Find a Doctor, Dentist or Hospital | Aetna (2024)

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  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
  • While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
  • Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
  • CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
  • Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
  • In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.

See CMS's Medicare Coverage Center

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain circumstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.
  • While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

  • The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

Go to the American Medical Association Web site

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".

The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

Find a Doctor, Dentist or Hospital | Aetna (2024)

FAQs

What pharmacy does Aetna Better health of Florida use? ›

CVS Specialty Pharmacy

Or, you can drop off and pick up your prescriptions at any CVS Pharmacy® location, including those inside Target stores. Just call CVS Specialty pharmacy at 1-800-237-2767 (TTY/TDD: 1-800-863-5488), Monday through Friday, 7:30 AM to 9:00 PM. They will help you fill the prescription.

Is Aetna accepted in Florida? ›

With Medicare Advantage PPO plans in Florida, you can visit any Medicare-approved doctor, in or out of the Aetna® provider network, who accepts our plan terms.

Does Aetna cover Ozempic for weight loss? ›

Aetna may or may not cover Ozempic. Coverage can depend on your plan's prescription drug coverage and whether you are taking Ozempic for type 2 diabetes or weight loss. Aetna typically requires prior authorization before Ozempic will be covered, especially if you don't have diabetes.

What is the difference between Aetna and Aetna signature administrators? ›

Aetna Signature Administrators® is the brand name for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Is Aetna better health Florida Medicaid? ›

Aetna Better Health of Florida is part of Aetna® and the CVS Health® family, one of our country's leading health care organizations. We've been serving people who use Medicaid services for over 30 years — from kids, adults and seniors to people with disabilities or other serious health issues.

Is CVS Health and Aetna the same company? ›

Aetna® is proud to be part of the CVS® family.

What is the difference between a PPO and a HMO? ›

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

What is the most popular Medicaid plan in Florida? ›

MIAMI – Oct. 18, 2022 – Molina Healthcare of Florida (“Molina”) is the top-rated Medicaid plan in Florida, with a rating of 4 out of 5 stars in the National Committee for Quality Assurance's (NCQA) Medicaid Health Plan Ratings 2022.

Is Aetna insurance good in all states? ›

Nationally, Aetna has an excellent reputation and has an AM Best “A” financial strength rating. In 2018, Aetna was acquired by CVS Health, but still provides employer health plans in all 50 U.S. states.

How to get Ozempic for $25 dollars a month? ›

How to get Ozempic for $25 a month. You can save on Ozempic and get it for as little as $25 a month (28 days) for up to 24 months through the Ozempic Savings Card program. You do need to have commercial or private insurance and a prescription for a 1-, 2-, or 3-month supply.

How can I get my Ozempic for free? ›

If you have Medicare or are uninsured, you may be able to get Ozempic for free through the Novo Nordisk Patient Assistance Program. Ozempic is one of the many medications listed as a covered product under this program.

How much is Ozempic without insurance? ›

Each box of Ozempic contains 4 weekly doses of Ozempic, which is roughly a monthly supply. The cost of a 30-day supply of Ozempic is $935.77 without insurance. However, the amount you pay will depend on your insurance coverage, the pharmacy you use, and any Ozempic coupons you may be eligible for.

What is Aetna known for? ›

Aetna product and program facts:

We offer: A range of insurance and employee benefits products. Programs and services that help control rising costs while striving to improve the quality of health care. Tools and information to help people make better-informed decisions about their health care and financial well-being.

What is the difference between Tier 1 and Tier 2 Aetna? ›

Tier 1 – Aetna® Premier Care Network Plus Multi-Tier providers. Utilizing a provider from this tier results in maximum savings for Aetna members. Tier 2 – Aetna Health broad network providers. Utilizing a provider from this tier results in standard savings for Aetna® members.

Is Aetna the same as Blue Shield? ›

Aetna and Blue Cross Blue Shield both sell Medicare Advantage plans throughout most of the United States. Aetna has more availability, with 49 states plus Washington, D.C. versus 42 for BCBS. Our research found that Aetna Medicare Advantage plans performed better on average versus BCBS Medicare plans.

What is the difference between CVS and CVS Specialty? ›

CVS Specialty offers a higher level of support than traditional retail pharmacies. You'll have access to a CareTeam, which includes clinical pharmacists and nurses who are specially trained for conditions like yours.

Is Aetna pharmacy the same as CVS Caremark? ›

CVS Caremark® is the pharmacy benefits administrator for Aetna Pharmacy Network. In order to service Aetna members, you will need to be a participating provider with CVS Caremark.

Who does Florida Blue use for pharmacy? ›

Amazon Pharmacy is an independent company contracted to provide Pharmacy Home Delivery services for both Florida Blue and Florida Blue HMO, an affiliate of Florida Blue.

How to use Aetna OTC benefits CVS? ›

Inform the cashier that you have the OTCHS benefit and present your member ID card before the cashier begins to scan products. Your insurance card is used to verify eligibility, not as a form payment. You can also cut out and present the QR Code to the store colleague at the register to assist with the transaction.

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