![]() 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 you have Aetna Medicaid coverage, member cost share for diagnostic testing related to COVID-19 will be waived.īy clicking on “I Accept”, I acknowledge and accept that: We will no longer cover out-of-network lab tests for members who do not have out-of-network benefits. If you have a Medicare Advantage plan, beginning May 12, 2023, members will continue to pay $0 in-network. Select drive-thru locations including CVS Pharmacy®, Walgreens® and Rite Aid may also be available for COVID-19 diagnostic lab tests. Log in to your secure member website to review your specific Aetna plan and coverage information and search for local in-network providers. Benefit cost sharing means that you may have to pay a portion of the diagnostic testing cost, through your deductible, copay or coinsurance. If you have coverage through your employer (plan sponsor), or an individual and family (ACA) plan, beginning May 12, 2023, most Aetna plans will cover COVID-19 diagnostic testing with standard benefit cost sharing for plans with in and out of network benefits including doctor's offices, clinics, labs and pharmacies where available. The Public Health Emergency (PHE) for COVID-19 ended May 11, 2023, changing federal rules for coverage of testing, vaccinations, and treatment.
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