Aetna dmo referral form 2025

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To request a referral, you must be: A participating Aetna provider designated as a PCP. In some states, Ob/Gyns may act as the PCP. The PCP making the referral must participate in the members benefits plan.
Therapy costs with Aetna typically range from $0 to $60 per session after meeting deductibles. Average costs vary by state, with most states falling between $30 and $50 per session. Many Aetna plans allow direct access to therapy without requiring a primary care physician (PCP) referral.
Q: Do I need to see my primary care doctor for referrals? A: If youre in a health maintenance organization (HMO) plan, youll need to see your primary care doctor for a referral. But you may self-refer to specialists within the Aetna Whole Health network if you arent in an HMO plan.
Consider a PPO plan if The ability to visit any dentist is most important. You can see any licensed dentist with this plan, so the network is generally larger than the DMO network. You are looking to see a specialist without having to get a referral. You dont need a referral to see a specialist with this plan.
Aetna Dental Maintenance Organization (DMO) A DMO is a network of dentists and specialists who provide dental care services at a fixed cost. With the DMO, a participant does not have to meet a deductible or file any claim forms. The Aetna DMO is available only in areas where there are participating dentists.
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If a plan requires a referral, it must be issued from the primary care physician (PCP) for all specialist visits, including those services performed in a facility. A referral isnt a substitute for a service that requires precertification. Visit our website to see if a service requires precertification.
A female member can choose an Ob/Gyn as her PCP. Women can also go to any obstetrician or gynecologist who participates in the Aetna network without a referral or prior authorization.
In the DMO insurance plan, you have to choose one of the primary care dentists in your area who will look after your general dental health problems. However, if your dentist determines that you need to see a specialist, he can refer you to one, and you dont have to pay any extra cost for that.

aetna referral form 2024