![]() ![]() 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. ![]() Notice: Any person who knowingly and with intent to injure, defraud or deceive any insurance company or other person files an application for insurance or statement of claim containing any materially false information or who conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.īy clicking on “I Accept”, I acknowledge and accept that: Information is believed to be accurate as of the production date however, it is subject to change. Aetna does not provide care or guarantee access to health services. Provider participation may change without notice. Providers are independent contractors and are not agents of Aetna. Health insurance plans contain exclusions, limitations and benefit maximums. This material is for information only and is not an offer to contract. Aetna Student Health SM is the brand name for products and services provided by Aetna Life Insurance Company and its applicable affiliated companies (Aetna). Self‐insured plans are funded by the applicable school, with claims administered on services provided by Aetna Life Insurance Company. Fully insured student health insurance plans are underwritten by Aetna Life Insurance Company. ![]()
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