as soon as it is planned. We may be able to authorize up to six months for the patient to get the service done.

Does Aetna require preauthorization?

What is prior authorization? Some care will require your doctor to get our approval first. This process is called prior authorization or preapproval. It means that Aetna Better Health® of California agrees that the care is necessary for your health.

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