![]() ![]() 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. If your loved one is considering suicide, starting an honest conversation about it can be the first step toward getting them help – and saving a life.īy clicking on “I Accept”, I acknowledge and accept that: While such interventions may ultimately involve the work of mental health professionals, they often begin with family and friends. “But what we don't hear about is how many people were able to talk to someone, were directed to get help, did get care and didn't go on to take their life.” She and other experts agree that there are tremendous opportunities to intervene and prevent vulnerable people from doing the unthinkable. “That’s what gets publicity,” Wagner says. Often, when we hear about suicide, it's in relation to someone who actually took his or her own life. Aetna members whose health plans includes Employee Assistance Program benefits can call the number provided by their employer. To get more information and advice on what to do in a specific situation, you can call hotlines like the National Suicide Prevention Lifeline (1-80) or Aetna’s Resources For Living. ![]()
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