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What does it mean to need a prior authorization?

What is a Prior Authorization? A prior authorization (PA), sometimes referred to as a \u201cpre-authorization,\u201d is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

What services does not require prior authorization?

No pre-authorization is required for outpatient emergency services as well as Post-stabilization Care Services (services that the treating physician views as medically necessary after the emergency medical condition has been stabilized to maintain the patient's stabilized condition) provided in any Emergency Department ...

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.

What is prior authorization Aetna?

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.

How do I upload documents to Aetna?

After logging in to your secure member website, follow these steps: Click "Claims Center," then "Submit claims" Complete your claim online. Copy, scan and upload your supporting documents, including itemized bills, original receipts. Click "submit claim" to complete the process.

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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.

What is prior authorization Aetna?

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.

What happens if you don't get pre-authorization?

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.

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.

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.

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