Aetna Emergency Room Payment Policy

Links to various non aetna sites are provided for your convenience only.

Aetna emergency room payment policy. In other cases you should notify your primary care doctor and aetna within 48 hours of an emergency. When seeking emergency care please note that. Emergency room level of care effective march 1 2020 the emergency room level of care payment policy will apply to all outpatient facility bill types. In the event that a member disagrees with a coverage determination aetna provides its members with the right to appeal the decision.

And its subsidiary companies are not responsible or liable for the content accuracy or privacy practices of linked sites or for. 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. Aetna s payment policy of ekg 12 lead service important message regarding aetna s payment policy of ekg 12 lead service cpt 93010 when billed with an emergency room evaluation management e m code cpt 99281 99285. Read more read less.

The department s sample of er claims denied by aetna in 2019 found that a stunning 93 were wrongly denied. Aetna went on to state that when a hospital or a physician bills a level 5 emergency room service with a designated minor diagnosis code they will reduce the level 5 to a level 99284 level 4 ed. Under this policy we will review ed claims for appropriate level of severity for the diagnosis on the claim. And its subsidiary companies are not responsible or liable for the content accuracy or privacy practices of linked sites or for products or services described on these sites.

A new insurance policy expects patients to diagnose themselves. Brittany cloyd was doubled over in pain when she arrived at frankfort regional medical center s emergency room on july 21 2017. And its subsidiary companies are not responsible or liable for the content accuracy or privacy practices of linked sites or for products or services described on these sites. Aetna s failure to follow california law for reimbursing emergency room claims is unacceptable acting dmhc director mary watanabe said upon announcing the latest fine on aug.

You are responsible for any emergency room copay. Any services you receive must be covered under the terms of your aetna plan. Links to various non aetna sites are provided for your convenience only.