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Prior authorization helps Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers ensure that applicable Medicare coverage, payment, and coding rules are met before DMEPOS items are delivered.
Generally the referral requirements are: HMO and Network Plans The PCP must provide a referral for specialty care. Only in-network providers are covered. POS Plans The PCP must provide a referral for specialty-care services from in-network providers.
The Aetna Open Access plan is a health maintenance organization (HMO) plan that gives members more freedom. Members can visit any in-network provider, like a primary care physician (PCP) or specialist, for covered services without a referral.
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?
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.
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People also ask

Yes. In order to be eligible for the Aetna Medicare Advantage (PPO) plan, you must be enrolled in both Part A and Part B. You must also continue to pay your Medicare Part B monthly premium to the Federal Government.
People with Original Medicare do not need a referral to see a specialist. However, people with certain Medicare Advantage plans may need a written referral document. The rules on this vary among plans, so anyone who needs more information should speak with their plan provider.
Aetna Medicare HMO plans with open access Patients are encouraged, but not required, to choose and use a participating PCP. PCP referrals arent required. Out-of-network services arent covered without prior approval except for emergency care, out- of-area urgent and emergency care, and out-of- area renal dialysis.

aetna prior authorization