All services deemed "never effective" are excluded from coverage.Not all plans are offered in all service areas.
5 STAR PHYSICAL DOCTOR HORIZON DIRECT ACCESS PLUS
Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠, Aetna Health Network Option ℠, Aetna Open Access ® Elect Choice ®, Aetna Open Access HMO, Aetna Open Access Managed Choice ®, Open Access Aetna Select ℠, Elect Choice, HMO, Managed Choice POS, Open Choice ®, Quality Point-of-Service ® (QPOS ®), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ®, Choose and Save ℠, Aetna Performance Network or Savings Plus networks. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Inpatient Acute Rehabilitation ProviderBy clicking on “I Accept”, I acknowledge and accept that:. Comprehensive Outpatient Rehabilitation. VIRTUA MEMORIAL HOSPITAL OF BURLINGTON COUNTY. VIRTUA - WEST JERSEY HEALTH SYSTEM - (BERLIN). VIRTUA - WEST JERSEY HEALTH SYSTEM (VOORHEES). VIRTUA - WEST JERSEY HEALTH SYSTEM (CAMDEN). UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER - PRESBYTERIAN. THOMAS JEFFERSON UNIVERSITY HOSPITAL - METHODIST CAMPUS. TEMPLE UNIVERSITY HOSPITAL JEANES CAMPUS. ST LUKE'S HOSPITAL SACRED HEART CAMPUS PSYCH. SAINT JOSEPHS HOSPITAL AND MEDICAL CENTER. SAINT CHRISTOPHER HOSPITAL FOR CHILDREN. ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET. ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL RAHWAY. 
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL AT HAMILTON.ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL.RARITAN BAY MEDICAL CENTER (PERTH AMBOY).PRIME HEALTHCARE SERVICES - SAINT CLARE'S, LLC.NEW YORK SOCIETY FOR THE RELIEF OF THE RUPTURED AND CRIPPLED.NEMOURS CHILDRENS HOSPITAL, SURGERY CENTER, DEPTFORD.MONMOUTH MEDICAL CENTER SOUTHERN CAMPUS.JERSEY CITY MEDICAL CENTER SATELLITE EMERGENCY DEPARTMENT.HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA.HOSPITAL FOR SPECIAL SURGERY MAIN CAMPUS.HEALTH CARE SERVICE CORPORATION OF NEW MEXICO.FRANKFORD HOSPITAL OF CITY OF PHILADELPHIA.COOPER HOSPITAL UNIVERSITY MEDICAL CENTER.CAPITAL HEALTH MEDICAL CENTER HOPEWELL CAMPUS.
ATLANTICARE REGIONAL MEDICAL CENTER - HAMMONTON CAMPUS. ATLANTICARE REGIONAL MEDICAL CENTER (POMONA). Licensed Certified Addictions Counselor (LCAC). If you are experiencing feelings of sadness, stress or are dealing with the struggle of substance use disorder, Braven Health has an extensive network of behavioral health professionals, counseling services and facilities that can help you live life to the fullest. Pediatric Neurodevelopmental Disabilities. Osteopathic Neuromusculosketal Medicine.
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