Aetna Emergency Room Policy

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.

Aetna emergency room policy. An emergency room copay does not apply when you are admitted for an overnight hospital stay. Aetna better health has posted a list of auto pay emergency room diagnoses that will. If you are admitted to a hospital that is not in aetna better health s network you may be transferred to a hospital in our network when your condition is stable if authorized by aetna better health. Prior authorization is not required for emergency services.

If you experience something unexpected chest pain. Go to the er where there s a wider range of specialists and treatment options. Any services you receive must be covered under the terms of your aetna plan. It has policies procedures and contact information.

Aetna better health premier plan require prior authorization for select acute outpatient services and planned hospital admissions. At the er the more severe the condition the sooner the patient will see a doctor. Aetna must follow the state s health care laws to ensure enrollees have access to the care they need according to california. This policy does not affect current ed claims processes for aetna s other products including our medicare and commercial plans.

If you cannot call go to the nearest hospital emergency room or call 911. And its subsidiary companies are not responsible or liable for the content accuracy or privacy practices. This has resulted in aetna wrongfully denying emergency room claims. Under this policy we will review ed claims for appropriate level of severity for the diagnosis on the claim.

You are responsible for any emergency room copay. Office manual for health care professionals applies to all regions mid america office manual supplement ia il in ks ky mi mn mo mt nd ne oh ok sd wi wy. In the event that a member disagrees with a coverage determination aetna provides its members with the right to appeal the decision. Urgent care typically works on a first come first served basis.