Some health care services need to be approved
Aetna Better Health must pre-approve some services before you can get them. We call this prior authorization. This means that your providers must get permission from us to provide certain services. They know how to do this. We’ll work together to make sure the service is what you need.
You can look at the online prior authorization search tool to see what services may need pre-approval.
Except for family planning and emergency care, all out-of-network services require pre-approval. You may have to pay for your services if you don’t get pre-approval for services that:
- Are given by an out-of-network provider
- Require pre-approval
- Are not covered by Aetna Better Health of Kansas
All services by providers that are not in our network need pre-approval.
The following are the steps for pre-approval:
- Your provider gives the Plan information about the services they think you need.
- We review the information.
- A Medical Director will review the information for any unapproved requests.
- You and your provider will get a letter when a service is denied.
- Your letter will explain why your request is denied.
- If a service is denied, you or your provider can file an appeal.